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Pelvic floor health 101: tips to improve bladder control

Bowel incontinence drops graphic

We all have one. Yet the health of our bladder isn’t something many of us give much thought to – at least, not until something goes wrong with it!

It’s important to know how to take care of your bladder, and to get the right advice for your age and life stage. Throughout your life, your daily habits and practices can put you in a better position to avoid bladder leakage or loss of bladder control, also known as urinary incontinence.

Urinary incontinence affects between 24-45% of women at some stage in their lives, with two-thirds of these being leaking due to coughing/sneezing/exercising. This is called stress urinary incontinence.

Incontinence can reduce your quality of life and stop you exercising or doing things you usually enjoy to keep healthy.

Here, Jean Hailes’ continence and pelvic floor physiotherapists Janetta Webb and Amy Steventon explain how to treat your bladder well at every life stage.

Two young women exercising walking outside

For young women (and all women needing to know the basics)

Don’t go to the toilet if you don’t need to go. Many girls and young women are taught to empty their bladders before they go out, before long car trips, or when they arrive at their destination. Instead, listen to your body’s messages and pay attention to your natural urges. Your bladder works best when it can tell you when it needs to be emptied, rather than the other way around!

It is normal to:

  • pass 250-500mL of urine each time you empty your bladder. This may vary with age, pregnancy and with specific medical conditions that affect the urinary system
  • empty the bladder 6-8 times in a 24-hour period (including up to once overnight)
  • need to empty the bladder every three to four hours during the day.

When the bladder is working well, you will:

  • need to go to the toilet when the bladder is full
  • make it to the toilet without rushing or leaking urine
  • be able to put off going to the toilet to empty your bladder if it is not a convenient time for you.

You can’t get an infection from a toilet seat, so please sit down. Your bladder empties itself much better when you are seated and relaxed on the toilet. If you need to, use a disposable toilet seat cover, but don’t get into the habit of hovering over the toilet.

Don’t strain to empty your bladder or your bowels. When urinating (or emptying your bowels), relax, take your time and let your body set the pace. Sitting, leaning forwards with a straight back, hips bent (so your knees are higher than your hips) and your feet elevated on a small foot stool (or up on your toes), with a relaxed tummy, is the ideal position to empty both your bladder and bowels.

Any bladder leakage in young women and girls should not be ignored. If you (or your daughter) get any sort of bladder leakage – for example, when playing sport, laughing, sneezing, jumping on a trampoline or with urgency and not making it to the toilet in time – visit your GP and get it treated early.

Bowel health affects bladder health. Being constipated is a common cause of urinary incontinence in girls and young women. Keep your bowels in check by staying hydrated, eating a diet rich in fibre and whole foods (such as fruits, vegetables and wholegrains) and exercising regularly.

How much water should you be drinking? Unless instructed otherwise by your doctor, aim to drink 1.5-2 litres of fluids every day, mostly water. This total includes everything that you drink, not just water. There is no evidence to support that drinking more than this is healthier.

If urinary urgency and/or leakage associated with urgency is an issue, switch to decaffeinated coffee and tea, reduce alcohol and avoid caffeinated or artificially sweetened drinks.

Aim to drink gradually and consistently over the day and avoid drinking large volumes in the evening or late at night.

Pelvic floor exercises and pelvic floor care is important at every life stage. If incontinence is an issue, pelvic floor exercises can cure or significantly improve urinary stress incontinence (leakage associated with coughing, sneezing, exercising) by up to 80%. So, it’s well worth investing a small amount of time each day to these exercises!

Pelvic floor exercises also help to reduce incontinence associated with urgency. Learn more about how to exercise your pelvic floor by listening to a podcast by our pelvic floor physiotherapist Janetta Webb.

Mother holding her infant baby 1

For pregnant women

Up to half of pregnant women experience urinary incontinence, so special attention needs to be given to your bladder (and urinary system) during this time.

