June 15, 2025 • 18 mins
Bladder weakness will affect 1 in 3 women in their lives, yet it's still a sensitive topic for so many. So to get past this stigma, Toni is chatting with physiotherapist and pelvic health expert Caitlin Fris about the wide range of things that can lead to bladder weakness, and what you can do to prevent it.
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Episode Transcript
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Speaker 1 (00:00):
We Need to Talk Conversations on wellness with Coast FMS
Tony Street.
Speaker 2 (00:05):
This episode is proudly brought to you by TENA. For
over twenty years, TENA has been helping Kiwei's rethink what
bladder leaks really mean. Affecting one in three women over
thirty five. They're more common than you think and nothing
to be ashamed of. That's why TENA offers a range
of thin, discrete products designed specifically for bladder leaks, not periods,
so you can feel protected, dry and confident. It's time
(00:29):
to rethink your protection. To learn more or request a
free sample, head to tenor dot co dot nz. This
week on We Need to Talk, we talk to Caitlin
Friss about bladder weakness.
Speaker 3 (00:39):
As women.
Speaker 2 (00:39):
Our bodies go through lots of different stages as we age, puberty, childbirth, postpartum,
perimenopause and menopause, just to name a few. My experience
is you often don't know what the challenges are going
to be until you're actually living them. No one really
warns you. I remember being pregnant with my first child,
Judy Aet, and getting wicked tailbone pain. So for the
first time in my life, I went and saw a
(01:01):
specialist pregnancy physio who fixed my tailbone pain in a
couple of visits and opened my mind to a whole
lot of other different issues and treatments that I might
have experienced or would potentially experience in the future, things
like pelvic flow disorders, pro lapse, and weakness of the bladder.
I had no idea, and to be honest, it's not
until recently since I've been experiencing perimenopausal symptoms and wanting
(01:24):
to know more, particularly as I returned to well trying
to play netball, that I've started really paying attention. Caitlin
Friss is the co founder of Unity Studios. She's a
physiotherapist with a postgraduate qualification in women and Men's pelvic health.
On the daily, she treats a wide range of pelvic
flow dysfunctions and is a wealth of knowledge, particularly for
(01:44):
women who might feel less inclined to talk about what
can often be sensitive topics. Caitlin, it's so great that
you have studied and are so involved in all things
women's health. It's quite a well, it's a touchy area
for a lot of people, right.
Speaker 4 (01:58):
Yeah, I mean it's it's a niche topic for in
terms of physio, but within that niche topic, there's lots
of further specialties that we can kind of go into, bladder, bowels, pain, sex,
things like that. But yes, all of those topics are
really tiboo or stigmatized. So it's really hard for people
(02:18):
to find help when they don't really know who they
should be seeing or what they should be doing about.
Speaker 2 (02:23):
It, and actually knowing that it's an issue that other
people are experiencing and do you think people are similar
to what I had? You kind of don't know about
it until you experience it and then you realize, oh,
there's actually all this treatment that I could get and
I didn't know that before.
Speaker 5 (02:36):
Yeah. Absolutely.
Speaker 4 (02:37):
So we know that about one in three women will
have leakage of urine or bladder leakage, but only about
two out of three of those will speak to a
health professional about it because of the sort of opinion
that it's like, oh, you're just a woman, so you're
going to leak a bit, and also because it's not
really something you talk to people at a cafe about.
When you're sitting down heavy coffee, you talking about your bladder.
(03:00):
So just knowing where to find help is a big issue,
but knowing that there is help out there out there
is difficult as well.
Speaker 2 (03:07):
Can we just talk about bladder weakness while we're talking
about it for a start? I know as a mother
of three that obviously you have bladder weakness when you
have a child and in that postpartum period, but I
also think there is the potential for that to happen
again around peri menopause.
Speaker 4 (03:24):
Is that right, Yeah, So it's really common to have
leakage of urin after having a baby. Usually it will
resolve in that first six weeks. So some people come
to me like two weeks post natal and they're like, oh,
I'm winning my pants, and I'm actually not that too concerned,
Like it's pretty distressing for them, But I give them
lots of education about what's happening in their body and
that everything should improve, and there's lots of things that
they can also do to help manage that early leakage.
(03:46):
When it comes past that six weeks post natal time,
that's when we think, okay, we really need to get
on top of it, put some things in place, manage
their palbot floor, maybe train their bladder a little bit better.
But yes, the vast majority of people will get some
in their first few months. They then might also start
looking again in that perium postmenopausal season of our lives.
(04:09):
That can be a hormonal thing. So estrogen plays a
big role in a bladder control and in vaginal tissues
and in urethra and all of everything in the palvits. Really,
it also can be just that you've had several more
decades of gravity on your palvits in that time. Plus
you know, in your case, in other people's case, the
(04:31):
three babies, full term babies or fullish term babies that
have sat on the palvic floor for nine months and
they're really heavy.
