Female Health

  1. Family Planning
  2. Depo Provera Injection
  3. Cervical Smears
  4. HPV, Cervical Cancer Vaccine
  5. Maternity and Infant Care Scheme
  6. Be Breast Aware
  7. Breast Pain - Mastalgia
  8. PHYSIOTHERAPY AND THE PELVIC FLOOR MUSCLES

Family Planning

  • Contraception Advice
  • Implanon Insertion & Removal
  • Depo - Provera
  • Testing for Sexually Transmitted Diseases (STDs)
  • Wart Freezing

DEPO PROVERA INJECTION

(150mg/ml)   = (medroxyprogesterone acetate)

Depo-Provera contains female hormone progestogen in the form of an injection and prevents an egg from ripening.  It causes changes in the lining of the womb and thickens the mucus at the entrance of the womb so makes it more difficult for sperm to enter the womb.

It should ideally be given on the first or second day of your period.  You should tell your doctor if you are taking any medication.

Benefits and possible side effects

  • 99% effective.
  • Effect lasts 12 weeks.
  • Good choice if you keep forgetting to take the pill.
  • Effects not reversible for the duration of injection.
  • Possible weight gain.
  • Possible slight increase risk of breast cancer.
  • After a first injection you could experience spotting, irregular and possible lengthy bleeding.
  • One third of women will have no period after the first injection.
  • After few injections your period could stop completely but don’t worry, you could also experience irregular bleeding.
  • Regular cycle and fertility may take a year or more to return after discontinuation of the depo injection.
  • No protection against HIV and STD.
  • Increases risk of osteoporosis

You should not use Depo–Provera if you have any of the following conditions:

  1. unusual vaginal bleeding of unknown cause.
  2. if you think you are pregnant.
  3. blood clots in the legs, lungs or anywhere else.
  4. cancer of the breast or sex organs.
  5.  liver problems.
  6. allergy to depo-provera or its ingredients.

You should tell your doctor if you have the above conditions or suffering from migraine/headaches, depression, raised cholesterol, heart disease, diabetes, family history of diabetes, asthma, epilepsy and kidney problems.

You should also read the appropriate leaflet that is usually enclosed with the depo-provera.

 

