The Culprit for Your incontinence - Well Below Your Pelvic Floor?

The negative effects on your pelvic floor may be closer than you realize to the actual floor -
​you know, the one that you stand on.

Are you struggling with urinary incontinence and looking for the best ways to take care of your pelvic floor? Maybe you’ve already done tons of kegels, and feel that your pelvic floor must be plenty strong. Maybe you still have that nagging sense of weakness, heaviness or pressure, not to mention the urinary urgency, frequency, and bladder leaks when it is least convenient. Not that there is ever a convenient time for bladder leaks…
 
Well, you may not have realized that your choice of footwear can have a profound impact on your bladder control. 

The way that your foot is positioned and the shoe that you wear not only sets up the way that your whole body is balanced and aligned when your foot hits the ground as you walk, but affects the ability of your pelvic floor to contract and relax normally. To be specific, wearing high-heeled shoes - really any shoe where your heel is higher than your toes in standing, but especially those sexy, high stilettos - causes a number of unnatural changes to your body that negatively impact the continence system:
 

• The ankle is put in a position that makes it harder for your pelvic floor to contract when needed
• The pelvis is tipped forward, putting your pelvic organs (bladder, uterus, rectum) in an orientation relative to gravity that is not natural for walking, and may cause the bladder to signal an urge before it is full.
• The hips and knees are made to stay slightly bent, and the S-curve of your spine is exaggerated, putting your strongest hip muscles, abdominals, and low back muscles all at a disadvantage for managing loads (i.e. your body, especially with changing terrains) and changes in pressure (hello laugh/cough/ sneeze). All of the muscles of the legs and hips are flexed the whole time while walking, rather than going through their natural cycles of contract/ relax throughout the gait cycle.
• There is an unnatural increase in muscle activity all the way up to the region of your upper back (thoracic spine), and neck, causing a stiffer rib cage and alterations in normal breathing mechanics. If you’ve hung around with me at all, you know a bit by now about the importance of good breathing for pelvic floor function and continence!
• All of this is not even to mention the extremely unnatural position of the feet themselves, and the distribution of body weight entirely over the base of the big toes. Watch this video to see a live CT scan of a woman’s foot in a stiletto shoe.

 
Now if you are experiencing any urinary incontinence, and are of an age where heels are behind you anyhow, you may be thinking that this point is not too relevant to women with incontinence. After all, heels are for younger women, right? Well, for one thing plenty of women in their 40’s 50’s, 60’s and beyond are still wearing heeled shoes the majority of the time. Also, consider the fact that 20% of women who are dealing with a leaky bladder are below the age of 30. This is far from simply an affliction of middle-aged or older women.
 
So what is the best footwear to choose to optimize your pelvic health? The first thing I would recommend is to completely avoid shoes with an “obvious” heel - that is anything that is clearly not flat, which means that the heel is probably higher than 1 inch. Invest in some good comfortable attractive flat shoes, of which there are many! If you want your feet to give you bonus points, look for a rounded or square toe-box (not pointy), and a flexible sole to the foot, as well as a structure that keeps the shoe on your foot without flopping around and without the need to “grip” the shoe with your toes to keep it on.
 
I’ve heard many women who have worn high heels for years say that they are so used to them that they are uncomfortable in flat shoes. Certainly the calf muscles and Achilles tendons are likely to become tight and shortened with many years of heel-wearing. The muscles and ligaments in the front of the hips and the low back muscles are prone to do the same. In this case, wearing flat shoes may take some getting used to, and may require a gradual transition over the course of a couple of weeks. The effort will be well worth it. No matter how accustomed you may feel you’ve become to wearing heels, this does not make the body position while wearing them any more natural or any less detrimental to the mechanics of walking.
 
Going beyond basic flat shoes, it may benefit you even more to realize that nearly all shoes that can be bought today have some amount of heel, or “drop” as it is officially called. That is, if the heel rests at a level that is at all higher than the toes, you are technically wearing a heeled shoe. If you want the best shot at optimal pelvic health (not to mention that of your knees, hips, spine, and basically everything from the ground up!) please look for shoes with what is called “zero drop”, or even a “negative heel”. Walking with your foot and ankle in this configuration puts your whole body in a better alignment to use all of your hip and core muscles automatically the way they were meant to work - including your pelvic floor.
And by the way, once you are in the right shoes, you will not need to think about consciously tensing your pelvic floor or holding in your abdomen. This is a bad habit that many women have adopted for various reasons. It is a pattern that is not helpful or natural in any shoe wear, but tends to be adopted even more strongly when wearing high heels. When you put on shoes that allow the body to walk as we were built to, you will not need more muscles working than should be at any given moment. And the ones that will help you the most will be in the best position to do so, when you need to walk, carry things, and laugh - all at the same time and with a full bladder!
 
For many women, footwear is a huge area of opportunity for improving pelvic health and quality of life. The impact of heeled shoes is an issue that if ignored, will make it hard to really get control of your bladder, no matter how meticulous you are about doing kegels and all the other exercises you may have been told will get your pelvic floor into shape.
 
If you are looking for more help getting control of your bladder so that you can live life the way you want to, there is much more to be learned in my book, “The Pelvic Floor Lowdown: An Expert Physical Therapist's Guide For Women on Getting Control of Your Bladder, Relieving Pain and Living the Life You Love.”

And as always, if you would like to ask about whether one-on-one help is the best way for you to get your best bladder control back, feel free to request a courtesy phone consultation by clicking on the button below.

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