Speaker 2 (04:37):
Yeah, And I think for my experience, and I'm quite
happy to share mine, I was one of those people
that it went away pretty quickly after having my babies,
and so then I was actually quite surprised when I
got it again in my early forties. And the only
reason I kind of knew about it was because I
started working out with my twelve year olds who I
coach in netball, and we started doing skipping and I
(04:58):
was like, oh, dear, I need to sort something out here.
And then I've carried on and I want to play
netball and I can see why if you don't get
it sorted, it can be a barrier for you because
playing sport, you don't want that to be happening in
the middle of a netball game.
Speaker 5 (05:10):
Right exactly.
Speaker 3 (05:11):
And what can you do?
Speaker 5 (05:13):
Yeah, heaps.
Speaker 4 (05:14):
We are big, particularly Unity being an exercise center as well.
We want to keep people exercising, so it might mean
that we change up how you're exercising initially and just
take the impact down. So when you said skipping, that's
a high impact exercise and as soon as you go
from walking to running or jumping, your body weight is
like time seven going through your leg as you hit
(05:36):
the ground with impact. So your publot floor needs to
be able to manage that increase in force. So we
might just change that a little bit initially as we
lift your pulot floor strength up. So that brings me
on to the next thing that we do, which is
palvot floor muscle training, which sounds really easy to sit
there and squeeze vagina, but actually we know that about
one in three people think they're squeezing their public floor.
(05:57):
They're actually doing something different, and a lot of those
people are actually bearing down or pushing down on the
palvot floor rather than lifting it up, and if they're
doing that several times a day, you know, sets of
ten throughout the day, they're going to make it things
worse over time, and that can contribute to things like
prolapse and more bladder leakage and stuff like that. So
knowing what to do is really important, and that's why
(06:18):
we exist public floor physios is that you don't know
if you're squeezing your powerful correctly until you have an
assessment with one of us. And then further on to that,
we might work on somebody's strength, get them stronger of
their publot floor. But for somebody else who might have
an overactive pulot floor, which is a power floor that's
just contracted most of the time and never relaxes, if
we strengthen that more and more and more, it's just
(06:38):
going to get worse and can actually make leakage worse
with strengthening and overactive palviot floor. Or we might focus
on technique or endurance or like some people just have
no like no ability to contract, so using little machines
and gadgets that we have to get them their polperful
going is that the kegel machine there's several out there. Yeah,
(07:00):
there's lots of different types. Still they work for some people. Yes, again,
if it's overactive, absolutely stay away. But if you just
like really don't know what you're doing, you've hand a
pulpt floor assessment, they've said there's not much happening there.
Then those internal devices that sort of hook up to
an app on your phone and you can like squeeze
and see get a bit of visual biofeedback are good
for some people. There's also like this sounds terrifying, but
(07:22):
we can use an electrical stimulation machine where a probe
goes into the vagina and then attaches to this little
unit that seems a really low grade and not comfortable.
We're not painful. Electrical stimulation to the pulp floor and
gets going to allow you to then build that's enough
strength to do it yourself.
Speaker 3 (07:40):
What sort of success rate do you have?
Speaker 4 (07:43):
About seventy percent of people with leakage will get vast
improvement and cure with pulvic floor muscle training.
Speaker 5 (07:52):
Thirty percent is quite.
Speaker 4 (07:54):
A a a big part of the leaking population that
they're not. But I think that when we look into
the research more, it's just that they're sort of given
pewerful exercises and sent on their way with Actually leakage,
as simple as it sounds, when you look at an
anatomical or cellular level, can actually be quite complex. So
there's lots of other things that we can do on
top of power floor muscle training, like prescribing vaginal estrogen
(08:16):
for the post natal or period post menopause or states
of low estrogen can make a significant difference to our
ability to hold onto urine. Obviously g B would do
that not for ZIO, but also assessing the bladder itself,
so how often you go to the toilet, whether you're
going to the toilet with urgency, like desperate to get there,
can't get pants down in time. That's and leaking on
(08:36):
the way to the toilet. That's really different to leaking
when you're skipping, jumping, coughing, laughing, really different types of leakage.
Speaker 3 (08:44):
Is that a worrying sign? Is it desperate to go
to the toilet?
Speaker 4 (08:47):
That's a sign of overactive bladder. So I feel like
I might have this that's really common. Yeah, Orective bladder
is like a bladder that sends you to the toilet often,
and you'll often get that sense of urge really quick.
So other people might build quite slowly, but for some
people you just get it straight away and you got
to like get there to the toilet, to the toilet,
(09:07):
maybe fear of leaking or actually leaking on the way
to the toilet. That's called urge urinary in continents, which
is quite different to stress urinary in continents, which is
the leakage of your owe on effort, coughing, sneezing, playing sports.
Speaker 1 (09:20):
Now that we need to talk with Tony Street.
Speaker 2 (09:24):
When I think of having babies and things, now, I
wasn't in the era where they have period underwear essentially,
and I think how great it is that in this
modern environment we have these options for not just our
young girls, but it's actually it helps for you know,
women's sort of post forty as well.
Speaker 5 (09:42):
Yeah.
