In this day and age more and more people are becoming aware as regards the importance of physical fitness. However, this is still in its nascent stage in our country. Even individuals who are aware miss out on the intricate nuances. Attention is paid to strengthening upper and lower limbs as also to crunches to trim the belly, but pelvic floor muscles are left to fend for themselves. Strengthening the pelvic floor muscles is of great importance. If these are left weak these can lead to urinary incontinence loss of bladder control. This may pose problems, hampering various activities (which are otherwise taken for granted).

Symptoms may vary from mild leaking to uncontrollable wetting. Anyone could be afflicted, although its incidence is higher in old age. The myth is that dribbling/incontinence of urine is part of aging. The fact is that incontinence is never normal at any age expect during infancy.

The pelvic floor is a broad sling of muscles, ligaments and tissues which supports the bladder, bowel and uterus.

Certain factors that affect these muscles are:
• Aging of the bladder muscles reduce the bladder’s capacity to store urine. Bladder control problems occur when muscles are too weak/too active. When bladder muscles which keep the bladder closed are weak, incontinence occurs while sneezing, laughing or lifting weight. This is called stress incontinence. When muscles becoming overactive, there is a strong urge for urinating, through there is very little urine in the bladder. This is known as urge incontinence or overactive bladder.
• Pregnant women too exercise stress incontinence. This is the result of increased weight of an enlarged uterus. Stress encountered during vaginal deliver also weakens the muscles which control the bladder. Weakness of the pelvic floor affects the vaginal muscles thereby reducing sexual pleasure.
• Enlarged prostate, prostate/bladder cancer can also lead to incontinence.
• Neurological disorders like Parkinson’s disease, stroke, brain tumour and spinal injury too can interfere with never signals involved during bladder control, causing urinary incontinence.
• Obesity- Being overweight lays undue pressure on the bladder and surrounding muscles weakening them.
This cause the leaking of urine while coughing, sneezing, etc.

Complications of chronic urinary incontinence include:
Skin problems – constantly wet skin causes rashes, itching, skin infections, etc.

Incontinence is a common cause for recurrent urinary tract infections.
Individuals afflicted by urinary incontinence start shying away from attending social gatherings. This could disrupt their concentration at work or keep individuals awake at night, leading to fatigue.

TREATMENT
Bladder training entails learning to delay urination after the urge to do so. Initially hold off for 10 minutes every time one feels an urge to urinate. The primary goal is to lengthen the time between the trips to the washroom. This process should be continued till one is able to urinate every two or four hours. Bladder training may also involve double voiding – urinating, then waiting a few minutes and trying again. This exercise helps to the bladder more completely, avoiding overflow incontinence.

Scheduled toilet trips means timed urination – going to the toilet clocking time rather than waiting for the urge/need to go, usually every two to four hours.

Avoiding alcohol, caffeine too facilitates bladder control.

Pelvic floor exercises strengthen pelvic floor and sphincter muscles thereby reducing stress leakage. Ideally, one should start exercises in a comfortable lying down position to get a feel of pelvic muscles. Once comfortable and aware of the technique, performing the same exercise in a sitting down position is the next step. The recommended practice is to exercise eight to ten times, three times a day (2006). If having problems with leaking urine, it’s a good idea and make pelvic floor exercises a part of life forever.

Method- imagine that one is trying to stop passing wins and flow of urine mid-stream at the same time without holding breath, tightening the abdomen or buttock muscles and squeezing legs.

Fast and slow contractions:
Slow contractions help to increase the strength of pelvic floor. Lift pelvic floor muscles to a count of 10. Relax and rest for a count of 10. Repeat 10 times.

Fast contractions help pelvic floor to cope with pressure for example, while coughing, laughing, etc. This works the muscles that quickly shut off the flow of urine. Lift your pelvic floor muscles quickly. Hold the contraction for one second. Relax the muscles and rest for one second. Repeat 10 times.