Latest / What The Peri? - With Kirsten Cooke / Perimenopause & Your Pelvic Floor — Leaking, Urgency & What Actually Helps (Ep 12)

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Perimenopause & Your Pelvic Floor — Leaking, Urgency & What Actually Helps (Ep 12) · What The Peri? - With Kirsten Cooke

0:07
SPEAKER_00: Welcome to What the Perry.
0:09
SPEAKER_00: I'm your host Kirsten Cook, personal trainer, menopause coach, and a woman living it right alongside you.
0:16
SPEAKER_00: This is the podcast for women navigating peri-menopause and menopause.
0:20
SPEAKER_00: The change you didn't ask for, but the conversations you need.
0:24
SPEAKER_00: Let's get into it.
0:33
SPEAKER_00: Come with me to a Saturday night you've been looking forward to for months.
0:37
SPEAKER_00: You've bought the tickets and sorted out who's minding the kids.
0:41
SPEAKER_00: You've talked three of your oldest friends into coming along.
0:44
SPEAKER_00: And now you're all standing in the crowd together, waiting for a band you haven't seen in years.
0:49
SPEAKER_00: The lights go down and the first chord rings out.
0:52
SPEAKER_00: The crowd lifts as one and before you've had a second to think, you're dancing the way you used to.
0:57
SPEAKER_00: Your arms are up, you're singing every word, and for a few minutes you feel about nineteen again.
1:03
SPEAKER_00: Then the chorus hits and you jump just once, the way your body remembered doing it, and in that one bounce you felt it.
1:11
SPEAKER_00: A warm trickle you can't stop and you can't take back.
1:14
SPEAKER_00: You lean over to tell your friend, and you tell her you just peed a little.
1:18
SPEAKER_00: You slip your jacket off, tie it round your waist and not the sleeves tied at the front.
1:23
SPEAKER_00: For the rest of the night, while the people around you jump and scream, you stand very still and sway from the hips up, and the whole time you're quietly scanning the room for the sign to the toilets, working out how you're going to get there without anyone noticing.
1:37
SPEAKER_00: Or you do what one of my friends and her girlfriends did on a night out.
1:41
SPEAKER_00: They tied their jackets round their waists, kept dancing the night away, and dealt with it when they got home, because they wanted to make the most of their night out.
1:49
SPEAKER_00: And of course they were all wearing black, because what you wear is one more decision you end up making before a day or a night out, depending on what you'll be doing.
1:58
SPEAKER_00: If you ever stood in front of the wardrobe and passed over the light-colored pants for that reason, you'll know exactly what I mean.
2:05
SPEAKER_00: And it isn't only for concerts, is it?
2:07
SPEAKER_00: It's the sneeze that ambushes you in the line at the grocery store with both arms full of baskets and groceries and nowhere to go.
2:15
SPEAKER_00: It's the friend whose story is so funny that you've doubled over at the cafe table.
2:19
SPEAKER_00: And then somewhere between the laughing and the tears, you realize you'll need to stand up very carefully.
2:26
SPEAKER_00: It's the Sunday afternoon when the kids are on the trampoline begging you to come in.
2:30
SPEAKER_00: You're standing on the grass with a cup of tea, smiling and saying, maybe next time.
2:35
SPEAKER_00: And you know full well there won't be a next time.
2:38
SPEAKER_00: I've been there myself, and I'll tell you that straight up.
2:42
SPEAKER_00: There was a stage when, if I laugh too hard, I'd just about pee my pants.
2:46
SPEAKER_00: And many of the women I work with have described these exact moments to me too.
2:51
SPEAKER_00: The concerts with friends, the sneeze, the laugh, the trampoline, they can't get on with their kids.
2:56
SPEAKER_00: So if any of this sounds like your life lately, please know you're in very good company, and there's nothing to be embarrassed about.
3:04
SPEAKER_00: So that's where we're headed today, to your pelvic floor and your bladder.
3:08
SPEAKER_00: We'll talk about what changes through perimenopause and why so much of this creeps up on us.
3:14
SPEAKER_00: We'll talk about why so many of us end up quietly arranging our lives around it.
3:18
SPEAKER_00: And I want to say something right from the start so you can hold on to it the whole way through.
3:23
SPEAKER_00: There's a great deal that helps.
3:25
SPEAKER_00: A lot of it is free, and you can start on some of it before this episode is even finished.
3:31
SPEAKER_00: I've seen what a difference it makes for the women I work with, and I'd love that for you too.
3:36
SPEAKER_00: Welcome back to What the Perry.
3:37
SPEAKER_00: I'm Kirsten Cook.
3:39
SPEAKER_00: Last week we waded into the supermarket aisle together, and at the end of that episode, I made you a promise, and today I'm keeping it.
3:46
SPEAKER_00: We're talking about your pelvic floor and your bladder and what changes through perimenopause.