Speaker 4 (09:43):
Absolutely, And even if you look at more into those undies,
there's period underwear which are like if you look at
the engineering of these, so dirty, but you have obviously
and it's quite interesting. So the period undies are made
to catch blood, so quite the skis thick stuff. But
if you like you know, have quite severe leakage and
you leak into that, you're just going to leak out
(10:03):
the sites so that there's continents underwear as well, and
they are designed. Some of them will like hold up
to five hundred mills of urine sometimes even like a liter,
which is a lot. So getting the right type of
underwear is something that we counselor our clients on as well.
Ideally we do our clients don't have to wear them
because they're not leaking, but to get them there and
(10:25):
to keep them playing sports while we're improving their leakage.
Something like some good underwear, good continent's pads would be
really good as well.
Speaker 2 (10:31):
Yeah, I'm really glad you made that distinction between period
underwear and bladder weakness, because I don't think I knew
there was a difference.
Speaker 3 (10:38):
Yeah, yeah, who knew.
Speaker 5 (10:40):
It's really interesting you should look into it.
Speaker 3 (10:42):
Yeah, from a physio perspective.
Speaker 2 (10:44):
You know, let's say I come in as a perimenopausal
woman wanting to stay active in sport.
Speaker 3 (10:50):
What would that look like? What would a visit look.
Speaker 5 (10:52):
Like for me?
Speaker 4 (10:53):
So if you're having some bladder leakage, it would be
an initial appointment, which book for an hour for because
we take a really thorough history. Because we're talking about
the palvis, and there's lots inside there, bladder, bowel function,
the ability like your sexual function, how many babies you've had,
(11:14):
how many injuries you've had around the area, cosix injuries
or tailwin injuries, hip stuff, knee stuff, things like that.
All of that affects your ability to hold urinine weirdly enough.
So we have to get a really thorough history about
people's all aspects of their very private lives, because things
like if somebody is leaking but they're constipated, if we
(11:37):
cure their constipation, often their leakage will get a whole
lot better. So we need to know about their bow
habits and stuff like that. Then we would so really
thorough history. Then we were doing a pulvic floor assessment,
so that would be one of usually two things.
Speaker 5 (11:52):
The most effective.
Speaker 4 (11:54):
And gives us, what gives us most information, is an
internal assessment, So that would be looking at the volva,
all the tissues on the outside and giving you to
contract and relax, teaching you how to do your palvot
floor exays because most people have no idea when they
come in, and then feeling inside of the vagina for
the pult floor muscles, which are about three or four
centimeters deep to the entrance of the vagina, giving your
(12:15):
strength rating out of five of those muscles and endurance rating,
so how long can you hold those muscles on for
and coordination like quick ones where you can relax properly.
It's funny to see the keen exercises, like actually, like
really competitive about this coin.
Speaker 3 (12:29):
It would be me, I'm already going what rating would
I be?
Speaker 5 (12:32):
Exactly?
Speaker 4 (12:33):
Yeah, And also checking for things like prolapse, So vaginal
proleps which is where one of or more of the
vaginal walls have been stretched, usually from a vaginal birth
or from things like kind of constipation or lots of exercise.
Because when the wall of the vagina that sort of
props the bladder up. When that's been stretched, that can
(12:55):
contribute to leakage of your ink bladders just not being
held very well in space.
Speaker 3 (12:59):
And if someone does have prolapse, what is the solution
from that?
Speaker 5 (13:03):
For that?
Speaker 3 (13:03):
I know people could have surgery for it.
Speaker 4 (13:05):
Right yeah, yeah, So it's kind of like one end
of the spectrum and good for a portion of people,
but most surgeons kind of coologists will refer to a
pulp floor physio for a good extent of three months
of physio stuff because a lot of them will be
able to manage and improve their prolapse symptoms just with
physio alone, and then we can refer on to surgery
(13:26):
if needed. So what we do again is perful muscle training,
getting everything supporting from up below, but also we can
fit vaginal pes series, which are an internal device. I
describe it as like a bra for your vagina. This
sort of sits in the vagina like a good fitting
tampon or menstrul cup. You don't know that it's there,
like you don't think about it, but it's sitting in there,
specifically designed and shaped for whatever proleps you have in
(13:47):
your body. And we fit it and we put it
in and most people are like, oh my god, that
feels so much better. And then they go for a
round and they're not leaking, they're not heavy in the vagina,
and they're just like so much happier and they're really
low risk as opposed to surgery comes with its own
own risks. So vaginal piece. There are also continents pesseries,
so pissories that were put in the vagina that supports
the bladder neck or the bladder wall and stops people
(14:08):
from leaking as well. So some people I fit pissories.
So just put this in before you niball game, like
you know, put your bra on, put your vagina bra in,
go up, yeah exactly, go hard, jump around to whatever.
This will manage your leakage and then always have a shower,
take it out, put it in a little tubley container.
Speaker 3 (14:25):
And back in your gym cat Wow, who knew?
Speaker 5 (14:27):
Yeah? Yeah not many people.
Speaker 3 (14:30):
Aren't aware of it.
Speaker 2 (14:31):
So what is it like when you have someone coming
that might have these issues? Do you often find they're
a bit embarrassed to tell you about it.