CERVICAL SMEARS 

What is a smear test and how is it taken?  A smear test (sometimes called a pap test) is used for cervical screening. It is a simple procedure where a doctor or nurse (smeartaker) takes a sample of cells from the cervix (neck of the womb) to look for early changes on the cells of the cervix. A smear test can identify cell changes before they become cancer cells. If these cells are not found and treated, they could become cancerous over time.
Quite simply, having a regular smear test could save your life.
You lie on youryour back for your smear test. The doctor taking the test will gently insert an instrument called a speculum into your vagina to hold it open. The cervix is the area where the top of the vagina leads to the uterus (womb). The doctor or nurse will use a small, specialised broom to gently brush off a sample of cells from the cervix. This sample is sent to the laboratory to be checked.
A smear test is not a diagnostic test. It is not required for clinical investigation of fibroids, cysts, heavy or painful periods or pain during intercourse. A smear test is not used to detect any changes in the womb, the fallopian tubes or the ovaries. If you have any concerns about any of these issues you should speak to your GP or nurse.
When is the best time to have a smear test?  The best time to attend for your smear test is mid-cycle - that is 10 to 18 days after the first day of your period (if you are having periods). If you are not having periods or are menopausal, you can attend for your smear test at any time as long as you are not bleeding.
Who should have a smear test?  Women aged 25 to 60 should have a regular smear test and continue to have regular mear tests after the menopause. If you are aged over 60 years and have never had a smear test, please contact your local CervicalCheck registered smeartaker to discuss your cervical screening needs. A woman over 60 who has not had a free CervicalCheck programme smear test before is entitled to do so.
I am not sexually active; do I need a smear test? CervicalCheck invites all women between the ages of 25 and 60 for cervical screening. But if you have never been sexually active with a man or woman, then the research evidence shows that your chance of developing cervical cancer is low. We do not say there is no risk, only a very low risk. In these circumstances, you might choose to decline the invitation for cervical screening on this occasion. If you are not currently sexually active but have had partners in the past, then we would recommend that you continue screening.
What is CervicalCheck?  CervicalCheck - The National Cervical Screening Programme is a Government-funded service that provides free smear tests to women aged 25 to 60.
What is cervical screening?  Cervical screening tests women for changes in the cells of the cervix (neck of the womb) by a smear test.
How can I be part of the programme?  To be part of the programme, you can arrange a smear test appointment with any registered smeartaker of your choice. Thousands of GPs, practice nurses, Women's Health, Family Planning and Well Woman Clinics all over Ireland are registered and you can see a full list in the 'Find a Smeartaker' section of this site. CervicalCheck also sends invitation letters to women who are on the CervicalCheck register. You can check that you are on the register in the 'Check Your Registration/Eligibility' section of this site. If you are not on the register you can add or update your personal details. If you have any questions you can call CervicalCheck on Freephone 1800 45 45 55.
Women who have already had a CervicalCheck smear test since the start of the programme in September 2008 will automatically be re-called by letter when their next smear test is due.
Women must sign the Cervical Cytology Form to take part in the programme and avail of a free CervicalCheck smear test. This allows CervicalCheck to receive, hold and use a woman's personal details and information about her smear test sample. This may include post-smear samples and colposcopy results. The Cervical Cytology Form has an information sheet attached to it explaining the smear test process and why consent is needed. The information sheet is available to women in Polish, Arabic, Chinese (Mandarin), French, German, Irish, Latvian, Lithuanian, Romanian, Russian and Spanish.
What is the CervicalCheck register?  CervicalCheck has developed a Cervical Screening Register (CSR). This is a list  of eligible women aged 25 to 60 from information received from the Department of Social and Family Affairs, from self-registration and colposcopy details.
The CervicalCheck register (list) is a secure electronic database that contains your name, address, date of birth and Personal Public Service Number (PPSNo.). The register (list) also records your smear test results and any related procedures that you might have had.  Be assured that your information is secure. To maintain confidentiality, you will be given a unique identification number by the CervicalCheck register. To keep the register (list) up to date, please let us know if there is any change to your personal details such as name or address.
The Health (Provision of Information) Act 1997 allows CervicalCheck to get your name, address and date of birth so that we can invite you for regular free smear tests.
I have received an invitation letter, what do I do now?  You need to make an appointment to have a free smear test with any smeartaker (GP or practice nurse) that is registered with CervicalCheck. GPs, Women’s Health, Family Planning and Well Woman Clinics all over Ireland are registered to take smear tests. Many GP practices and clinics have a choice of either a male or a female smeartaker. Click on this link to find all registered smeartakers. http://www.cervicalcheck.ie/screening_locations/find_a_smeartaker.494.stsearch.html
Results  The result of your test will be available from your smeartaker. CervicalCheck will send you a letter about your results within four weeks of your smear test. Most smear test results are found to be normal. Please try not to worry if you are called back for another test. For women who receive a not normal result, the doctor or practice nurse will explain the result and advise you of recommended follow-up.
If your result is not normal you may need to have another free smear test or a more detailed examination of the cervix using a type of microscope. This test is called a colposcopy. A colposcopy is free of charge as part of the CervicalCheck programme. If you decide to be referred as a private patient using your private health insurance you will have to pay a fee. If there are cell changes on your cervix they can beeasily treated to prevent them developinginto cancer cells.

NORMAL RESULTS   About 9 in 10 routine cervical screening tests are normal. You will be sent a letter inviting you for another one in 3-5 years. (Note: a normal result means you have a very low chance of developing cancer of the cervix - not a 100% guarantee that it will not occur.)

ADEQUATE RESULTS  This sometimes occurs. This simply means no result can be given. For example, if the smear method was used, an inadequate test may occur because there was some blood or too much mucus on the slide and the cells could not be seen properly. Sometimes it is because a smear of cells was too thick or too thin to assess properly. You will be asked to attend for a repeat test. However, with the newer liquid based cytology method, the number of tests that are 'inadequate' and need repeating is much less than with the traditional smear method.

