- Christine MacMillan, PT
Posture and the Bladder
One of the first things I do during a Pelvic Health assessment is take a look at posture. The way we position our skeleton has a huge effect on bladder support, and small changes to our postures can make a big difference for things like bladder leakage and bladder prolapse. So how exactly does posture affect the bladder? Picture how your pelvis is shaped like a bowl that contains your pelvic organs. (In women, our pelvic organs include the bladder in the front, the uterus in the middle and the rectum in the back). The bit of bowl right under the bladder would be your pubic bone, which acts like a physical shelf for the bladder when you are standing with good posture. With that bony shelf in place, we have strong support beneath the bladder and we also have a firm surface under the bladder "neck" (aka the urethra) so that when we experience downward "pressure" - like a cough, sneeze or a jump - the urethra is compressed against the pubic bone (picture kinking a hose), keeping us continent. In other words, no bladder leaks!
If that pelvic "bowl" were to tip backwards, you can imagine that the "shelf" of the pubic bone is now almost in front of the bladder rather than underneath it. In this posture, the downward pressure from a cough, sneeze or jump doesn't push the bladder against the pubic bone; it pushes your bladder back against the wall of your vagina. This type of pressure over long periods of time (think pregnancy... heavy lifting... chronic coughing etc) can actually lead to the development of a "bulge" at the vaginal opening. This bulge is your vaginal wall being pushed "in" by the weight of the bladder, and is termed bladder "prolapse". The other effect of this poor positioning of the bladder is that your urethra is no longer compressed against the bone below during a cough or sneeze, leading to less effective urethral closure (aka less bladder control!). The "hose" is not kinked as effectively and leakage occurs.
This "bowl-tipped-backwards" is the most common postural fault I see in women with prolapse and bladder leakage. This is the bum-tucked-under posture (if you also have a bit of a flat bum, I'm especially talking to you!) and is often accompanied by an upper body slouch. Very often women develop this posture during and after pregnancy as an adaptation to a growing belly, and most continue to lift and carry in this posture.
So what are some simple things you can do?
1. When you feel a cough or a sneeze coming on, try tipping your pelvis forward and visualize positioning your bladder back on top of your pubic bone. If you know how to contract your pelvic floor muscles (aka the Kegel - this is a skill pelvic health physiotherapists teach!), engage those muscles too. Sometimes just leaning forward is enough to eliminate the bladder leakage.
2. When you will be on your feet for prolonged periods of time, think about standing with more support. Think about "untucking" your bum and "nodding" your pelvis slightly forward so that your perineum (the space between your vagina and your anus) is looking straight down at your ankles. You should notice that in this position your ribcage is "stacked" perfectly above your pelvis. Stand like this especially while you are holding anything heavy!
3. Strengthen the muscles of your pelvic floor. Very often posture is just one piece of the puzzle. Most women with symptoms of bladder leakage or prolapse also have developed weakness in the pelvis floor muscles (the "bottom of the bowl"). Pelvic Health physiotherapists are specially trained to teach pelvic floor exercises and to prescribe individualized home exercise programs aimed at improving these symptoms. Ask your local physio clinic if they have a physiotherapist trained in Pelvic Health who can complete an assessment and develop a treatment program for you. If you are in the Ottawa area and want to work with me, contact Cooper Physiotherapy Clinic in Greely at 613 821-1662 or email me directly at firstname.lastname@example.org.