Speaker 4 (14:39):
Yes, but by the time they've I think the hardest
thing is booking an appointment, right, So getting to that
point where you're like, Okay, I really need to do
something about this, and booking an appointment. But when they
come in with that, Once they book to the appointment,
they're kind of given a like rigio form that they
have to fill out with lots of questions about their
powlit ful functions, so they kind of know what they're
(14:59):
com in for. Their kind of prepped. I think a
little bit like they're sit in the waiting room with
like ten other women that some of them feeding their
babies like it sort of feels like they're in the
space and they are what they're about to talk about.
And I think that we as public floor physios. Obviously
I'm biased, but I think that we are very empathetic
people that make people feel really comfortable, and we kind
of have to dig straight into you know, your bladder
(15:21):
function and sexual function quite early on in the appointment.
So they're making people feel comfortable is really important to us.
Speaker 2 (15:28):
So what sort of stage should you be at before
you come and see a pelvic floor physio.
Speaker 4 (15:34):
Any stage, it's never too late to get improvements. The
best improvements are made when it's early on in the piece,
so when you're just starting to experience symptoms. The very
best outcome is when people come to us preventatively. So
we have an appointments called a prenatal war and a
fitness prenat a wharf and a post nadal whoff well
where we do a sort of around twenty weeks of
(15:54):
pregnancy is when we suggest somebody coming in and around
six weeks postnatal, but again at any stage of pregnancy
or postnator, we'll see someone for the appointments that's just
a recommended time and we'll do a even if they're
not looking well, there's no issues, we will do an
ultrasound assessment of their palviot floor, which is another way
we can check. Gives us a relatively rudiment tree view.
But it's nice for someone to see their palpt floor
(16:15):
and a screen because we put the ultra sound on
their lower tummy, find their bladder on the screen, and
their public floor should move underneath it if they're using
it quickly, so that visual bio feedback is really nice
for people to see what's happening, because you can't see
your palvialt floor, and if you're doing it quickly, you
don't see any movement from the outside, so nobody knows
what's going on. But that's when we can sort of
pick up, oh yeah, you're not really like, you're not
really able to engage it very well. Let's sort of
(16:38):
get that going when you're pregnant, so that when you're
out the other side and things aren't you know, might
not be working well with your bladder function or proleps whatever,
that we're able to get on top of it quickly.
Speaker 5 (16:47):
You know what you're doing and things like that.
Speaker 4 (16:48):
So in a much the same way that you service
your car and you have a comprehensive check every year,
there is the capacity to do that for your public
floor and your body too.
Speaker 2 (16:57):
Wow, Because I think in the conversations that I've had
in the past, throughout pregnancy, post babies, now perimenopause, and
overwhelmingly someone will either say, oh, yeah, I've got a
really good palvet floor or oh my palvet floor is shocking.
Speaker 3 (17:12):
But actually, are you saying we probably have no idea?
Speaker 5 (17:15):
How do you know?
Speaker 3 (17:15):
How do you know if it's good?
Speaker 5 (17:17):
Only by seeing one of us? Yeah?
Speaker 3 (17:19):
So actually we're just talking a load of are we.
Speaker 4 (17:21):
I mean, if you've got a good like not much
bladder control issues, then obviously pelpful is.
Speaker 5 (17:25):
Doing something well.
Speaker 4 (17:26):
So you could probably confidently say it's okay, But it
might be just around the corner that you start leaking.
So the only way you really know is having assessment
is one of us.
Speaker 2 (17:34):
Yeah, So what would be your advice today for someone
that I don't know? Maybe they are getting bladder leakage
from sneezing, skipping, playing the sport they love. It might
even be none of the above. Maybe they just get
leakage randomly, which is a thing, right, Yeah.
Speaker 4 (17:48):
Yeah, just again they're overre it to bladder. Just leakage
on the way to the toilet or when you first
get up to get up for the day. People might
wet themselves on the way to the toilet. Yeah, I
would say go see your pelviot floor for you earlier.
Other than, like like I said, when you get on
top of it earlier, you have a much shorter journey
to dryness than if it's gotten pretty severe and usually
(18:09):
left untreatedlycuage will get with over time.
Speaker 2 (18:12):
I feel like there will be people that will say,
I don't have time to do all the exercises. Is
it a big time consuming thing?
Speaker 5 (18:20):
Not really, You're just like I'm doing it now.
Speaker 3 (18:23):
Oh gosh, I wish you'd told me I would have
done mine.
Speaker 5 (18:26):
I'm winning absolutely are see.
Speaker 3 (18:28):
I knew this was going to get competitive. Caitlin, thank
you so much.
Speaker 2 (18:31):
That was a real eye opener today and so much
information there on so many different things relating to the
pelvic floor.
Speaker 3 (18:38):
Yeah.
Speaker 2 (18:38):
I think people are gonna really like this no matter
what stage of the process they're at.
Speaker 5 (18:43):
Thank you. Thanks ing.
Speaker 1 (18:44):
We need to talk with COASTFMS Tony Street.