ABNORMAL RESULTS  Some changes in the cells are found in about 1 in 10 tests. There is a range of changes that may occur. In nearly all cases, these changes do not mean cancer.  Minor or borderline abnormal changes are quite common. These often clear away on their own and most mild changes do not progress to anything serious. However, any change needs to be monitored as some may progress to become more serious in the future. A repeat test after 6-12 months is commonly advised, depending on the type and degree of change. Often the changes will have gone when the test is repeated. If the changes do not go, or the changes are more marked, then a referral to colposcopy is advised. Rarely, a cancer of the cervix is diagnosed by a cervical screening test.

What is colposcopy?  Colposcopy is a more detailed examination of the cervix. In this test a speculum is gently put into the vagina so the cervix can be seen. The doctor uses a magnifier (colposcope) to look at the cervix in more detail. A liquid is used to 'paint' the cervix which shows up the abnormal cells. It takes longer than a normal screening test (about 15 minutes). It is done by a specialist at hospital. During colposcopy it is usual to take a small piece of tissue from the cervix (biopsy) to make a more detailed assessment of the cells.

Can abnormal cells be treated?

Yes. A minor abnormal change often goes away by itself. This is why a repeat test after 6-12 months may be all that is needed. If the cells remain abnormal, or the changes are more marked, then treatment is offered. This will stop cancer from developing in the future.

The types of treatments that are used include:

  • Cryotherapy - freezing the affected area of the cervix which destroys the abnormal cells.
  • Laser treatment - this destroys or cuts away abnormal cells.
  • Loop Diathermy - a thin wire loop cuts through and removes the abnormal area of cells.

These treatments are done as an out-patient and do not take long. They are usually successful and are usually needed only once. Follow up and regular screening tests are needed for the next few years check that the treatment has been successful. It takes a few weeks for the cervix to heal after treatment. Once it has healed, a normal sex life can be resumed. Treatments do not affect fertility.

How effective is the cervical screening test?  The test is about 80% effective. This means that for every 10 women who would have developed cancer of the cervix, about 8 cases can be prevented. So, although it does not detect an abnormality every single time one occurs, overall it is a reliable test.

I have never had sex. Do I need a cervical screening test?  The test is recommended for all women - even if you have never had sex. However, the risk of getting cervical cancer is very low if you have never had sex with a man. This is because the main underlying cause of cervical cancer is a past infection with a virus called HPV virus. This is a very common virus that is normally passed on by having sex.

I have had a hysterectomy - do I need to have a cervical screening tests?  This depends on the type of hysterectomy, and why it was done. Get your doctor to advise. In general, if you have a total hysterectomy (removal of the uterus and cervix) for a reason not due to cancer, then you no longer need cervical screening tests. Some types of hysterectomy leave the cervix in place, and some are done to remove a cancer. In these situations, a test of the cells of the remaining cervix, or of the top of the vagina, may still be advised.

HPV, Cervical Cancer Vaccine

Here's what you need to know about Gardasil.

Gardasil, the new vaccine against human papilloma virus (HPV) -- which causes cervical cancerand genital warts -- is now available nationwide.

Here is what you need to know now about this new vaccine.

1. What is Gardasil?

Gardasil is a vaccine, licensed for use in June 2006, by the FDA. It targets four strains of human papillomavirus (HPV) -- HPV-6, 11, 16, and 18. HPV-16 and HPV-18 account for about 70% of all cervical cancers. HPV-6 and -11 cause about 90% of genital warts. HPV is also linked to anal cancer.

2. How does HPV spread?

Sexual activity spreads the virus, a very common one. It's one of the most common sexually transmitted diseases (STDs) in the country, according to the CDC, with more than 20 million people currently infected and another 6.2 million contracting the virus each year.

About half of those with HPV are aged 15 to 24.