3:51
SPEAKER_00: We'll look at why so many of us end up planning the day around the nearest toilet.
3:56
SPEAKER_00: And most importantly, we'll talk about what helps.
3:59
SPEAKER_00: I know this is a topic so many women carry around in silence, so it feels a bit awkward listening to this in the car with the windows down.
4:06
SPEAKER_00: But turn it up anyway, because I'm really glad you pressed play.
4:10
SPEAKER_00: So let me walk you through where we're going first.
4:13
SPEAKER_00: First, I want to talk about how this shows up in real life before we go anywhere near the science.
4:19
SPEAKER_00: Then I'll explain what's going on underneath.
4:21
SPEAKER_00: That includes the two different kinds of bladder trouble, because that matters a lot for what helps.
4:27
SPEAKER_00: After that, we'll go through the things that make a difference.
4:30
SPEAKER_00: That's your pelvic floor exercises, Pilates, weights versus jumping, your bladder habits, those miserable urinary tract infections, and a quick word on your sex life, and then I'll leave you with three things to do this week.
4:43
SPEAKER_00: Now, back in the exercise episode, I talked about pelvic floor symptoms being one of the reasons women stop exercising.
4:50
SPEAKER_00: I said the answer was to get it looked at and then keep going.
4:54
SPEAKER_00: Today I want to go much deeper than I could there.
4:57
SPEAKER_00: There's one more thing I'll flag before we start too.
5:00
SPEAKER_00: Later in the series, there's a whole episode on sexual health, and that's where I'll go properly into the changes in your vaginal tissue.
5:07
SPEAKER_00: Today you'll get a quick look at them, but just enough to see where they fit in the bigger picture.
5:13
SPEAKER_00: Before we get into muscles and hormones, I'd like to spend some time on what this is like to live with.
5:18
SPEAKER_00: For a lot of you, it's crept in so slowly you might not have noticed how much room it takes up.
5:24
SPEAKER_00: Some of you know where every single toilet is, in the shopping center, at the school, at the netball courts, and along the drive to work.
5:31
SPEAKER_00: You go just in case before you leave the house, then you go again before you get in the car to come home, whether you need to or not.
5:39
SPEAKER_00: And some of you now have a panty liner or a pad living permanently in your handbag.
5:44
SPEAKER_00: It sits in there next to your keys and your lip balm, the way you once carried tissues.
5:49
SPEAKER_00: You reach for the black leggings rather than the beautiful pastel ones, without really thinking about why anymore.
5:56
SPEAKER_00: You cross your legs the moment you feel a sneeze building, and you've got very good at it too, a quick sneeze and cross that you could probably do in your sleep.
6:05
SPEAKER_00: So the list of things you'll say yes to gets shorter and shorter.
6:08
SPEAKER_00: You pass on the skipping game in the backyard and the jumping castle at your kids' birthday party.
6:14
SPEAKER_00: You don't sign up for the fun run your workplace is putting a team together for.
6:18
SPEAKER_00: You hang back at the bounce birthday party where the other mums are bouncing around in their grippy socks, and you tell yourself you're just not a jumping person these days.
6:27
SPEAKER_00: That's a lot easier to say than the real reason.
6:30
SPEAKER_00: Then there's the rush at the front door, which so many of you will know.
6:34
SPEAKER_00: You're fine in the car and fine walking up the driveway, but the second your key goes into the lock, the urge suddenly comes and it comes on strong.
6:42
SPEAKER_00: The closer you get to the toilet, the worse it gets.
6:45
SPEAKER_00: You're dropping the shopping in the hallway and heading straight for the bathroom, hoping you'll make it in time.
6:50
SPEAKER_00: And afterwards you stand there for a second wondering when exactly your body started doing this.
6:56
SPEAKER_00: Some of you are also getting up in the night to wee, once, twice, sometimes more.
7:01
SPEAKER_00: That comes on top of the broken sleep so many of us already have at this stage, which I talked about in the sleep episode.
7:09
SPEAKER_00: You lie there afterwards, wide awake, wondering if you'll need to go again before the alarm.
7:14
SPEAKER_00: Some of you have stopped going to a class you love, and others have never quite made it to the gym in the first place, because you didn't want to risk leaking in front of a room full of people.
7:24
SPEAKER_00: And I completely understand that.
7:26
SPEAKER_00: But often the part that weighs heaviest is the quiet embarrassment of it all.
7:31
SPEAKER_00: So many women don't tell anyone, not their partner, not their closest friend, and not their doctor.
7:37
SPEAKER_00: They assume it's just what happens after you've had kids or what happens at this age.
7:42
SPEAKER_00: So they decide it's something to put up with and to keep to themselves.
7:45
SPEAKER_00: And I understand that too, because it can feel like a very private and slightly mortifying thing to say out loud.