Speaker 5 (18:47):
If you enjoyed the.
Speaker 1 (18:48):
Podcast, click to share with family or friends. To get
in touch, email we need to talk at Coast Online,
dot co dot mz
We Need to Talk Conversations on wellness with Coast FMS
Tony Street.
Speaker 2 (00:05):
This episode is proudly brought to you by TENA. For
over twenty years, TENA has been helping Kiwei's rethink what
bladder leaks really mean. Affecting one in three women over
thirty five. They're more common than you think and nothing
to be ashamed of. That's why TENA offers a range
of thin, discrete products designed specifically for bladder leaks, not periods,
so you can feel protected, dry and confident. It's time
(00:29):
to rethink your protection. To learn more or request a
free sample, head to tenor dot co dot nz. This
week on We Need to Talk, we talk to Caitlin
Friss about bladder weakness.
Speaker 3 (00:39):
As women.
Speaker 2 (00:39):
Our bodies go through lots of different stages as we age, puberty, childbirth, postpartum,
perimenopause and menopause, just to name a few. My experience
is you often don't know what the challenges are going
to be until you're actually living them. No one really
warns you. I remember being pregnant with my first child,
Judy Aet, and getting wicked tailbone pain. So for the
first time in my life, I went and saw a
(01:01):
specialist pregnancy physio who fixed my tailbone pain in a
couple of visits and opened my mind to a whole
lot of other different issues and treatments that I might
have experienced or would potentially experience in the future, things
like pelvic flow disorders, pro lapse, and weakness of the bladder.
I had no idea, and to be honest, it's not
until recently since I've been experiencing perimenopausal symptoms and wanting
(01:24):
to know more, particularly as I returned to well trying
to play netball, that I've started really paying attention. Caitlin
Friss is the co founder of Unity Studios. She's a
physiotherapist with a postgraduate qualification in women and Men's pelvic health.
On the daily, she treats a wide range of pelvic
flow dysfunctions and is a wealth of knowledge, particularly for
(01:44):
women who might feel less inclined to talk about what
can often be sensitive topics. Caitlin, it's so great that
you have studied and are so involved in all things
women's health. It's quite a well, it's a touchy area
for a lot of people, right.
Speaker 4 (01:58):
Yeah, I mean it's it's a niche topic for in
terms of physio, but within that niche topic, there's lots
of further specialties that we can kind of go into, bladder, bowels, pain, sex,
things like that. But yes, all of those topics are
really tiboo or stigmatized. So it's really hard for people
(02:18):
to find help when they don't really know who they
should be seeing or what they should be doing about.
Speaker 2 (02:23):
It, and actually knowing that it's an issue that other
people are experiencing and do you think people are similar
to what I had? You kind of don't know about
it until you experience it and then you realize, oh,
there's actually all this treatment that I could get and
I didn't know that before.
Speaker 5 (02:36):
Yeah. Absolutely.
Speaker 4 (02:37):
So we know that about one in three women will
have leakage of urine or bladder leakage, but only about
two out of three of those will speak to a
health professional about it because of the sort of opinion
that it's like, oh, you're just a woman, so you're
going to leak a bit, and also because it's not
really something you talk to people at a cafe about.
When you're sitting down heavy coffee, you talking about your bladder.
(03:00):
So just knowing where to find help is a big issue,
but knowing that there is help out there out there
is difficult as well.
Speaker 2 (03:07):
Can we just talk about bladder weakness while we're talking
about it for a start? I know as a mother
of three that obviously you have bladder weakness when you
have a child and in that postpartum period, but I
also think there is the potential for that to happen
again around peri menopause.
Speaker 4 (03:24):
Is that right, Yeah, So it's really common to have
leakage of urin after having a baby. Usually it will
resolve in that first six weeks. So some people come
to me like two weeks post natal and they're like, oh,
I'm winning my pants, and I'm actually not that too concerned,
Like it's pretty distressing for them, But I give them
lots of education about what's happening in their body and
that everything should improve, and there's lots of things that
they can also do to help manage that early leakage.
(03:46):
When it comes past that six weeks post natal time,
that's when we think, okay, we really need to get
on top of it, put some things in place, manage
their palbot floor, maybe train their bladder a little bit better.
But yes, the vast majority of people will get some
in their first few months. They then might also start
looking again in that perium postmenopausal season of our lives.
(04:09):
That can be a hormonal thing. So estrogen plays a
big role in a bladder control and in vaginal tissues
and in urethra and all of everything in the palvits. Really,
it also can be just that you've had several more
decades of gravity on your palvits in that time. Plus
you know, in your case, in other people's case, the
(04:31):
three babies, full term babies or fullish term babies that
have sat on the palvic floor for nine months and
they're really heavy.
Speaker 2 (04:37):
Yeah, And I think for my experience, and I'm quite
happy to share mine, I was one of those people
that it went away pretty quickly after having my babies,
and so then I was actually quite surprised when I
got it again in my early forties. And the only
reason I kind of knew about it was because I
started working out with my twelve year olds who I
coach in netball, and we started doing skipping and I
(04:58):
was like, oh, dear, I need to sort something out here.