3. Who should get the vaccine?

Gardasil is approved by the FDA for girls and women ages 9 to 26. The CDC and the American Academy of Pediatrics recommend that the vaccine be given routinely to girls at age 11 to 12 years old, although doctors may choose to vaccinate girls as young as 9. The CDC also recommends the vaccine for women age 13 to 26 who did not receive the vaccine at an earlier age.

However, if a girl or woman is already infected with HPV, the vaccine will not prevent that strain of HPV from causing disease. It will protect against new infections with other strains of HPV included in the vaccine.

The vaccine is also being studied in women up to age 45, although that group may be targeted for the vaccine later.

The vaccine is being studied in males, too. Men can get HPV infections and can pass the virus to their sex partners. HPV causes genital warts and is associated with rare cases of cancer of the penis. Particularly in gay men, HPV is linked to anal cancers. Merck is currently testing Gardasil in men, including gay men.

4. What is the best way to talk to my daughter about this?

Emphasize that the primary goal is to help prevent cervical cancer. If you, as a parent, are worried this will give your child a false sense of security that she can't catch a sexually transmitted infection from sexual activity, you can also emphasize that the vaccine only protects against certain strains of HPV -- not against any of the many other types of sexually transmitted infections.

5. Does Gardasil protect against all cervical cancers?

No. The vaccine does protect against the strains of HPV most likely to cause cancer. But it does not protect against all HPV strains.

However, recent reports suggest that the vaccine may give wider protection than originally thought. There is preliminary evidence it may offer some protection against other HPV strains, which cause 8% or 9% of cervical cancers.

6. How effective is the new vaccine?

Studies have shown it is 100% effective in the prevention of cervical precancers and noninvasive cervical cancers caused by HPV-16 and 18 in those not already exposed to those strains, according to Merck & Co. Inc., which makes Gardasil. Merck is a WebMD sponsor.

7. If someone is already sexually active, will this vaccine still work?

If a person has been infected with any of the four strains the vaccine protects against, the vaccine won't provide protection against that type. But it will prevent infection from the other three.

8. How long is Gardasil effective?

Research suggests the vaccine lasts at least four years. Long-term results are not yet certain. The protection might last longer.

9. Does the vaccine actually contain HPV or any live virus?

No. It has a virus-like particle, but not the actual virus.

10. Is Gardasil safe?

Clinical trial data have found it is safe.

11. Will the new vaccine make cervical cancer screens such as the Pap test passé?

No. Screening with a Pap test is still needed, since the vaccine does not protect against all cervical cancer.

Cervical cancer is the second most common cancer in women worldwide. There are about 500,000 new cases, and 250,000 cervical-cancer deaths each year. According to the World Health Organization, nearly 80% of cases occur in low-income countries, where cervical cancer is the most common cancer in women.

Maternity and Infant Care Scheme

The Maternity and Infant Care Scheme provides an agreed programme of care to all expectant mothers who live in Ireland. The service is provided by a family doctor (GP) of your choice and a hospital obstetrician. You are entitled to this service even if you do not have a medical card. Virtually all GPs have agreements with the HSE to provide these services; they do not have to be part of the medical card scheme. The Scheme also provides for two post-natal visits to the general practitioner.

The GP provides an initial examination, if possible before 12 weeks, and a further 6 examinations during the pregnancy, which are alternated with visits to the maternity hospital. The schedule of visits may be changed by your general practitioner and/or hospital obstetrician depending on your individual situation.

Where an expectant mother suffers from a significant illness, e.g. diabetes or hypertension, up to 5 additional visits to the GP may be provided. Care in respect of illnesses which are co-incidental with, but not related to your pregnancy does not form part of the Scheme.

After the birth, the GP will examine the baby at 2 weeks and both mother and baby at 6 weeks.

The GP who attends the mother also provides care for the new-born baby. This entails two developmental exams during the first 6 weeks following the birth, that are free of charge. The baby's entitlement to free GP services depends on whether the parents have a medical card. This means that visits to the GP for any conditions related to the baby's health during this six week period or afterwards are not covered by the scheme.

The public health nurse visits the mother and baby at home during the first 6 weeks.

