Improving core strength, balance, & incontinence in menopause
What if we said you could improve your balance and maybe reduce urinary incontinence (leaking) – at the same time?
Menopause and falling
September 22, 2018 is Falls Prevention Awareness Day, according to the National Council on Aging. A study by the National Center for Health Statistics and the Centers for Disease Control and Prevention (CDC) found that falls are the most common cause of non-fatal injuries to women. While the Council is looking primarily at seniors, even younger women in menopause are more prone to falling than their pre-menopausal sisters.
Falls happen — a lot — and can cost us a lot more than dirty clothes and wounded dignity. According to Sixty and Me, "Roughly 1 percent of older Americans who experience a fall will die as a result of this fall. This amounts to approximately 32, 000 deaths per year or just under 90 deaths per day due to falls." So it's important to take the issue seriously.
Why? Well, loss of estrogen weakens muscles, and it can also affect a woman’s inner ears, which are critical to our sense of balance. Additionally, our proprioception – our conception of our body’s place in space – can be a bit untrustworthy during this time.
Given how common falls are in menopausal women (and how serious they can be, thanks to the weakened bones of osteoporosis), we thought we’d talk to our amazing PTs, Dr. Brianna Droessler-Aschliman and Dr. Meagan Peeters-Gebler, for advice on how to stay upright and in balance.
Better balance … and a bonus
Turns out our pelvic experts had even better information than we expected!
Incontinence often occurs or worsens during perimenopause and menopause, Meagan reminded us, and here’s where things get interesting: because urinary continence and balance both rely on core muscles, solving for X may also mean solving for Y.
When this topic came up, Meagan decided to do some digging into the question of balance and incontinence. Is balance different in women who leak?
Answer: yep. The question, as far as the pelvic floor is concerned, is the center of pressure. You want your body to be in good alignment so the pressure on the pelvic floor is distributed evenly, including when your bladder is full. In women who leak, that center of pressure is displaced – not in alignment – and the uneven distribution may be part of what causes incontinence.
Women who don’t suffer from incontinence tend to have a more even distribution of pressure and experience fewer issues with balance.
Solve for X, solve for Y.
Breathing also plays a role here, so hang in with us for a second, it’s a bit complicated. Your inner ear gets input from your body on your position: sitting, standing, lying, stable, wobbly. That system communicates back and forth with your core and pelvic muscles (among others), making adjustments to keep you upright and in balance. It also communicates with your diaphragm, which is a muscle at the top of your core that regulates breath.
We know that breathing incorrectly can negatively impact your pelvic floor, so it’s important that your inner ear gets the right information to feed to your diaphragm.
Right breath, right balance, right alignment, right use of core muscles equals fewer falls and less tendency to leak. Ta da!
So, knowing all this, what do we do now?
How to fix it all?
There are a lot of factors involved in falling: your muscles, your proprioception, your environment. The best way to protect yourself from falling is to tackle them all.
Integrate your pelvic floor in your work on balance, say our PTs. There’s a chicken-and-egg effect here where working on your pelvic floor may take some of the burden off lower stabilizer muscles in your feet and ankles, and working on greater strength and flexibility in feet and ankles may take the burden off your pelvic floor.
Stronger and more flexible feet and ankles. The muscles of our feet, particularly on the inside, are critical to our negotiation with the surface below us. The demand is different if we’re walking on a smooth sidewalk or a rooted and rocky forest trail. Our feet and ankles should be strong enough to catch us when the surface suddenly changes. If they’re not, the burden of correcting posture has to travel up the chain to hips and core.
Correct pelvic floor issues. Work with your PT or do your kegels to keep pelvic floor muscles fit. Having a strong core enables you to catch yourself should you start to fall. Also, Brianna reminds us, a stronger pelvic floor means less urinary urgency and fewer trips to the bathroom in the night. “Women who have to rush to the bathroom are at a much higher risk of tripping over the rucked up carpet or their cat,” says Brianna, “and I probably see the most falls from women who are sleepy, moving around their house in the dark, to go to the bathroom. If we can take you from three or four trips per night to one or none, your risk of falling goes way down.”
Balance and Proprioception
While the effects of estrogen on your inner ear are largely out of your control, you can train your body and brain to be more aware of your position in space. Tai Chi, yoga, and basic balance exercises can help you get stronger, be more in control of your movements, and be in better balance.
Also, learn the right way to regain balance when you go a bit wobbly. “We’re afraid to fall, so we immediately reach out our hands,” Meagan says. “But the wobble is your body doing what it’s supposed to do, it’s correcting. Take the big step; lift your foot – use the body’s built-in ways to catch itself.”
Be aware of tripping hazards, both PTs agree. Make sure throw rugs are taped down, pick up dog or kid toys, throw out those slippery piles of magazines. If you do have to get up in the night, illuminate your path with some dim nightlights. Have the right footwear for the occasion: Yaktrax on slippery sidewalks, good boots for hiking or rough trails, save the heels for the office. “Slow down!” says Brianna. “When you’re moving, put away your phone and pay attention to your environment. One of my patients reads the newspaper while walking. Aaaaaaand that’s why he’s a patient.”
So on Falls Prevention Awareness Day, we challenge you to take a moment to minimize your risk. Check your environment for hazards. Light the way from bed to bathroom. Check into a tai chi group at your local park, or just do a few kegels as you’re finishing up this blog and emailing it to a friend. Your bones, your brain – and your bladder – will thank you.
Have you dealt with balance issues or suffered from a fall? Share with us in the comments, talk with us in the Gennev community forums, or share on Gennev's Facebook page or join Midlife & Menopause Solutions, our closed Facebook group.
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