7:52
SPEAKER_00: It's not exactly something you bring up over coffee.
7:55
SPEAKER_00: But then there's the other side.
7:56
SPEAKER_00: Once women realize how common this is and start sharing it with their girlfriends, it often turns into a bit of a running joke.
8:04
SPEAKER_00: Remember my friend at the concert with her girlfriends, all of them with jackets tied around their waists.
8:10
SPEAKER_00: They weren't standing there embarrassed.
8:12
SPEAKER_00: They embraced it.
8:13
SPEAKER_00: They had a good laugh, and they still laugh about it now.
8:16
SPEAKER_00: Once you share it, it's so much easier to find the humour in it, and you realize you're far from the only one, which takes a lot of the sting out of it.
8:25
SPEAKER_00: So here's what I'd like you to hear.
8:27
SPEAKER_00: This is very common, and I promise you're in enormous company.
8:31
SPEAKER_00: But it doesn't mean you have to accept it.
8:33
SPEAKER_00: Jean Hales, the Australian Women's Health Organization, puts it simply, common, but not normal.
8:40
SPEAKER_00: So in other words, the fact that so many of us are dealing with it doesn't make it something you just have to live with.
8:46
SPEAKER_00: And as you're about to hear, there's a great deal that can be done about it.
8:50
SPEAKER_00: I'd much rather that you knew that now rather than find out years from now.
8:55
SPEAKER_00: To understand why any of this happens, it helps to get to know the muscles at the center of it.
9:00
SPEAKER_00: A lot of us were never told about them.
9:02
SPEAKER_00: Your pelvic floor is a group of muscles at the very base of your pelvis.
9:07
SPEAKER_00: It's a bit like a sling or a hammock, and it holds up your bladder and your bowel.
9:11
SPEAKER_00: It keeps you dry when pressure comes down on it, and it plays a part in sex as well.
9:17
SPEAKER_00: Like any other muscle in your body, it can get weaker, but it also can go the other way and be too tight, which actually surprises a lot of women.
9:25
SPEAKER_00: Now there are two quite different kinds of bladder trouble, and it's worth knowing which one you've got.
9:30
SPEAKER_00: What helps can be different for each, so this part really matters.
9:34
SPEAKER_00: The first kind is leaking when pressure comes down on your bladder suddenly.
9:39
SPEAKER_00: That's the laugh, the sneeze, the cough and the jump at the concert.
9:43
SPEAKER_00: It's the moment you lift a heavy bag of shopping out of the boot.
9:47
SPEAKER_00: Your pelvic floor isn't quite holding firm against the sudden push from above, and so a little bit escapes.
9:54
SPEAKER_00: The second kind is urgency.
9:56
SPEAKER_00: That's the sudden, desperate feeling of needing to go right now.
10:00
SPEAKER_00: It's the needing to we often through the day.
10:03
SPEAKER_00: It's the rush at the front door, and it's the waking at night because your bladder won't let you sleep through.
10:08
SPEAKER_00: Some of you will recognize yourselves in the first kind, and some in the second, and plenty of you will be nodding along at both because a lot of women have a mix of the two.
10:17
SPEAKER_00: I find it helps just to know they're different things.
10:21
SPEAKER_00: So let's start with the leaking with pressure kind because there's some good news here.
10:25
SPEAKER_00: A large American study followed women who were in their 40s and early 50s when it began.
10:30
SPEAKER_00: That's right where most of you are now.
10:32
SPEAKER_00: It found leaking was very common through midlife, but developing regular leaking or leaking getting worse wasn't tied to menopause itself or to falling estrogen.
10:43
SPEAKER_00: It had much more to do with the getting older part, having had babies and weight.
10:48
SPEAKER_00: The women who didn't put on weight or develop diabetes were less likely to start leaking or to find it getting worse.
10:55
SPEAKER_00: There's more from that study that I find so reassuring too.
10:58
SPEAKER_00: For plenty of women, the leaking came and went, and it settled down just as often as it started.
11:04
SPEAKER_00: So this kind of leaking is mostly about the muscles and the pressure landing on them.
11:09
SPEAKER_00: I think that's good news.
11:10
SPEAKER_00: Because muscles respond to training at any age.
11:14
SPEAKER_00: None of us can turn back the clock, but we can make those muscles stronger.
11:18
SPEAKER_00: That's a big part of what we'll go to in the second half of this episode.
11:22
SPEAKER_00: But the urgency side is where your hormones really do come into it.
11:26
SPEAKER_00: Your bladder, your urethra, which is the tube you wee through, and your vagina all respond to estrogen.
11:33
SPEAKER_00: They all sit very close together too.
11:35
SPEAKER_00: As estrogen falls through perimenopause, the tissue in all three tends to get thinner and more easily irritated.
11:42
SPEAKER_00: That can bring on urgency and needing to go more often.