If the baby is born in a hospital, it is usual to carry out screening for metabolic disorders (the Guthrie or heel prick test). If the baby is born at home, the test may be carried out by the GP or in the out-patients department of a hospital. This test requires parental consent.

After you and your baby leave hospital you will be visited in your home by the public health nurse.  The PHN will give you advice and support in the care of both yourself and your baby. 

Visit to the general practitioner For your baby:

The scheme provides for two designated visits to the general practitioner for your baby

(i) within two weeks of birth

The visit helps re-establish the link between you and the general practitioner.  It enables the general practitioner to check on your health status to review your hospital care experience and to discuss any difficulties you may have in managing your baby.(ii)  at six weeks of age

This visit is to review general health, to conduct another developemental examination, to review feeding practice and the overall management of the baby and to finalise immunisation plans.

  (please see Childrens Health for immunisation table).

for you:

the scheme also provides for the GP to carry out a post natal examination of the mother six weeks after the birth, although by arrangement it may be carried out by the hospital. 

Your Babys Health.  Breast milk is an ideal food for infants.  It is easily digested and it contains all the nutrients babies need for growth and development.  It contains anti-bodies which protect your baby against infection.

While you are still pregnant you should consider breastfeeding your baby to give him/her the best start in life.  Your GP, public health nurse or maternity hospital will be happy to give you advise and support.

Immunisation  Immunisation against a certain number of infectious diseases is provided free of charge. Vaccines are administered at varying ages by the general practitioner.

Remember

  1. Breast feeding is best for your baby
  2. Not earlier than 72 hours and not later than 120 hours after birth your baby should be screened for metabolic disorders ( the Guthrie or heel prick test)
  3. Always place your baby on his/her back when you put them to sleep
  4. Never smoke or allow anybody else to smoke in the presence of your baby
  5. When your baby is 2 weeks of age, you should visit your GP to discuss the babys health and to discuss immunisation plans for your baby.

The combined Obstetric Card

When your application for care under the scheme has been approved by your local health service executive area, you will be provided with the Combined Obstetric Card.  You should bring this card with you on your visits to both the GP and the hospital.

Your health during your pregnancy It is important that you take full care of yourself during your pregnancy for both your own and your baby’s sake by following your doctors advise and adhering to the following:-

  1. Do not smoke
  2. Take one folic acid tablet (400 mg) daily, ideally two months before conception and for the first twelve weeks of your pregnancy.  Consult you pharmacist for details.
  3. Do not take medication unless advised by your doctor
  4. Do not take alcohol as it can harm your baby
  5. Do not eat liver, pates unpasteurised soft cream chesses, or unpasteurised diary products.  Ensure that raw fruit and vegetables are thoroughly washed before eating. Ensure that meat is cooked through until the juices run clear.
  6. Eat a normal well balanced diet and maintain good physical condition throughout your pregnancy.
  7. Your doctor may prescribe iron tablets which you should take as prescribed.
  8. During the last twelve weeks of your pregnancy you should attend ante-natal classes, ideally in the hospital where you plan to deliver your baby.
  9. If you have any bleeding during your pregnancy, you should contact your GP.
  10. Avoid coming into contact with cat faeces and avoid handling cat litter.

BE BREAST AWARE 

One of the most important things that you can do for your health is to get to know your breasts. Breast cancer is the most common female cancer so it is important to look after your breasts by being breast aware. Being breast aware means getting to know how your breasts look and feel so you know what is normal for you. You can then feel more confident about noticing any unusual changes.

Women themselves find most lumps. Remember that most breast lumps are not due to cancer but you don’t know if you don’t ask. Even though it is uncommon, men can also get breast cancer so they need to be breast aware too.  Early detection provides the best possible chance of surviving the disease.

How can I be breast aware?

Breast awareness means becoming familiar with your breasts, how they look and feel at different times of the month. Try to get used to looking at and feeling your breasts regularly. By doing this you will be more able to notice any changes that aren’t usual for you. Use times like having a bath or shower to notice how your breasts look and feel. Running a soapy hand over your breasts and armpit helps you to feel the texture of your breast more easily. You may notice that your breasts change in size, shape or in how they feel at different times of the month. Your breasts may become lumpier or more tender around the time of your menstrual period, for example. As you become familiar with your breasts you’ll become more confident in knowing what is normal for you.