And then I've carried on and I want to play
netball and I can see why if you don't get
it sorted, it can be a barrier for you because
playing sport, you don't want that to be happening in
the middle of a netball game.
Speaker 5 (05:10):
Right exactly.
Speaker 3 (05:11):
And what can you do?
Speaker 5 (05:13):
Yeah, heaps.
Speaker 4 (05:14):
We are big, particularly Unity being an exercise center as well.
We want to keep people exercising, so it might mean
that we change up how you're exercising initially and just
take the impact down. So when you said skipping, that's
a high impact exercise and as soon as you go
from walking to running or jumping, your body weight is
like time seven going through your leg as you hit
(05:36):
the ground with impact. So your publot floor needs to
be able to manage that increase in force. So we
might just change that a little bit initially as we
lift your pulot floor strength up. So that brings me
on to the next thing that we do, which is
palvot floor muscle training, which sounds really easy to sit
there and squeeze vagina, but actually we know that about
one in three people think they're squeezing their public floor.
(05:57):
They're actually doing something different, and a lot of those
people are actually bearing down or pushing down on the
palvot floor rather than lifting it up, and if they're
doing that several times a day, you know, sets of
ten throughout the day, they're going to make it things
worse over time, and that can contribute to things like
prolapse and more bladder leakage and stuff like that. So
knowing what to do is really important, and that's why
(06:18):
we exist public floor physios is that you don't know
if you're squeezing your powerful correctly until you have an
assessment with one of us. And then further on to that,
we might work on somebody's strength, get them stronger of
their publot floor. But for somebody else who might have
an overactive pulot floor, which is a power floor that's
just contracted most of the time and never relaxes, if
we strengthen that more and more and more, it's just
(06:38):
going to get worse and can actually make leakage worse
with strengthening and overactive palviot floor. Or we might focus
on technique or endurance or like some people just have
no like no ability to contract, so using little machines
and gadgets that we have to get them their polperful
going is that the kegel machine there's several out there. Yeah,
(07:00):
there's lots of different types. Still they work for some people. Yes, again,
if it's overactive, absolutely stay away. But if you just
like really don't know what you're doing, you've hand a
pulpt floor assessment, they've said there's not much happening there.
Then those internal devices that sort of hook up to
an app on your phone and you can like squeeze
and see get a bit of visual biofeedback are good
for some people. There's also like this sounds terrifying, but
(07:22):
we can use an electrical stimulation machine where a probe
goes into the vagina and then attaches to this little
unit that seems a really low grade and not comfortable.
We're not painful. Electrical stimulation to the pulp floor and
gets going to allow you to then build that's enough
strength to do it yourself.
Speaker 3 (07:40):
What sort of success rate do you have?
Speaker 4 (07:43):
About seventy percent of people with leakage will get vast
improvement and cure with pulvic floor muscle training.
Speaker 5 (07:52):
Thirty percent is quite.
Speaker 4 (07:54):
A a a big part of the leaking population that
they're not. But I think that when we look into
the research more, it's just that they're sort of given
pewerful exercises and sent on their way with Actually leakage,
as simple as it sounds, when you look at an
anatomical or cellular level, can actually be quite complex. So
there's lots of other things that we can do on
top of power floor muscle training, like prescribing vaginal estrogen
(08:16):
for the post natal or period post menopause or states
of low estrogen can make a significant difference to our
ability to hold onto urine. Obviously g B would do
that not for ZIO, but also assessing the bladder itself,
so how often you go to the toilet, whether you're
going to the toilet with urgency, like desperate to get there,
can't get pants down in time. That's and leaking on
(08:36):
the way to the toilet. That's really different to leaking
when you're skipping, jumping, coughing, laughing, really different types of leakage.
Speaker 3 (08:44):
Is that a worrying sign? Is it desperate to go
to the toilet?
Speaker 4 (08:47):
That's a sign of overactive bladder. So I feel like
I might have this that's really common. Yeah, Orective bladder
is like a bladder that sends you to the toilet often,
and you'll often get that sense of urge really quick.
So other people might build quite slowly, but for some
people you just get it straight away and you got
to like get there to the toilet, to the toilet,
(09:07):
maybe fear of leaking or actually leaking on the way
to the toilet. That's called urge urinary in continents, which
is quite different to stress urinary in continents, which is
the leakage of your owe on effort, coughing, sneezing, playing sports.
Speaker 1 (09:20):
Now that we need to talk with Tony Street.
Speaker 2 (09:24):
When I think of having babies and things, now, I
wasn't in the era where they have period underwear essentially,
and I think how great it is that in this
modern environment we have these options for not just our
young girls, but it's actually it helps for you know,
women's sort of post forty as well.
Speaker 5 (09:42):
Yeah.
Speaker 4 (09:43):
Absolutely, And even if you look at more into those undies,
there's period underwear which are like if you look at
the engineering of these, so dirty, but you have obviously
and it's quite interesting. So the period undies are made
to catch blood, so quite the skis thick stuff. But
if you like you know, have quite severe leakage and
you leak into that, you're just going to leak out
(10:03):
the sites so that there's continents underwear as well, and
they are designed. Some of them will like hold up
to five hundred mills of urine sometimes even like a liter,
which is a lot. So getting the right type of
underwear is something that we counselor our clients on as well.