11:46
SPEAKER_00: It can also bring on a stinging or burning feeling when you wee and more urinary tract infections or UTIs.
11:53
SPEAKER_00: And while we're here, I'll touch briefly on the changes in your vaginal tissue because they're part of the same picture.
11:59
SPEAKER_00: As estrogen drops, the lining of the vagina gets thinner and drier.
12:04
SPEAKER_00: The labia, the lips on the outside, can shrink a little too.
12:08
SPEAKER_00: I'm only mentioning it today because I want you to know it's all connected.
12:12
SPEAKER_00: The sexual health episode later in the series is where we'll go into it properly.
12:16
SPEAKER_00: I promise I won't leave you hanging on that one.
12:18
SPEAKER_00: Earlier I said your pelvic floor can be too tight rather than too weak, and I'd like to slow down on that for a moment.
12:25
SPEAKER_00: Some women have a pelvic floor that's holding on all the time and can't fully let go.
12:30
SPEAKER_00: A tight pelvic floor can cause urgency, constipation, and pain with sex.
12:36
SPEAKER_00: So for those women, squeezing harder isn't the first step, and it may even make things worse.
12:41
SPEAKER_00: What they need to do first is learn to relax those muscles.
12:45
SPEAKER_00: That's one of the big reasons I keep saying it's worth getting assessed rather than guessing.
12:50
SPEAKER_00: Now, prolapse very briefly because a lot of women worry about it without knowing what to look for.
12:56
SPEAKER_00: It can feel like heaviness or dragging down below.
13:00
SPEAKER_00: It might feel like something is sitting low or bulging, and it's often worse at the end of a long day on your feet.
13:06
SPEAKER_00: It's common and there's real help for it.
13:09
SPEAKER_00: So if that sounds familiar, a pelvic floor physio or your GP is the place to start.
13:14
SPEAKER_00: Please don't sit on it for years because you're worried about what they'll find, because the help that's available is far better than the worrying.
13:21
SPEAKER_00: And the last piece of the picture is your bowel, which doesn't get talked about nearly enough.
13:26
SPEAKER_00: When you're constipated and straining on the toilet, you're pushing down hard on your pelvic floor.
13:32
SPEAKER_00: If that's happening day after day, it adds up to a lot of strain on those muscles over the years.
13:37
SPEAKER_00: So looking after your bowel is looking after your pelvic floor as well.
13:41
SPEAKER_00: Enough fiber, enough water, and enough movement all count.
13:45
SPEAKER_00: It's one of the simplest places to begin, and I'd start there before anything fancy.
13:50
SPEAKER_00: Now this is the part I've been wanting to get to because this is where it turns hopeful.
13:55
SPEAKER_00: There's a long list of things that make a real difference here.
13:58
SPEAKER_00: Most of them are well within your reach, and some of them cost nothing at all.
14:02
SPEAKER_00: Some of them just need a bit of guidance from the right person.
14:05
SPEAKER_00: So I'll go through each of them in turn.
14:08
SPEAKER_00: I'll tell you what the research says and where my own experiences come into it.
14:13
SPEAKER_00: The first thing on that list is your pelvic floor exercises.
14:16
SPEAKER_00: Of everything that helps with leaking, these have the strongest evidence behind them.
14:21
SPEAKER_00: When researchers pulled the trials together into big reviews, women who did pelvic floor exercises were far more likely to say their leaking was cured or better, and the women in those trials were mostly in their mid-40s to mid-sixties.
14:36
SPEAKER_00: So this research was done on women just like you.
14:39
SPEAKER_00: They're recommended as the first treatment for both kinds of leaking, the pressure kind and the urgency kind, and for the women who have both.
14:48
SPEAKER_00: So how do you find them?
14:49
SPEAKER_00: Continents Health Australia suggests you imagine you're trying to stop the flow of we and hold in wind at the same time.
14:57
SPEAKER_00: Squeeze and lift up and in, hold it for a few seconds, then let it go completely and rest.
15:04
SPEAKER_00: Keep breathing normally the whole time.
15:07
SPEAKER_00: Try not to clench your bum, your thighs, or your tummy hard because the work needs to come from deep inside.
15:14
SPEAKER_00: You can do them every day, any time at all.
15:17
SPEAKER_00: Lying down is easiest to begin with, then sitting, and then standing once you've got the hang of it.
15:22
SPEAKER_00: But there's one thing I'd like to be really clear about.
15:25
SPEAKER_00: Stopping your wee midstream on the toilet is only a way to find the muscles, and only once.
15:31
SPEAKER_00: It just tells you what you're feeling for.
15:33
SPEAKER_00: It's never the exercise itself, and it isn't something to keep doing.
15:37
SPEAKER_00: So find the feeling once on the toilet, and then do your actual practice anywhere else.
15:42
SPEAKER_00: You can do them in the car, at your desk, or while the kettle boils.