What are the changes to look for?

• Any lumps, thickening or bumpy areas in the breast or armpit that seem different from other breast tissue.  This is very important if it is new

• Any changes in the size or shape of the breast (it may be normal for you to have one breast larger than the other)

• Change to the nipple, such as crusting, ulceration, bleeding or a change in the direction or shape of the nipple

• Veins that are standing out more than usual for you

• Any puckering, dimpling or redness of the skin of the breast

making cancer less frightening by enlightening

When should I see the doctor?

You know better than anyone how your breasts look and feel normally, so if you do notice a change do go and see your doctor as soon as possible. Nine out of ten breast changes are not due to cancer but it is very important to make sure.

What is breast screening and when can I have it?

Women in Irelandare invited for a mammogram (breast x-ray) every two years from the ages of fifty to sixty four. This is a free service offered by BreastCheck which is the National Breast Screening Programme. BreastCheck compiles a list of women eligible for screening from details supplied by the Dept of Social and Family Affairs, General Medical Services (GMS) and health insurance providers. These personal details are kept safe and confidential.   Make sure that you are on the register by contacting BreastCheck on Freephone 1800 45 45 55 or checking online at www.breastcheck.ie.

• Maintaining a healthy weight

• Doing regular exercise

• Not drinking too much alcohol

The Breast Awareness 5-point Code

• Know what is normal for you

• Know what changes to look and feel for

• Look and feel

• Report any changes to your doctor without delay

• Attend routine breast screening if you are aged between 50 and 64

Breast Pain - Mastalgia

Breast pain is one of the more common reasons why ladies attend breast clinics.

It can vary from mild premenstrual discomfort to a more severe pain, which persists through out the cycle or from the time of ovulation.  In most cases the breasts are more sensitive prior to menstruation and less sensitive as the period starts.

Breast pain may be present in one or both breasts.  It may be localised (isolated to one particular spot) or diffuse (encompass most of the breast).  It can radiate into the armpit, even down as far as the elbow.  Some people describe it as a ‘heaviness, soreness or ache’.

Peak incidence of Mastalgia occurs in the 35-45 year age group.  It becomes rare after the menopause however the use of HRT may account for women who complain of it in this age group.

Cyclical breast pain does not have any relationship to breast cancer.  Women with cyclical breast tenderness may have breasts that react abnormally to normal levels of hormones in the pre menstrual phases of their menstrual cycle.

There is evidence to suggest that some women have reduced levels of certain essential fatty acids.  An essential fatty acid is a nutrient that the body can’t make but it is essential for good health.    

Treatment Options

Dietary

  • Decrease weight
  • Reduce the intake of caffeine
  • Eat a low fat diet

Bra Fitting

Be sure to wear a well fitting support bra, which has been measured correctly.  Bra size will change with weight fluctuation.  When breast tenderness is at it peak wearing a bra at night has proven helpful for some people.

Evening Primrose Oil.

Evening primrose is a perennial herb that takes its name from its habit of opening its flower between the hours of 6 and 7 o’clockin the evening.  

It is a rich source of gamolenic acid an essential fatty acid necessary for the breast.  If taken on a regular basis it can relieve cyclical breast pain in ladies.

Evening primrose oil is sold in supermarkets, health food stores and pharmacies.  It comes in different strength capsules 500mg , 1000mg and 1500mg.  A dose will be recommended by your doctor usually of 1000mg to 1500mgs.  It is taken every day initially.  Once the discomfort eases the dose can be reduced gradually.  It usually takes 8-12 weeks to see an improvement.  Evening primrose Oil is not recommended during pregnancy or prgnanacy planning.

  • Geranium oil (5 drops in a warm bath) is sometimes soothing.

