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This article was published 11/02/2021 (845 days ago), so information in it may no longer be current.

Physiotherapists want to know about your pelvic floor health. You may be shy to talk about your bathroom habits, but they have heard it all and are here to help.

Did you know that physiotherapists can provide simple techniques to address bladder and bowel dysfunctions? Pelvic floor physiotherapy clinics offer healthy choices to treat pelvic floor conditions. For some people, a change in toileting postures and pattern are enough to improve bladder or bowel dysfunction.

The field of pelvic floor physiotherapy is based on scientific evidence. Research shows that proper voiding and exercise can go a long way to prevent or correct bladder and bowel dysfunction. Conservative management should be your first line of defence.

When healthy, the biomechanics related to emptying your bladder and bowel are rarely considered. The body simply follows instinct. As problems arise, consulting a physiotherapist trained in pelvic floor health can make all the difference!

The pelvic floor muscle works hard. It keeps your bladder and bowel closed, so that we do not leak when not in the washroom. But when we are in the washroom, relaxation is the key. The muscle needs to fully relax and—let things pass. When the pelvic floor muscle doesn’t fully relax, or is in spasm, incomplete bladder or bowel emptying can occur. This can happen when the muscle is unhealthy or with medical conditions such as a bladder or yeast infection.

The pelvic floor muscle plays a role in bladder, bowel and sexual function. When the muscle is not healthy, pelvic pain or sexual dysfunctions, can result.

While a thorough pelvic floor assessment and investigation is needed to determine the best toileting postures and habits specific for each person, the following advice should be beneficial for most people:

Should you hover?

Women often talk about hovering to avoid contact with the toilet seat. Hovering is not the same as squatting to pee. Hovering is described as standing over the toilet seat while emptying the bladder with a key goal of avoiding contact with the toilet seat. The most common practice of this posture is in public restrooms.

Hovering requires many muscles to actively contract. Typically, the pelvic floor muscle will help stabilize the pelvis and trunk so that you maintain your balance. This makes it difficult to properly empty the bladder because while the pelvic floor muscle is contracting, the urethra (the tube that drains the bladder) may be partially closed off resulting in a slow flow of urine.

To speed up the process, you may be tempted to contract your abdominal muscles to put pressure on your bladder. You may also instinctively hold your breath as you push so that you urinate more quickly. The best way to void is as a passive event. Let the bladder empty itself. All you need to do is sit, relax, breathe, and avoid forcing the flow.

Note that hovering occasionally should not cause issues. However, when done repeatedly and over time, this posture may lead to problems with your pelvic floor muscle – affecting the bladder and bowel.

Should men sit or stand?

For men, a common question is whether to sit or to stand when voiding. If you are healthy, either option works. However, if you are feeling as if you are not fully relaxed when voiding in a standing position, then try sitting. As men age, and especially for those experiencing prostate changes, sitting to pee can dramatically improve the flow. This leads to a more complete emptying of the bladder.

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Can physiotherapy help children experiencing bed wetting?

Bedwetting issues can be frustrating. Often this resolves on its own as kids grow older. However, as children get older, if they continue to experience bedwetting and are bothered or embarrassed by it, or worry about social situations, such as sleepovers, you may choose to consult a physiotherapist for help.

Treatment is often as simple as education and exercise. Children may be taught different toileting postures and patterns. There are also products, such as bed alarms that may be appropriate for your child. Your physiotherapist may determine that pelvic floor muscle exercise is required and prescribe accordingly. If the bedwetting has become a stress for the household, why not try games? Games, developed to properly empty the bladder, can improve function and lighten-up the atmosphere so children can have fun with peeing.

If you have questions, experience any bladder or bowel issues or pelvic pain, contact a physiotherapist trained in pelvic floor care.

Dr. Kelli Berzuk is a physiotherapist at Nova Physiotherapy/Incontinence & Pelvic Pain Clinic. You can find Kelli, and many other great physiotherapists, in the Find a Physiotherapist section of our website at mbphysio.org.