15:46
SPEAKER_00: And here's something that surprises a lot of women.
15:49
SPEAKER_00: According to Jean Hales, about one in three women don't do pelvic floor exercises correctly.
15:54
SPEAKER_00: That means plenty of us have been squeezing away faithfully and getting nowhere.
15:59
SPEAKER_00: So if you've tried them before and nothing changed, please don't decide they don't work for you.
16:04
SPEAKER_00: Get your technique checked by a pelvic floor physiotherapist.
16:08
SPEAKER_00: I mean one who works in pelvic floor, not just any physio.
16:12
SPEAKER_00: They can tell whether you're switching on the right muscles and how hard to work them.
16:17
SPEAKER_00: Dr.
16:18
SPEAKER_00: Kelly Kasperson is a urologist in the United States who works with women through perimenopause and menopause, and she hosts a podcast called You Are Not Broken.
16:27
SPEAKER_00: From her work with women, she's very clear that these exercises aren't right for everyone.
16:32
SPEAKER_00: If you've got pain or tension down there, squeezing harder can make things worse, not better.
16:37
SPEAKER_00: And she makes a point that surprises a lot of women, which is that you can have weak muscles and tight muscles at the very same time.
16:45
SPEAKER_00: That's the kind of pelvic flaw that often comes with urgency, pain with sex or constipation.
16:51
SPEAKER_00: And for those women, learning to relax it comes before learning to strengthen it.
16:55
SPEAKER_00: I can't tell which kind you have without an assessment, and neither can you.
16:59
SPEAKER_00: And her view is that everybody does well with a good pelvic floor physio, even when things are going well, so that you've already got someone in your corner if they stop going well.
17:09
SPEAKER_00: If you'd like to talk to someone first, there's a free National Continence helpline staffed by Continence nurses.
17:16
SPEAKER_00: The number is 1-800-3306.
17:20
SPEAKER_00: Ring them with your questions, however small or awkward they feel.
17:23
SPEAKER_00: They can also point you towards a pelvic floor physio near you.
17:27
SPEAKER_00: I'd much rather you made the call than sat on it for another year.
17:31
SPEAKER_00: Pilates is next, and this one's personal for me.
17:34
SPEAKER_00: That laughing too hard leaking I mentioned at the start has improved for sure, and I put that down a lot to Pilates.
17:41
SPEAKER_00: And many of the women I work with have had the same experience, and they've loved what Pilates has done for their pelvic floor.
17:48
SPEAKER_00: Now, in the exercise episode, I said Reforma Pilates is a form of resistance training.
17:53
SPEAKER_00: I also said that for women who are exhausted or low, it might be the only resistance training they're doing.
17:59
SPEAKER_00: But for women who leak, there's another reason it matters.
18:02
SPEAKER_00: Reformer is often their way back into resistance training at all.
18:06
SPEAKER_00: You're lying down or seated, working against springs rather than heavy weights.
18:11
SPEAKER_00: And there's no jumping, so you can work really hard without a fear of a leak in front of a room full of people.
18:17
SPEAKER_00: And a good instructor will keep reminding you to switch on your pelvic floor as you go.
18:21
SPEAKER_00: And I was pleased to see the research backs this up, with one important condition.
18:26
SPEAKER_00: A trial in women past menopause found Pilates worked as well as dedicated pelvic floor training for leaking, but that was because the women were consciously switching on their pelvic floor during the exercises.
18:38
SPEAKER_00: A recent review of the trials found the same that exercises like Pilates did as well as pelvic floor training.
18:45
SPEAKER_00: The message is clear to me.
18:46
SPEAKER_00: The benefit doesn't come from just turning up to class, it comes from switching your pelvic floor on while you're there.
18:53
SPEAKER_00: So if you're already doing Pilates, take that into your very next class.
18:57
SPEAKER_00: Before each movement, find that gentle lift you've been practicing lying down and keep it there as you work.
19:04
SPEAKER_00: If you're not doing Pilates yet and you've been nervous about exercising because of leaking, a reformer class could be a really lovely place to start.
19:12
SPEAKER_00: Tell your instructor what's going on because a good one will be glad you did.
19:16
SPEAKER_00: And give it a few weeks before you judge it because these muscles take a little time to wake up.
19:22
SPEAKER_00: So let's talk about weights and jumping because this is where a lot of women get confused.
19:26
SPEAKER_00: Some end up avoiding exercises altogether just to be safe, and that's a real loss at a stage of life when your muscles and your bones need it most.
19:35
SPEAKER_00: My view is that weights are generally well tolerated by the pelvic floor, and they can even help it.
19:41
SPEAKER_00: It's impact and sudden pressure that's most often the trigger, which means running, skipping, jumping, and dancing, and it also means laughing and sneezing, which are the same sudden push from above.