Ideally we do our clients don't have to wear them
because they're not leaking, but to get them there and
(10:25):
to keep them playing sports while we're improving their leakage.
Something like some good underwear, good continent's pads would be
really good as well.
Speaker 2 (10:31):
Yeah, I'm really glad you made that distinction between period
underwear and bladder weakness, because I don't think I knew
there was a difference.
Speaker 3 (10:38):
Yeah, yeah, who knew.
Speaker 5 (10:40):
It's really interesting you should look into it.
Speaker 3 (10:42):
Yeah, from a physio perspective.
Speaker 2 (10:44):
You know, let's say I come in as a perimenopausal
woman wanting to stay active in sport.
Speaker 3 (10:50):
What would that look like? What would a visit look.
Speaker 5 (10:52):
Like for me?
Speaker 4 (10:53):
So if you're having some bladder leakage, it would be
an initial appointment, which book for an hour for because
we take a really thorough history. Because we're talking about
the palvis, and there's lots inside there, bladder, bowel function,
the ability like your sexual function, how many babies you've had,
(11:14):
how many injuries you've had around the area, cosix injuries
or tailwin injuries, hip stuff, knee stuff, things like that.
All of that affects your ability to hold urinine weirdly enough.
So we have to get a really thorough history about
people's all aspects of their very private lives, because things
like if somebody is leaking but they're constipated, if we
(11:37):
cure their constipation, often their leakage will get a whole
lot better. So we need to know about their bow
habits and stuff like that. Then we would so really
thorough history. Then we were doing a pulvic floor assessment,
so that would be one of usually two things.
Speaker 5 (11:52):
The most effective.
Speaker 4 (11:54):
And gives us, what gives us most information, is an
internal assessment, So that would be looking at the volva,
all the tissues on the outside and giving you to
contract and relax, teaching you how to do your palvot
floor exays because most people have no idea when they
come in, and then feeling inside of the vagina for
the pult floor muscles, which are about three or four
centimeters deep to the entrance of the vagina, giving your
(12:15):
strength rating out of five of those muscles and endurance rating,
so how long can you hold those muscles on for
and coordination like quick ones where you can relax properly.
It's funny to see the keen exercises, like actually, like
really competitive about this coin.
Speaker 3 (12:29):
It would be me, I'm already going what rating would
I be?
Speaker 5 (12:32):
Exactly?
Speaker 4 (12:33):
Yeah, And also checking for things like prolapse, So vaginal
proleps which is where one of or more of the
vaginal walls have been stretched, usually from a vaginal birth
or from things like kind of constipation or lots of exercise.
Because when the wall of the vagina that sort of
props the bladder up. When that's been stretched, that can
(12:55):
contribute to leakage of your ink bladders just not being
held very well in space.
Speaker 3 (12:59):
And if someone does have prolapse, what is the solution
from that?
Speaker 5 (13:03):
For that?
Speaker 3 (13:03):
I know people could have surgery for it.
Speaker 4 (13:05):
Right yeah, yeah, So it's kind of like one end
of the spectrum and good for a portion of people,
but most surgeons kind of coologists will refer to a
pulp floor physio for a good extent of three months
of physio stuff because a lot of them will be
able to manage and improve their prolapse symptoms just with
physio alone, and then we can refer on to surgery
(13:26):
if needed. So what we do again is perful muscle training,
getting everything supporting from up below, but also we can
fit vaginal pes series, which are an internal device. I
describe it as like a bra for your vagina. This
sort of sits in the vagina like a good fitting
tampon or menstrul cup. You don't know that it's there,
like you don't think about it, but it's sitting in there,
specifically designed and shaped for whatever proleps you have in
(13:47):
your body. And we fit it and we put it
in and most people are like, oh my god, that
feels so much better. And then they go for a
round and they're not leaking, they're not heavy in the vagina,
and they're just like so much happier and they're really
low risk as opposed to surgery comes with its own
own risks. So vaginal piece. There are also continents pesseries,
so pissories that were put in the vagina that supports
the bladder neck or the bladder wall and stops people
(14:08):
from leaking as well. So some people I fit pissories.
So just put this in before you niball game, like
you know, put your bra on, put your vagina bra in,
go up, yeah exactly, go hard, jump around to whatever.
This will manage your leakage and then always have a shower,
take it out, put it in a little tubley container.
Speaker 3 (14:25):
And back in your gym cat Wow, who knew?
Speaker 5 (14:27):
Yeah? Yeah not many people.
Speaker 3 (14:30):
Aren't aware of it.
Speaker 2 (14:31):
So what is it like when you have someone coming
that might have these issues? Do you often find they're
a bit embarrassed to tell you about it.
