Linda Brubaker, MD is a urogynecologist in Chicago who advocates C/Sec to
prevent pelvic floor dysfunction and said so at her presentation at the
First International Conference on the Pelvic Floor in Montreal last
September. I have met a number of American and Australian female OB-GYN
physicians who plan to have an elective Cesarean to avoid PFD!! In Rio
de Janiero this is one of the main reasons for the higher than 65% rate (
the figure I last heard). There is at least that show less USI following
C/Sec but my mind tends to distrust and misplace such information!
Few people trust Mother Nature any more...
We have to keep in mind that recent studies (in US and Norway) have shown
1/3 of competitive college athletes (nulliparous) to have USI. In May
this year I heard a paper at the World Confederation of Physiotherapy in
Yokohama about Scandinavian research that found 80% ( yes EIGHTY percent)
of teenaged gymnasts suffered from USI (correlating with onset and
duration of training). There are women who develop incontinence in
pregnancy who miscarry, have C/Secs (as you noted) so it is not
inevitably "the trauma of parturition" but clearly sometimes it certainly
is! (22% of American women have 4th degree tears...extensions of that
unkind cut, the episiotomy).
USI is a complex problem with many causes. Emotions (being "pissed off"),
lifestyle (no longer squatting for ADL...in Australia you can get a frame
called "In Lieu" for your toilet), diet (lack of whole foods to build
collagen, bladder irritants etc) and obesity (the average American gained
10 lbs in the last decade; >30% are morbidly obese). After my recent trip
to Australia, I would say that that it is heading in the same direction,
sadly.
Japan is too: chubby kids and adult diapers for sale in convenience
stores...I never saw either in former visits.
Living half the year in the Caribbean, where I also travel extensively
and always visit maternity and WH clinics, it has become clear to me that
incontinence is as uncommon among the blacks as it is common among the
whites. The whites develop prolapse/incontinence, the blacks have more
fibroids. I conclude that there is some biological superiority among
blacks despite their diet: e.g. strong bones & teeth, great skin tone,
lack of grey hair, infrequent pelvic floor dysfunction (despite obesity
that is very common in the anglophone islands but conspicuous by its
absence in the francophone islands). Whites have to work much harder to
stay continent, especially as we are living ever-longer. The trend in
Germany is to use functional activities rather than isolated exercises as
a half-century of kegeling has not made a dent in the incontinence growth
industry ( over $28 billion in the US, and almost $11 billion just for
pads and laundry! That's more than the GNP for some small countries!). I
address this issues in my video Pelvic Power, and the forthcoming book.
Hormones can do it, too! Just like around menopause...
Elizabeth Noble, PT
OB-GYN Courses, New Life Images, Women's Health Resources
448 Pleasant Lake Avenue, Harwich, MA 02645
Ph: (508) 432-8040 Fx: (508) 432-9685
www.capecod.net/newlife
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