19:53
SPEAKER_00: When researchers pulled studies of women together, high impact exercise was much more likely to bring on leaking than low impact exercise.
20:02
SPEAKER_00: The moves that came up most were often skipping and jumping, things like box jumps and double skips, and that won't surprise you if you've picked up a skipping rope lately.
20:12
SPEAKER_00: But weights are a different story.
20:14
SPEAKER_00: In the exercise episode, I told you about the Gold Coast study of women past menopause doing heavy lifting.
20:20
SPEAKER_00: Their pelvic floor didn't get worse, and in women who already had a prolapse, it actually improved a little.
20:26
SPEAKER_00: There was also a small study of women who were new to lifting who did 12 weeks of squats and deadlifts.
20:33
SPEAKER_00: Their pelvic floor got stronger, and most of the women who'd been leaking were leaking less by the end of that study.
20:40
SPEAKER_00: Now I want to be honest and practical with you here because lifting isn't automatically leak-free.
20:45
SPEAKER_00: In one study, women who'd had babies leaked more on weighted squats as well.
20:50
SPEAKER_00: That doesn't mean squats are off the table for you, but it does mean your breath and your technique matter a great deal.
20:56
SPEAKER_00: And in my experience, a few small changes in how you lift can make a huge difference.
21:02
SPEAKER_00: So how do I teach women to lift in a way that looks after the pelvic floor?
21:06
SPEAKER_00: The first thing I'd want you to know is that your pelvic floor isn't a muscle that only works when you squeeze it on purpose.
21:12
SPEAKER_00: It switches on by itself as part of the way you brace, together with your tummy, your back, and your breath.
21:19
SPEAKER_00: So it's a bit like the bottom of a can holding firm while the sides tighten around it.
21:24
SPEAKER_00: So for your heavier lifts, like a squat or a deadlift, take a quick breath down into your belly, brace all the way around your middle, and lift.
21:32
SPEAKER_00: That short breath hold on a heavy lift is normal, and pelvic floor physios who work with women who lift will tell you the pelvic floor joins in as part of that brace without you having to think about it.
21:44
SPEAKER_00: The thing to avoid is taking a big breath and then pushing down as if you're straining, because that's what sends the pressure straight down onto your pelvic floor.
21:53
SPEAKER_00: And if you do leak or you feel a heaviness or a dragging down below, two things can help.
21:58
SPEAKER_00: Lift your pelvic floor.
22:00
SPEAKER_00: Or gently just before you brace, or breathe out through the hard part of the lift and then drop the weight a little for now.
22:07
SPEAKER_00: If an exercise still brings it on, I'd swap it for something else for now and see a pelvic floor physio who will teach you to brace in a way that suits your body.
22:16
SPEAKER_00: The answer isn't never lifting heavy or never jumping again.
22:19
SPEAKER_00: You can build back up once your pelvic floor is ready for it.
22:23
SPEAKER_00: Now, your everyday bladder habits are next, and there's a lot you can change here without spending a cent.
22:29
SPEAKER_00: As a rough guide, it's normal to wee roughly every two to four hours during the day.
22:34
SPEAKER_00: Ideally, it's no more than once a night.
22:36
SPEAKER_00: If you're going a lot more than that, a bladder diary is a really useful place to start.
22:41
SPEAKER_00: For a few days, simply write down when you go and when you have the urge.
22:46
SPEAKER_00: Take that to a pelvic floor physio or a GP and they'll see the pattern straight away.
22:50
SPEAKER_00: It's a small bit of effort that saves a lot of guessing and it often shows you things you'd maybe not have noticed on your own.
22:57
SPEAKER_00: And when the urge hits, the most important thing is not to run, even though every part of you wants to.
23:04
SPEAKER_00: Stop where you are and stay still, right there in the hallway if you have to.
23:08
SPEAKER_00: Then do a few quick, strong squeezes of your pelvic floor and take a slow breath.
23:13
SPEAKER_00: Wait for the wave to pass, which it usually will, and then walk calmly to the toilet.
23:18
SPEAKER_00: Rushing tends to make the urgency worse, so that front door sprint is actually working against you.
23:24
SPEAKER_00: Learning to pause is a skill, and it gets easier the more you practice it.
23:28
SPEAKER_00: There's also something called bladder training, which you do with a pelvic floor physio.
23:33
SPEAKER_00: You gradually stretch out the time between trips to the toilet so your bladder learns to hold more again.
23:39
SPEAKER_00: There's good evidence for it with urgency, and it can make a big difference to how often you're going.
23:44
SPEAKER_00: And please don't cut back on water to avoid leaks.
23:47
SPEAKER_00: I know it's tempting, but it backfires because it leads to constipation, and that puts even more strain on your pelvic floor.
23:54
SPEAKER_00: Now, coffee, and I'm choosing my words carefully here.