Speaker 4 (14:39):
Yes, but by the time they've I think the hardest
thing is booking an appointment, right, So getting to that
point where you're like, Okay, I really need to do
something about this, and booking an appointment. But when they
come in with that, Once they book to the appointment,
they're kind of given a like rigio form that they
have to fill out with lots of questions about their
powlit ful functions, so they kind of know what they're
(14:59):
com in for. Their kind of prepped. I think a
little bit like they're sit in the waiting room with
like ten other women that some of them feeding their
babies like it sort of feels like they're in the
space and they are what they're about to talk about.
And I think that we as public floor physios. Obviously
I'm biased, but I think that we are very empathetic
people that make people feel really comfortable, and we kind
of have to dig straight into you know, your bladder
(15:21):
function and sexual function quite early on in the appointment.
So they're making people feel comfortable is really important to us.
Speaker 2 (15:28):
So what sort of stage should you be at before
you come and see a pelvic floor physio.
Speaker 4 (15:34):
Any stage, it's never too late to get improvements. The
best improvements are made when it's early on in the piece,
so when you're just starting to experience symptoms. The very
best outcome is when people come to us preventatively. So
we have an appointments called a prenatal war and a
fitness prenat a wharf and a post nadal whoff well
where we do a sort of around twenty weeks of
(15:54):
pregnancy is when we suggest somebody coming in and around
six weeks postnatal, but again at any stage of pregnancy
or postnator, we'll see someone for the appointments that's just
a recommended time and we'll do a even if they're
not looking well, there's no issues, we will do an
ultrasound assessment of their palviot floor, which is another way
we can check. Gives us a relatively rudiment tree view.
But it's nice for someone to see their palpt floor
(16:15):
and a screen because we put the ultra sound on
their lower tummy, find their bladder on the screen, and
their public floor should move underneath it if they're using
it quickly, so that visual bio feedback is really nice
for people to see what's happening, because you can't see
your palvialt floor, and if you're doing it quickly, you
don't see any movement from the outside, so nobody knows
what's going on. But that's when we can sort of
pick up, oh yeah, you're not really like, you're not
really able to engage it very well. Let's sort of
(16:38):
get that going when you're pregnant, so that when you're
out the other side and things aren't you know, might
not be working well with your bladder function or proleps whatever,
that we're able to get on top of it quickly.
Speaker 5 (16:47):
You know what you're doing and things like that.
Speaker 4 (16:48):
So in a much the same way that you service
your car and you have a comprehensive check every year,
there is the capacity to do that for your public
floor and your body too.
Speaker 2 (16:57):
Wow, Because I think in the conversations that I've had
in the past, throughout pregnancy, post babies, now perimenopause, and
overwhelmingly someone will either say, oh, yeah, I've got a
really good palvet floor or oh my palvet floor is shocking.
Speaker 3 (17:12):
But actually, are you saying we probably have no idea?
Speaker 5 (17:15):
How do you know?
Speaker 3 (17:15):
How do you know if it's good?
Speaker 5 (17:17):
Only by seeing one of us? Yeah?
Speaker 3 (17:19):
So actually we're just talking a load of are we.
Speaker 4 (17:21):
I mean, if you've got a good like not much
bladder control issues, then obviously pelpful is.
Speaker 5 (17:25):
Doing something well.
Speaker 4 (17:26):
So you could probably confidently say it's okay, But it
might be just around the corner that you start leaking.
So the only way you really know is having assessment
is one of us.
Speaker 2 (17:34):
Yeah, So what would be your advice today for someone
that I don't know? Maybe they are getting bladder leakage
from sneezing, skipping, playing the sport they love. It might
even be none of the above. Maybe they just get
leakage randomly, which is a thing, right, Yeah.
Speaker 4 (17:48):
Yeah, just again they're overre it to bladder. Just leakage
on the way to the toilet or when you first
get up to get up for the day. People might
wet themselves on the way to the toilet. Yeah, I
would say go see your pelviot floor for you earlier.
Other than, like like I said, when you get on
top of it earlier, you have a much shorter journey
to dryness than if it's gotten pretty severe and usually
(18:09):
left untreatedlycuage will get with over time.
Speaker 2 (18:12):
I feel like there will be people that will say,
I don't have time to do all the exercises. Is
it a big time consuming thing?
Speaker 5 (18:20):
Not really, You're just like I'm doing it now.
Speaker 3 (18:23):
Oh gosh, I wish you'd told me I would have
done mine.
Speaker 5 (18:26):
I'm winning absolutely are see.
Speaker 3 (18:28):
I knew this was going to get competitive. Caitlin, thank
you so much.
Speaker 2 (18:31):
That was a real eye opener today and so much
information there on so many different things relating to the
pelvic floor.
Speaker 3 (18:38):
Yeah.
Speaker 2 (18:38):
I think people are gonna really like this no matter
what stage of the process they're at.
Speaker 5 (18:43):
Thank you. Thanks ing.
Speaker 1 (18:44):
We need to talk with COASTFMS Tony Street.
Speaker 5 (18:47):
If you enjoyed the.
Speaker 1 (18:48):
Podcast, click to share with family or friends. To get
in touch, email we need to talk at Coast Online,
dot co dot mz
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