Healing from incontinence

Urinary incontinence is common in pregnancy and is reported by about 60 percent of women. For these women, the severity of their condition can increase during the course of their pregnancy, especially peaking in the second and third trimesters. Of these women who experience incontinence in pregnancy, 70 percent go on to resolve the condition postpartum – and within the first year, the prevalence of incontinence drops down to 11 to 23 percent. Dr Bongi Makhubo, obstetrician gynaecologist from Life Anncron in Klerksdorp sheds more light on the topic. 

Early incontinence is normal

Pregnancy can affect the normal way your urethra relaxes and contracts and many women, particularly those who had a vaginal birth, can experience incontinence after childbirth. “The pubic and pelvic muscles and the anal sphincter can be injured in up to 40-80% of births and so, leaking a little bit after birthing your baby vaginally is quite within the normal range, but it is not normal if it lasts for months afterwards,” says Dr Makhubo. “Directly after birth, using a thick maternity pad helps to absorb the leaks, but once you have stopped bleeding and incontinence persists, you might need a specialist appointment to discuss the problem further.” 

Stress incontinence is also quite common in new mothers and affects roughly a third of women in the first year after birth. Stress incontinence leaks happen when the mother laughs, coughs, sneezes or goes for a run. Lifting heavy things can also cause these leaks,  which are due to increased intra-abdominal pressure and a defective urethral support or closure.

<FACT BOX>What causes incontinence after birth? Dr Makhubo shares the facts: 

  • Weakening of the pelvic floor muscles or injury to the nerves supplying the structures of the pelvic floor, due to a prolonged or difficult labour. 
  • Carrying a bigger than normal baby in utero, leading to difficulty in delivering or stretching and compression of the pelvic floor.
  • High levels of elastin, a hormone which allows for more stretching of the skin and connective tissue, can cause prolapse and in turn, incontinence (as opposed to collagen, which is decreased during pregnancy).  
  • Assisted delivery, especially with the use of forceps. Research shows that there is less injury and urinary incontinence noted with the use of ventouse in comparison. 
  • Maternal age; the higher the age the higher the association with urinary incontinence.
  • Parity; incontinence is more common with parous women, however of note is that the highest risk of incontinence is with the first delivery, then 10% risk increase with each subsequent birth.
  • Vaginal delivery definitely predisposes women to a higher risk of incontinence and most women will be incontinent for a few weeks; however most will be normal within a year.

What can help?

“Pelvic floor muscle training or kegels exercise are by far the best way to combat the problem postpartum, although the research differs as to how much of the exercises should be done. However, these can be done anywhere, and one way to remember to do them is to pick an anchor which will remind you to do them. For example, when stopping at a robot or boiling the kettle: each time you do one of these activities, do some pelvic floor exercises too,” says Dr Makhubo. 

She suggests that physiotherapy can also help in some cases. “A physiotherapist will give you cones or a pessary that can be used to squeeze and strengthen the pelvic floor muscle.” Dr Makhubo also encourages lifestyle modifications, such as drinking less coffee and alcolhol and stopping smoking. Decreasing BMI can also help improve incontinence issues. “If lifestyle modifications have been made and incontinence persists, then medical treatments can be offered,” she says. “The last resort is surgery.”