23:57
SPEAKER_00: Last week I called a coffee before training the best pre-workout there is, and I still stand by that.
24:03
SPEAKER_00: I'm not about to take it off you, but if urgency is your main problem, try a fortnight with less coffee and see whether anything changes.
24:12
SPEAKER_00: If it does, that's useful to know.
24:14
SPEAKER_00: But if it doesn't, then enjoy your coffee and know it isn't the culprit.
24:18
SPEAKER_00: I'd always rather you tested it for yourself than gave up something for no reason.
24:22
SPEAKER_00: And one gentle word on weight, which I talked about properly in the weight episode.
24:27
SPEAKER_00: Extra weight around the middle presses down on the pelvic floor all day long.
24:31
SPEAKER_00: Women who lose some weight often find their leaking improves, so it's one more lever you can pull if and when it feels right for you.
24:38
SPEAKER_00: There's no shame attached to it at all, and it's never the only answer, but I just want you to know that it's there.
24:45
SPEAKER_00: Okay, let's talk about UTIs, and I'll explain why they can start turning up more often at this stage of life.
24:51
SPEAKER_00: Estrogen feeds the good bacteria that live in your vagina and keep it slightly acidic.
24:57
SPEAKER_00: That acidity helps keep out the bacteria that cause infection.
25:01
SPEAKER_00: As estrogen falls, those good bacteria start to thin out, and your vagina sits right next to your urethra, the tube you wee through, so it becomes easier for the wrong bacteria to find their way up into your bladder.
25:14
SPEAKER_00: Research has found this shift has often already started in perimenopause, not just after menopause.
25:21
SPEAKER_00: Dr.
25:21
SPEAKER_00: Kasperson, the urologist I mentioned earlier, has something to say here too.
25:26
SPEAKER_00: From her work with women, she describes UTI rates climbing steeply through perimenopause and beyond.
25:32
SPEAKER_00: So if they've started turning up more often for you, you're very much in line with what she sees.
25:37
SPEAKER_00: It isn't because you've done anything wrong, and it isn't something to feel embarrassed about.
25:42
SPEAKER_00: It's a change happening inside your body at this stage of life, and it deserves proper attention rather than quiet suffering.
25:50
SPEAKER_00: And this one is close to home for me.
25:52
SPEAKER_00: I get frequent mini UTIs, which is what I call them, and they've been getting more frequent, so I'm talking with my hormone doctor right now about starting vaginal estrogen because of it.
26:02
SPEAKER_00: Vaginal estrogen is the most effective thing for UTIs that keep coming back at this stage of life.
26:08
SPEAKER_00: I'll unpack it properly in the sexual health episode.
26:11
SPEAKER_00: I'm sharing my own situation because I'd hate for you to think you're the only one dealing with this.
26:17
SPEAKER_00: But there's also a non-medication option with reasonable evidence behind it, which is cranberry.
26:22
SPEAKER_00: Cranberry products lowered the chance of UTIs coming back in women who get them again and again.
26:28
SPEAKER_00: Tablets or capsules are the way to go rather than a glass of sugary juice every day.
26:32
SPEAKER_00: Cranberry helps prevent them though, and it won't treat an infection once you've already got it.
26:37
SPEAKER_00: So if you have symptoms, the burning, the stinging, the constant urge, please see UGP and get it sorted.
26:44
SPEAKER_00: A UTI isn't something to try and tough out on your own.
26:48
SPEAKER_00: Now before I wrap up this section, I'd like to give you a quick taste of how this connects to your sex life.
26:53
SPEAKER_00: Your pelvic floor muscles are the ones that contract when you have an orgasm.
26:58
SPEAKER_00: When researchers reviewed the trials in women past menopause, pelvic floor training improved arousal, orgasm, and satisfaction.
27:06
SPEAKER_00: The biggest change of all was in orgasm, and a pelvic floor that's too tight can make sex painful, which is another reason to get assessed.
27:14
SPEAKER_00: So those daily squeezers are doing far more for you than just keeping you dry.
27:19
SPEAKER_00: Dr.
27:20
SPEAKER_00: Kasperson from her work with women describes sex and a healthy pelvis as a three-legged stool.
27:26
SPEAKER_00: You need a sex therapist, a pelvic floor physio to look after the muscles, and a doctor like her for the hormones and anything surgical.
27:34
SPEAKER_00: And if any one of those legs is missing, the stool falls down.
27:38
SPEAKER_00: There's so much more I'd like to say about this, and I will.
27:40
SPEAKER_00: It's all coming in the sexual health episode later in the series.
27:44
SPEAKER_00: For today, I just want you to know your pelvic floor is part of that story too.
27:49
SPEAKER_00: So let me bring all of that together into three things you can do this week.
27:53
SPEAKER_00: I'd rather you walked away with a few clear steps than a headful of information and no idea where to begin.
27:59
SPEAKER_00: The great news is none of them take long and you can start the first one today.