 

PHYSIOTHERAPY AND THE PELVIC FLOOR MUSCLES

POOR BLADDER CONTROL PROBLEMS

Poor bladder control and having wetting accidents are common problems. Many women do not report incontinence to their doctor and so put up with accidents for many years before seeking help. You should not leak when coughing, sneezing, lifting, exercising or during intercourse. You should also be able to control the urge to empty the bladder and make it to

the toilet in time. You should not have to keep going “just in case”.  Pelvic floor exercises are effective, if you use the correct muscles to control your bladder. If in doubt about your exercises, seek help from a Chartered Physiotherapist.

STRESS INCONTINENCE

This is leaking from the bladder when you cough, sneeze or exercise. It is associated with weakness of the pelvic floor due to pregnancy, childbirth and menopause.

URGENCY

This is an overwhelming desire to pass urine which means rushing to the toilet.

URGE INCONTINENCE

This is due to over-activity of the bladder muscle or nerves. It gives a sensation of urgency to pass urine and you may not reach the toilet in time. Having to get up more than once a night is common.

THE BLADDER

The bladder is a balloon like muscle, which stores urine. It can hold around 500mls or 1 pint. As it fills to capacity, itgives a sensation to pass urine. By tightening your pelvicfloor muscles you should be able to delay the urge andpostpone emptying the bladder until it is convenient. It isnormal to empty your bladder 4-7 times in the day andonce at night.

PELVIC FLOOR MUSCLES

The pelvic floor muscles are like a trampoline and work to support the bladder, vagina, womb and rectum, holding them in the correct place. These muscles should react automatically to close the bladder outlet when you cough or sneeze. During childbirth, these muscles can be damaged and the muscles are no longer as effective at controlling the bladder outlet.

ABDOMINAL MUSCLES

The deep muscles of your abdomen support your spine and pelvic floor. These supporting muscles provide a “girdle of strength” around your pelvis and work for long periods of time. They work most effectively when the pelvis is held in the natural ‘neutral’position. To be more effective in doing your exercises AIM to find this neutral position. Imagine a compass on your lower

abdomen, the navel is north and pubic bone is south. Your pelvic bones are east and west. In neutral, the line between the pubic and pelvic bones remains horizontal. Start your exercise with your pelvis in this position whether you are lying, sitting or standing.

POSTURE

When your posture is correct you will look and feel better. It also enables you to improve the control over the pelvic floor for longer periods of time e.g. Out for a walk.

FINDING THE CORRECT POSTURE

_ Hold your head up but not your chin.

_ Shoulders back and neck long.

_ Breathe deeply.

_ Pelvis in neutral.

_ Knees straight not locked.

_ Weight between the big toe, little toe and heel.

FINDING THE ABDOMINAL MUSCLES

These muscles are easiest to find in side lying with the tummy relaxed. Check your pelvis is in neutral whether in lying, sitting or standing. Slowly and gently draw in the lower abdominal muscles as if bringing your tummy towards your spine (and your hip bones together).

Don’t move the spine or pelvis. Keep breathing and hold the muscle for at least 10 seconds. When you can do 10 x 10 second holds, introduce the hold while walking with a good

posture. Make sure your technique is correct. Using this abdominal muscle can help you find your pelvic floor muscle. To achieve the best control of the bladder you need to contract and squeeze the abdominal and pelvic muscles together. It is not easy to find the pelvic floor muscles and

it can take a lot of time and concentration.

STOP TEST

When passing urine, try to stop or slow mid stream. This is a test only and NOT an exercise. (You should not dothis test more than once per week).

SELF TEST

When in the bath, put one or two fingers into the vagina and see if you can feel the squeeze.

THE PELVIC FLOOR EXERCISE (THE PELVIC ELEVATOR)

Every one is different and needs an exercise programme to suit their individual needs.

_ Sit comfortably on an upright chair, knees apart.

_ Make sure you are sitting with the weight evenly on both buttocks.

_ Imagine your pelvic floor is like a lift. Try to take the lift up and down to different floors.

_ Continue to breathe deeply down to the bottom of your rib cage throughout this exercise.