Medical treatment and surgical options

  • Medication:
    • Estrogen creams, duloxetene and even botox can help to alleviate incontinence. 
  • Medical devices:
    • A vaginal pessary, which can be used for prolapses. It is a ring-like device and acts as a support for the bladder. A disposable urethral insert may also be prescribed and serves as a leakage barrier. 
  • Bulking agents:
    • Bulking agents are injected into the urethra to help plump up the tissues where urine is released from the bladder and help to hold it in. 
  • Surgery: The underlying principle of surgery is to support the urethra, so that the bladder can work effectively. 
    • “Retropubic urethropexy ( Burch’s Colposuspension ) is used most common surgery for this condition. It is an abdominal procedure, where the pubocervical fascia is attached to a copper ligament or to the pubic symphysis (pelvic bone),” explains Dr Makhubo. “This helps lift the anterior vaginal wall and tissues surrounding the urethra and bladder, which helps to alleviate incontinence. 
    • Slings: There are various kinds of slings and they are all made of mesh. The use of mesh has been approved by the FDA and the South African Urogynaecology Society endorses and supports the use of this method for incontinence. A ‘hammock’ is created using mesh and tissue to support your urethra and can be done under local anaethesia.
      • Pubovaginal slings, mid-urethral slings, mini-slings and micro-slings are used as a means to help incontinence, but implanting mesh where it is needed, in and around the urethra. These range from being quite invasive to non-invasive. Your care provider will help you decide on the best approach for you. 

Yoga: Good for the mind, body and soul

Show aging the door as you slip into your comfy yoga pants and into a yogic posture to ensure your longevity.

We all know the feeling… losing keys, forgetting names of people, places and familiar-on-the-tip-of-your-tongue words… Unnerving as it is, we all get to that point, sometimes as young as forty. A recent pilot study, which involved participants over the age of 50, explored the relationship between performance on memory tests before and after a yoga session. Results of the study showed a significant improvement in memory and levels of depression in the older adults who took part. It also showed that yoga was as effective as other memory enhancement training techniques and had additional physical benefits. Good news for our aging brains and bodies – and some might argue, good news for the soul! Biokineticist Mark Stevens, a stones throw from Life The Glynnwood Hospital and Hatha and prenatal yoga instructor Deevya Vasson Lalla share their insights into the over 5000-year-old ancient art of yoga as a form of physical exercise with multiple benefits. 

Yoga is so much more than just exercise

“The combination of breath work, stretches and relaxation techniques practiced on a regular basis helps the body move out of survival mode which has many positive side effects on your health,” says yoga instructor Deevya. “You may notice a change in your state of mind, the lowering of high blood pressure, improvements in your posture with ease of movement and increased strength and flexibility.” Not only that, yoga assists with brain function and the ability to focus, enhancing concentration and memory, explains biokineticist, Mark. “Participating in regular physical activity definitely has a positive effect on the neuromuscular link between one’s brain and muscular system. From a movement disorder point of view, practicing certain movements, improving flexibility and strength, challenging balance and proprioception and correcting gait are vital in maintaining one’s independence and improving quality of life,” he says. “Exercises to help improve the neuromuscular link between one’s brain and feet can be as simple (not always that easy for some) as doing toe taps and calf raises or balancing on one leg. Often the more active one is, the slower the rate of decline in muscle strength, flexibility and proprioception as one gets older.” 

What do I need to get started?
“You don’t need much to get started with your yoga practice, but it does help to find a good teacher at a venue close to home, so that it is easy and convenient to attend a class,” says Deevya. “You need a willingness to try, a good attitude, comfortable pants and t-shirt and a soft surface to do your poses on. If you don’t have a yoga mat, don’t let that stop you – a carpet will work just fine.” Biokineticist Mark adds that it is also important to ensure that if you have had a previous injury, that you first check with your physiotherapist or doctor that you may engage in the exercise of your choice. “This is determined on an individual basis – and the important thing is that you engage in some form of physical activity. Enter a race,  book a yoga session, commit to doing something physical. It doesn’t have to be too big or daring or expensive. Find a partner, friend or family member to join you and motivate each other to start. Set a goal and write it down. Tell your partner, friend or family member what your goal is and commit to it. It could be walking your first 5km race, losing 5kg, entering a cycle challenge or attending at least one exercise session a week for the next three months,” he says. “Consistency is key and don’t quit too soon. Unfortunately there are no quick fixes and improving one’s fitness, flexibility or strength does take time, persistence and perseverance.”

