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Hi, and thanks for the great question.
Leaking urine when coughing, sneezing or generally on exertion is known as stress incontinence, and it is very common in women after childbirth, with 1/3 of women suffering from it. It is still very much a taboo, so it’s great to increase awareness of this condition, and let women know that there are effective treatments available.
With stress incontinence, weakened pelvic floor muscles are to blame. This weakness in the pelvic floor has also been linked to back pain, and decreased sexual function. But don’t worry... just like with other muscles the pelvic floor will strengthen if trained.
The N.I.C.E guidelines state that following the birth of their first child all women should be shown how to perform pelvic floor strengthening correctly. Unfortunately with staff cut backs this isn’t happening in many of our Hospitals here in Ireland. However there are some women’s Health Physiotherapists working in Private Practice, like myself and my colleague Sandra McGovern here at BodyRight.
The problem with pelvic floor exercises is that they are so easy to do wrong! Which is why learning them one-to-one is advised. There are also many tools out there to help you to strengthen your pelvic floor. Though it is a good idea to start by correctly exercising the pelvic floor actively first. You mentioned vaginal cones (which I’ll explain about later), there is electrical stimulation (a bit like slender tone for the pelvic floor!), and there are other different types of bio feedback devices, that let you know how much and how well you are achieving a contraction in your pelvic floor muscles.
There has been a lot of research into pelvic floor strengthening, and most studies find a 70% recovery rate from stress incontinence in women after a 4-6 week period of training. There doesn’t seem to be a difference between active pelvic floor exercises, vaginal cones or electrical stimulation. So it is really about choosing a method which is appropriate for the individual and keeping motivated and sticking to a program, just as if you were training for a fitness event.
To answer your question regarding vaginal cones, yes I do recommend them to some women, but not routinely. I recommend them for women who tend to need more motivation to adhere to their exercises. I often recommend them to busy mums because they can be used whilst you get on with your daily routine. The principle behind them is a system of different sized and weighted cones, which are inserted into the vagina. The aim is to keep them in place by actively engaging the pelvic floor muscles. The very presence of the cone encourages the muscles to work. As pelvic floor strength improves, you can use heavier weights. In terms of which brand, again it depends on the individuals strength, awareness and ability to perform the correct muscle pattern which we find on examination.
Whilst most women with urinary incontinence will be improved following these simple treatments there will always be a small number who will require help from a gynaecologist or urologist and this will sometimes mean surgery. However N.I.C.E. guidelines suggest 3 months of pelvic floor training before considering surgery.
So thanks again for raising such an important issue, you are most definitely not alone. It’s just people don’t talk about it. If you would like any further advice or information feel free to contact me at the Clinic, on 041 9843950.
Best wishes, Sarah.