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Confidence in Continence

A female patient of mine came to me looking for a solution to her painful lower back. Several Mezieres’ methods sessions later her back pain was gone for good. That was good news, but nothing worth writing home about or writing for Positive Health since remedying the ‘common’ bad back is routine work; except that, in this case, the ‘cure’ of the painful back was unexpectedly concomitant with restored bladder continence. My patient’s urinary incontinence (UI), not divulged before, had disappeared at the same time as her painful lower back.

During the usual note-taking of the first session and during the following sessions, my patient never mentioned her bladder problems. This is understandable as it is not exactly a glamorous condition if there was ever one. But now that the treatment killed two birds with one stone she felt free to share with me this happy outcome.

Other Mezieres’ method practitioners have also encountered cases where the treatment of lower back pain was accompanied by an improvement or a cure of bladder incontinence. It is therefore legitimate to investigate the relationship between shape and bladder function. Shape conditions function and I can’t see any reason why the urogenital region should be an exception to this law.

It has been estimated that bladder incontinence affects about 6 million people in the UK and reaches 5% of the total population in developed countries. Although impressive, these figures might be even higher as a good portion of those suffering from this condition are too embarrassed to report it.

It is not surprising then that it has been called the silent epidemic. UI is often the source of shame, embarrassment, depression, worry, feeling old, and of self-imposed social exclusion. It interferes with simple daily activities which can lead to an avoidance of sexual intercourse or a shunning of sporting activities. Even coughing, sneezing, laughing or a little physical effort can be a cause for worry as they can provoke a leak or dribbling. Looking for toilets becomes a constant preoccupation.

The problem is much more common in women than in men: about 4% of men suffer from UI for about 37% of women aged from 15 to 95. Interestingly, UI is common among women who had never had a vaginal birth or even who have never been pregnant.

After this brief but gloomy survey of UI, let us look at one of its possible cause and how to remove it.

A hypothetical relationship between lower back pains (LBP) and UI has often been noted. A study by Eliasson et al (2008) observed that 78% of women with LBP also reported UI. P. Kamina, in 1984, had noted the incidence of a forward pelvic tilt and an increased lumbar lordotic curve (the hollow in your lower back) both in UI and in prolapses. Moreover, walking with high heels or walking on a downward slope, activities which tend to increase the lumbar curve, also increase the risk of leaking.

On the contrary, activities which correct, even if momentarily, this undue lumbar curve has a positive effect on continence. Professor Stuart Stanton, Chairman of the Continence Foundation and Consultant Urogynaecologist at St George’s Hospital in London says that “Squat’ toilets are an excellent way for women to exercise their perineum and pelvic floor muscles and control their urinary stream from the age of 2½-3 years onwards. Reports from the developing world suggest that urinary incontinence is much less in women who squat.” A study conducted by Minaire and Coll has showed that a decrease of the lumbar curve improves the perineal contractions in two thirds of women.

In the ideal shape of the lumbo-pelvic region, intra-abdominal forces are directed towards the ano-coccygeal region, domain of the posterior perineum which is the strong and ‘shock-absorbing’ region of the pelvic floor. But with an increased lumbar curve and a forward tilt of the pelvis, these forces are directed towards the urogenital cleft which belongs to the anterior perineum and which is, anatomically speaking, the ‘Achilles’ heel of the pelvic floor.

If during pregnancy and post-partum due attention is not given to shape and posture, the curves of the spine will deepen and, as a result, the intra-abdominal forces will be directed towards the weakest part of the perineum.
In normal shape, the resulting forces from abdominal pressure are directed towards an axis aligned with the anal canal which makes defecation easy (it’s why squatting toilets are best). But when, due to a departure from normal shape, this axis is aligned towards the weak anterior perineum defecation then becomes strained and has a deleterious effect on the pelvic floor. Consider also that during coughing, intra-abdominal pressure rises from 8mm to an impressive 80 mm of mercury and you realise that it does not take very long before the whole pelvic floor collapses. Without any support the pelvic viscera move down, giving rise to prolapses and disorders of the uro-genital functions.

Lodosis (anterior curve of the spine) is the mother of all distortions; distortions lead eventually to disorders. The Mezieres’ method focuses on reshaping the body by primarily restoring the curves of the spine towards normality. As such it can play an important role in fixing our internal plumbing.

And, because two precautions are better than one, adopt squat toilets!

Kamina P : Facteurs favorisant les prolapsus et l’incontinence d’urine d’effort chez la femme – GREPA – 1984 ; 14-18.

MINAIRE P / LYONNET A / SABOT E / CHEVALLARD J / BRAIZE C / BENOIT-GONIN P : rééducation périnéale et statique lombo-pelvienne – Annales kinésithérapiques; t 15, 7-8 : 391-394 MASSON Paris 1988.

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