28:03
SPEAKER_00: Pick the one that speaks to you the most if three feels like too many.
28:07
SPEAKER_00: Step one, find your pelvic floor and do your exercises every day this week.
28:12
SPEAKER_00: Imagine you're stopping the flow of Wii and holding in wind at the same time.
28:17
SPEAKER_00: Squeeze and lift up and in like an internal zipper.
28:21
SPEAKER_00: Hold for a few seconds, then let it go completely.
28:24
SPEAKER_00: If you're leaking or you've tried these before and nothing changed, book in with a pelvic floor physio or ring the National Continents Helpline on 1-800-3306.
28:35
SPEAKER_00: They'll help you work out your next step.
28:38
SPEAKER_00: Step 2.
28:39
SPEAKER_00: Look after it when you move.
28:41
SPEAKER_00: On the reformer, find that gentle lift and keep it there as you work.
28:45
SPEAKER_00: When you lift something heavy, whether it's a barbell or the shopping out of the boot, brace all the way around your middle and never push down.
28:53
SPEAKER_00: And if you leak or feel heaviness, lift your pelvic floor just before the effort.
28:58
SPEAKER_00: Breathe out as you go, and go a little lighter for now.
29:01
SPEAKER_00: If jumping brings on leaks for you right now, leave it out for the time being.
29:06
SPEAKER_00: Build back up to it gradually because that's a pause, not a forever.
29:09
SPEAKER_00: You'll get back on that trampoline.
29:12
SPEAKER_00: Step 3.
29:13
SPEAKER_00: Check in with your bladder.
29:14
SPEAKER_00: Notice how often you're going this week.
29:16
SPEAKER_00: Roughly every two to four hours during the day, and ideally no more than once a night, is a good guide.
29:22
SPEAKER_00: If urgency is your main issue, try a fortnight with less coffee.
29:26
SPEAKER_00: Practice that stop, squeeze, and breathe trick when the urge hits.
29:31
SPEAKER_00: And if UTIs keep coming back, try cranberry tablets and have a chat with your GP about what else might help.
29:38
SPEAKER_00: All the research I've drawn on today is in the show notes, along with the helpline number, so there's no need for you to scramble for a pen if you're driving or out walking.
29:46
SPEAKER_00: It'll all be there for you when you're ready.
29:48
SPEAKER_00: Now here's where I want to leave you today.
29:50
SPEAKER_00: Think back to that woman at the concert with her jacket knotted around her waist.
29:55
SPEAKER_00: Maybe she stood still for the rest of the night while her friends danced around her, or maybe she danced the night away anyway, having pedo pants.
30:03
SPEAKER_00: Either way, she deserves so much more than that, and so do you.
30:06
SPEAKER_00: She deserves to dance until the very last song.
30:10
SPEAKER_00: She deserves to jump on the trampoline with her kids and to laugh until she cries without crossing her legs first.
30:16
SPEAKER_00: This is very common, but it isn't something you have to put up with quietly.
30:20
SPEAKER_00: And I'd love for you to be the one dancing at the next concert.
30:23
SPEAKER_00: So I'll leave you with three things because they're simple enough to start tonight.
30:28
SPEAKER_00: Find your pelvic floor, work it every day and get it checked by a pelvic floor physio if nothing changes.
30:34
SPEAKER_00: Brace well when you move, never push down, and ease off the jumping for now while you build up.
30:40
SPEAKER_00: And keep an eye on your bladder habits, your coffee, and your UTIs, and talk to your GP if something doesn't feel right, because you deserve proper help with this.
30:50
SPEAKER_00: And if this episode made you think of someone, please pass it on.
30:53
SPEAKER_00: Maybe it's the friend who crosses her legs every time a sneeze is coming.
30:57
SPEAKER_00: Maybe it's the one who always seems to have a jacket tied around her waist, or the friend who always wears black.
31:03
SPEAKER_00: Send it to her because she might be waiting for someone to say this out loud.
31:07
SPEAKER_00: And if you haven't already, follow the show so next week's episode turns up in your feed.
31:12
SPEAKER_00: And if you've got a minute, please leave a review or a rating because it helps other women find their way here.
31:18
SPEAKER_00: I'm so glad you're here.
31:20
SPEAKER_00: Look after yourself, and I'll see you next week.
31:26
SPEAKER_00: Everything I've mentioned today is referenced in the show notes, along with all the links.
31:30
SPEAKER_00: And you can find me at KirstencookCoaching.com.
31:34
SPEAKER_00: Just a reminder, though, this is education, not medical advice.
31:39
SPEAKER_00: So take these conversations to a practitioner who will actually listen to you.
31:44
SPEAKER_00: Thank you so much for being here and for listening to the What the Perry podcast.
31:48
SPEAKER_00: The change you didn't ask for, the conversations you need.