<Sidebar> Yoga instructor Deevya shares her top five yoga practices to get you startedSukhasana – Easy Pose
Benefits: Opens the hips, lengthens the spine and prepares the body for concentration and meditation.
Method: Sit on the floor with your legs crossed at your shins and the spine elongated. If you struggle to sit up without rounding the upper body or your knees lift up above your hips then sitting on a pillow and against the wall will make this pose more comfortable. Alternate Nostril Breathing
Benefits: Helps balance the body and mind, strengthens the lungs and helps clean the lymphatic system. Method: Sit in easy pose or on a chair. Place your thumb and ring finger on either side of your nose. Press your thumb down on the right nostril and breathe out gently through the left nostril. Now breathe in from the left nostril and then press the left nostril gently with the ring finger. Removing the right thumb from the right nostril, breathe out from the right. Breathe in from the right nostril and exhale from the left. Continue for a few rounds keeping the breath smooth and relaxed. Standing Forward Bend
Benefits: A great stretch for the hamstrings, glutes and spine. Your head is also below the heart so you are getting the benefits of doing an inversion – it calms the brain, reduces stress and anxiety and relieves headaches and sinus. A great one to do before bed or when waking up in the morning.
Method: Stand with your feet hip width apart, hinge from your hips all the way down and rest your hands on the floor next to your feet. Keep the knees soft if straight legs is uncomfortable and rest the hands on a block or pillow if it doesn’t reach the floor. Don’t forget to breath and just allow the body to relax and release. Alternatively hold onto your elbows. Cat Cow
Benefits: Relieves any tightness in the muscles of your back and keeps the spine healthy and flexible. Method: Come onto hands and knees with hands underneath the shoulders, palms flat and knees underneath the hips. Keep a neutral spine and as you inhale lift the head and push the chest through the arms, arching the spine. Exhale and round the spine, tuck the chin, and tuck the tailbone. Close your eyes and try to synchronise the breath with the movement as you do a few rounds.Supine Spinal Twist
Benefits: This pose releases the lower back, helps to open your chest and shoulders, relieves any upper back tension and elongates the muscles of the spine.
Method: Lie on your back and hug your knees into your chest. Take the arms out in line with your shoulders and take both knees over to the left side, resting knees and feet on the floor. Slowly breathe as you relax the right shoulder to the ground and look over the right hand. If you struggle to get the knees to the floor, try putting a pillow between your knees. Hold for a few breaths and repeat on the other side looking over the opposite hand.
masi 1.jpg

My grandmother: the yoga aunty to all who knew her
“My grandmother Jasoda ‘Bhikibhen’ Keshav, otherwise known as ‘masi’ (‘aunty’ in Gujarati) to her many regular yoga students, taught in Rylands in Cape Town for 49 years. She started her yoga classes in the early sixties making the decision to dedicate her life to sharing the gift of yoga with other women, never charging them for attending. The classes started small, once a week on a Saturday morning, but soon grew to twice a week, including a Wednesday morning as word spread. Before she died at the age of 84 she had taught hundreds of women and stayed active until her last days. One could often hear her say; ‘one day when I am not here, you girls must remember what I taught you’, alongside the motto, which became the motto of many – ‘watch your thoughts… be the observer and you will conquer the mind and its illusions.’ I believe that yoga was her life – and she inspired so many women to use yoga to nourish their bodies and minds. She was the sharpest, wittiest woman I knew and I miss her quick tongue and soft hands. She was testament to the fact that yoga keeps you healthy, fit and living mindfully.” – Rekha Chavda granddaughter to Jasoda ‘Bhikibhen’ Keshav. 

For more information and to find a yoga instructor near you, visit http://za.greendock.com/directory/yoga/studios.html for a directory of practitioners. 

Get kids moving

Unplug yourself from social media, get your trainers on and get the kids moving. 