Dedicate a daily session to your pelvic floor. To avoid incontinence in pregnancy, learn how to correctly exercise your pelvic floor muscles (the 'sling' of muscles that support the bladder, bowel and womb). Regular pelvic floor exercise during pregnancy will reduce your risk of incontinence during pregnancy by 25% and in the first six months postnatally by almost 30%. Every day, try to set aside a dedicated time that you can focus on doing just your pelvic floor exercises, and nothing else.

Squeeze at pressure points. Additionally, get into the habit of squeezing your pelvic floor muscles while doing activities that put more pressure on your bladder, such as coughing, sneezing, bending or lifting.

Change is normal. It’s normal for pregnant women to urinate more frequently and to need to use the toilet during the night. But watch out for constipation, which is common during pregnancy (see tips above regarding bowel health and fluid intake).

Don’t ignore pain. Lower back pain or pelvic joint pain during pregnancy can impact your pelvic floor. Seek a referral to a physiotherapist who specifically treats these conditions – find one by visiting the CFA Find a Physio website.

Keeping fit is key. However, make sure it’s pregnancy-appropriate exercise. Visit the Pelvic Floor First website.

Woman Leaving School With Child

For postpartum women

The first few days and weeks after birth is a crucial time for your pelvic floor. During the first few weeks after your baby is born, sit or lie down and rest as much as possible. Start your pelvic floor exercises as soon as you can do so comfortably, without any pain. This will usually be in the first few days after delivery. All women need to exercise their pelvic floor muscles after giving birth, regardless of whether they have had vaginal or caesarean birth, even if there are no symptoms of pelvic floor weakness.

Get some extra support. Postnatal compression garments can give extra support to the perineum (the area between the vagina and anus). Using several menstrual pads pulled up with firm underwear can also help support this area. Additionally, when first using your bowels after giving birth, and in the first few postnatal weeks, support your perineum with your hand; wrap toilet paper around your hand while you do this if you prefer. During the first few weeks you may like to support your perineum with your hand when you cough, sneeze or lift. As your pelvic floor muscles become stronger, they can take over this supportive role.

Be cautious with heavy loads. Try to avoid lifting anything heavier than your baby in the first six weeks after birth. When you lift your baby, or anything else, prepare your body first by drawing in your pelvic floor muscles. Hold these muscles while you are lifting. This will help to protect this area from stretching and weakening while it is recovering.

Return to a healthy fitness as soon as you are comfortable. One of the best early postnatal exercises is walking. But if you experience bladder leakage with any exercise, such as jogging or gym workouts, it’s your body telling you that you’re not ready for that particular form of exercise. Seek treatment for leakage early.

A note for breastfeeding mums. Oestrogen plays an important role in bladder and pelvic floor muscle function. Breastfeeding keeps your levels of this hormone low. Therefore, while you are breastfeeding, bladder leakage may become an issue, as lower oestrogen levels may weaken your pelvic floor muscles

Women group at gym laughing working out resting

For menopausal & postmenopausal women

Incontinence issues often arise in menopause. This is due to the falling levels of oestrogen, which can impact bladder control. Incontinence is also more common after gynaecological surgery.

Night-time bladder habits. If you wake during the night because of insomnia or night sweats, don’t just go to the toilet for ‘something to do’, or to help you get back to sleep. Empty your bladder only when needed.

Urinary tract infections are more common in midlife women. This is because of the reduction of oestrogen. Seek advice from your GP.

Tips for healthy ageing

Maintain your levels of fitness. The fitter you are, the better your flexibility, strength and endurance will be. This not only means you’ll be more able to maintain pelvic floor strength, but also helps with being able to make it to the toilet in time and can reduce the risk of falls. A combination of cardiovascular training with weight or resistance training is ideal.

Get back pain and hip pain treated. Don’t allow pain to limit your mobility.

Learn more about bladder health and urinary continence and how to do your pelvic floor exercises by visiting the Jean Hailes Bladder, bowel & pelvic floor exercises webpages.