_ Breathe in deeply and then all the way out.

_ Take the lift to the first floor by tightening the lower abdominals and back passage. As soon as you have tightened - resume normal breathing while you hold.

_ Release the muscle completely.

_ Next time contract the muscles and take the lift to the second floor. Stop breathing as you contract - resume breathing as you hold. Release completely.

_ Continue this again to the third floor.

_ Correct breathing and the ability to release the muscle to the basement during the programme is very important.

TRAINING THE MUSCLES

_ In order to control the bladder and stop accidents you must increase the strength and endurance  of the muscles.

_ To train the muscles you need to spend time every day doing the exercise until the muscle feels tired.

_ Aim to squeeze harder to take the lift higher.

_ Aim to squeeze longer to hold the lift longer at each floor.

_ Count how long you can hold for and how many times you can repeat the squeezes. This will enable you to know that you are increasing your exercise programme and improving your strength.

_ Record your programme to see your progress.

STOPPING THE LEAKS AND CONTROLLING THE BLADDER

Once you have mastered these exercises USE them when you NEED them.

SQUEEZE WHEN YOU SNEEZE

_ As you breathe in to cough or sneeze, quickly take the muscle to the third floor and hold it whileyou cough or sneeze.PRACTICE HOLDING the muscle and COUGHING.

_ CONTROLLING THE URGE, stop and take a few deep breaths, squeeze as hard as you can

until the urge fades, then holding the muscle at the first floor walk to the toilet. Squeeze hard again when undressing.

POINTS TO REMEMBER

_ Don’t go to the toilet “just in case”. Learn to take control of your bladder and have confidence.

_ Most women only leak when doing activities. To prevent accidents when out walking or doing

exercises, learn to hold your posture and abdominalcontrol. Holding the lift at the first floor gives you similar control.

_ The more control you need, the harder you must squeeze the muscles.

_ Use your exercises when you need them and do them regularly.

_ Drink normally: 1.5 litres of water a day.

_ Avoid tea, coffee, fizzy drinks and alcohol.

_ Watch your weight, being over weight can put a further strain on your muscles.

_ Avoid constipation and straining by taking extra fibre in your diet.

_ It may take up to 6 months to train the muscles.

_ Improvements can continue for up to a year.

BLADDER RETRAINING

For people who have problems making it to the toilet in time (urgency or urge incontinence), simple bladder training can improve your symptoms.  An average person can hold 400 to 500mls of fluid and passes urine six to eight times in a 24 hour period. When you have a problem with urgency it is usually due to a disturbance in the reflexes of the bladder or reduced bladder size. The bladder gives off strong messages that it wants to contract and you are unable to do anything to stop the reflex, the bladder contracts and the pelvic floor is not strong enough to resist it.

To retrain your bladder, when you feel the urge to go to the toilet during the day try and hold on for a few minutes longer than you normally would before passing urine. Try not to rush to the toilet at the point when your urge is strongest (see diagram). Use the techniques below

to practice holding. It is very difficult at first and often impossible. If the urge is too severe then you should practice these techniques in conjunction with drug therapy. Bladder retraining may also be used for someone who has an over stretched bladder.

YOUR RETRAINING PROGRAMME

When the urge starts stand still, as the urge rises squeeze your pelvic floor, as the urge peaks distract yourself, as it subsides wait and walk calmly to the toilet.

Helpful hints for holding on:

• Stand still or sit down. Sitting and leaning forward is best.

• Practice deep regular breathing.

• Think of something else other than the toilet.

• Tighten your pelvic floor muscles.

• Press on your pelvic floor muscles and hold the pressure for as long as it takes for the urge to subside.

• Stand up on your toes for a long as it takes the contraction to subside (this helps settle the reflexes).

• Avoid large quantities of alcohol, avoid tea and coffee.

• Drink at least a litre of water daily.

 

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Jervis Medical Centre
(Opposite Cineworld Cinema)
Corner of Jervis / Parnell Street. Dublin 1
City Centre.

Contact Jervis Medical Centre Dublin (01) 873 59 59