If you take people without back pain and put them through a CT scan or MRI, you get some
surprising results!

It turns out that some of these changes are just normal part of the ageing process. If your MRI says something scary, don't be afraid. Herniated discs, facet joint osteoarthritis and other signs of degeneration sound scary but in fact they are very normal! These findings compare with grey hair or getting bald and are not always pain producing structures. If you are not sure of the language used in a scan talk to the physiotherapists at Newcastle Integrated Physiotherapy for advice.

If you find you are experiencing an episode of leakage you are probably not alone! 1 in 3 women experience some form of leakage for a variety of reasons many of which are entirely treatable.

Statistics show that 70% of people with urinary incontinence do not seek advice or treatment for their problem (Millard, 1998). Below are some facts on incontinence, and what you can do if you're experiencing symptoms.

What is Incontinence?

The term 'Incontinence' refers to "accidental or involuntary loss of urine from the bladder, or faeces or wind from the bowel" (Continence Foundation of Australia).

How Many People are Affected by Incontinence?

Up to 13% of Australian men and 37% of Australian women (i.e. 1 in 3) experience urinary incontinence.

Different Types of Incontinence

There are many different types of incontinence, with the most common ones listed below:

* Urge incontinence

Management and Treatment of Incontinence

Pelvic Floor & Kegel Exercises

Gluteal muscle strengthening exercises are also recommended, because they help PFMs to work at optimal length, and help support the pelvis and sacrum (Continence Foundation of Australia).

When to seek professional help?

Research shows up to 50% of women who attempt Kegel Exercises from a handout get the technique wrong, which can worsen the problem (Bump et al., 1991).

Contact: Our Women's Health Physiotherapist, Newcastle Integrated Physiotherapy Tel: (02) 4957 2961

During pregnancy, the growing uterus stretches the muscles in the abdomen. This can cause the two large parallel bands of muscles that meet in the middle of the abdomen to separate a condition called diastasis recti or diastasis recti abdominis. Diastatsis recti reduces the integrity and functional strength of the abdominal wall and can aggravate lower back pain and pelvic instability.

Who is at Risk of Separation?

Women expecting more than one baby, petite women, those with a pronounced sway back, or with poor abdominal muscle tone are at risk. For some women, it simply how their bodies respond to pregnancy

How do I know if I have Abdominal Separation?

If you lie on your back, knees bent at 90° with feet flat, slightly lift the head placing chin on chest. Your muscles will tense and you can place your fingers on the midline. Separation consisting of a width of 2 fingertips or more is the determining factor for diagnosing diastasis recti.

Don't panic if you feel a "gap" in your belly in the first few postpartum weeks. Everyone's connective tissue at the midline is lax after childbirth. As you recover, your midline will slowly regain its former density and elasticity, and the "gap" will become shallower.

How Can I Reduce the Separation?

Exercise can be used to improve the integrity of the abdominal muscles and should be undertaken as the first approach to healing. There are many home workout programs, such as the MuTu System or the Tummy Team that are designed specifically to strengthen the core while avoiding exercises that can exacerbate the problem, such as crunches -- a major diastasis recti no-no. If you are concerned in any way an appointment with a specially trained physiotherapist is recommended to receive the correct guidance and advice.

Special Precautions for Women with Diastasis Recti/Abdominal Separation

• Abdominal exercises that flex the upper spine off the floor or against the force of gravity such as: as crunches, oblique curls, "bicycles," roll ups/roll downs, etc.
• Any exercise that causes your abdominal wall to bulge out upon exertion.
• Lifting and carrying very heavy objects
• Intense coughing without abdominal support. During pregnancy or after childbirth, if you develop a cough, place your hands across your belly and manually splint your abdomen together during coughing episodes.
• To protect your mid line during pregnancy, always use the "log roll" manoeuver when rising from the floor or out of bed.

Please consult our Women's health specialist physiotherapist for further information or for assessment of your Diastasis Recti.