There are 20-million children in South Africa and of those, 60 percent attend under-resourced schools, which often means they have little, limited or no access to physical education. Physical activity is vital for a child’s development and lays the foundation for a healthy and active life. In South Africa, every school-going child should access at least 90 minutes of physical activity per week, within the prescribed school curriculum. However, since physical education was removed from the school curriculum in 1999, children have become more sedentary, opting to spend free time connected to the internet, where it is accessible, exercising no more than their thumbs on small screens. South African children have poor physical activity levels, according to the 2014 Healthy Active Kids South Africa Report Card and as adult South Africans, we have a responsibility to inspire our youngsters to move more for better health and longevity. Charlene Yared-West speaks to the experts for some inspiring and fun ways to get kids moving… 

A bleak future without exercise

Dr Claire Nicholson, founder of the Move-It, Moving it Matters™ Programme points out a sad trajectory into adult life for children who do not exercise. “Without change, we can expect to see obese adults with life spans shorter than their parents,” she says. Dr Nicholson heads the programme Move-It, Moving it Matters™ (movingmatters.co.za), a healthy, active living initiative and one of its funding partners is Life Healthcare, which is committed to quality supporting interventions. It continues to gain momentum and respect locally, nationally and internationally and is a powerful educational suite of Programmes which stimulate positive engagements in activity, for life. The programme is currently in the hands of 20,000 children in Public schools across South Africa. “Our aim is to educate adults and children about the immense value of physical activity and to make it a fun alternative so that they go out there and just do it!” she explains. 

Make exercise fun and meaningful
Show your kids you care and give them the gift of your time when you set out for physical activity, explains Tracy Clifford Statt, hypnosis practitioner for the motivational exercise programme Hypnocize.co.za. “The fun factor is very important and children prefer short bursts of activity. Also, avoid nagging and negative language and be sensitive to insecurities like being overweight, or uncoordinated. Choose appropriate activities which won’t embarrass the participants,” she says. “It is also very helpful to set daily goals  for activity with your children – begin with short 10 minute bursts and work up to 30 minute play sessions.” 

Encouragement and support are key

Mr Kiruben Naicker, biokineticist at Life Mount Edgecombe Hospital in KwaZulu Natal notes that he is seeing more children with from obesity in his practice, from as young as seven or eight years old. “Parents often think their children will grow out of their baby-fat… until they see that children have in fact grown into obesity. Obese kids often become obese adults unless a lifestyle change is made,” he says. “Children need good examples to follow, encouragement and support – and parents play a big role in this. Whether it is washing the car together on a Sunday afternoon, taking a walk on the beach or showing them it’s a healthier choice to take the stairs instead of the lift are all good ways of imparting the importance of movement. Choose age appropriate activities and the sky’s the limit!” 

Be interested in their interests

“Children should be overjoyed by their own joy – and parents should partake in that joy by showing an interest in their children’s interests,” says Dr Nicholson. “So, even if that interest is in building Legos, parents should get onto the floor and play with their children. This can be built upon and taken outdoors where it can become a more physical activity, like building with bricks for example. Pay attention to what they are drawn to for clues into what they possibly would enjoy.”  

Invest in their lives

According to Andrew Wyllie, Personal Trainer and owner at personalsublime.co.za, encouraging movement in children is an investment in their lives. “Exercise builds confidence, encourages teamwork and social skills, helps build physical development and maturity, and also inspires creativity,” he says. “The bottom line is that children need to discover and explore that side of  their own development and be in awe of their amazingly agile and strong bodies.” 

<Sidebar> You don’t need a gym membership to move – explains Naicker. “Always ask yourself the question ‘how can I get my child to be more active?” Here are some ideas to get you started…

  • Play catch in the backyard. 
  • Go riding a bike together.
  • Take a morning family stroll  in nature.
  • Grab a towel and go to the beach. 
  • Take the stairs instead of a lift.
  • Take a walk instead of a drive.
  • Ban Technology for a day – then be ready to engage children in an activity like Twister.
  • Go for a swim as a family.
  •  Take it outside – indoor activity is sweaty and stifling.
  • Plan for Rainy Days – a novel activity like blowing up balloons and chasing them around the room.