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A New Model of Female Urinary Incontinence

The functional anatomy and physiology of the female urinary continence system remains inaccurately modeled by urology and gynecology, the medical practices that treat the condition of urinary incontinence.

Urologists and gynecologists have looked at the problem of urinary incontinence through an exceedingly narrow lens, and onto a diamond-shaped set of muscles called the “pelvic floor.”

This field of vision arises when a woman is placed on her back in the lithotomy position, on either an exam or operating table, with knees bent and feet held in high stirrups.

From this perspective Dr. Arnold Kegel devised his theory of pelvic floor strengthening in the treatment of urinary incontinence, by way of simplistic and conceptually flawed exercises known as kegels. It is also the position women are placed in for incontinence surgeries, all of which are associated with negative long-term outcomes.

In reality, kegels have no bearing on the female urinary continence system, which develops over the first years of life as we learn to crawl, stand, and walk. When symptoms fail to respond to kegel therapy, women are often told they are not performing them correctly. Surgery is usually offered as a definitive cure.

If Dr. Kegel had widened his perspective to include what he had been taught in medical school about anatomy, biomechanics, and human development, perhaps he would have realized that urinary continence depends upon three essential structural alignments.

A newborn baby girl comes into the world with a straight spine and a flexion, external rotation contracture of her hip joints. In other words, her legs are bent at the hips and turned out to the side. Full external rotation of the hips is the starting point of the urinary continence system, a position in which ligaments and other soft tissues surrounding the urethra and bladder are unwound, or relaxed.

Within approximately six months she has internally rotated her hips so that her limbs are positioned underneath her body for crawling. She still has a predominately straight spine, and the diamond-shaped wall of muscle containing orifices for her urethra-bladder, vagina-uterus, and anus-rectum is at the back of her body. Internal rotation of her hip joints begins to tighten and strengthen tissues supporting her urinary continence system, including the long, strap-like muscles of her inner thighs.

When she stands up and begins walking, her pelvis does not rotate backward into a bowl shape as early anatomists believed. This 500 year-old anatomical error is the reason women are still being taught they have a muscular pelvic “floor” underneath them, supporting the pelvic organs above.

Actually, the child stands up by profoundly curving her lumbar spine. Her pelvis remains in the quadrupedal position with a wall of muscle at the back. Her pubic bones come together underneath her like straps of a saddle forming a strong, bony pelvic floor.

The dynamics of breathing and the force of lumbar curvature move her bladder forward against her lower abdominal wall to form a right angle with her urethra. The 90º urethra-bladder angle acts like a kink in a garden hose to control the flow of urine, while lumbar curvature winds up and tightens all the tissues of pelvic organ support. Bipedal hip alignment and lumbar curvature create a self-locking urinary continence system that lasts a lifetime.

Then why do so many women suffer from involuntary loss of urine? The answer lies in loss of full range of motion of the hip joints and flattening of the lumbar spine. These structural changes compromise the highly developed urinary continence system.

It is widely accepted by urology and gynecology that widening of the urethra-bladder angle causes symptoms of urinary incontinence. Yet, these practices never developed a model for how incontinence emerges, or how to restore the female continence system to healthy function. For over 50 years kegels have been the only conservative treatment offered by doctors and physical therapists.

When a woman lies on her back and contracts her pelvic sphincters she is actually pulling the back of her bladder toward her front vaginal wall. Ironically, her incontinence symptoms may improve, but only at the expense of even greater widening of the urethra-bladder angle. Eventually an uncomfortable bulge may appear in her vagina, known as cystocele, or pelvic organ prolapse. Cystocele is actually the posterior aspect of the urethra-bladder angle, which has ballooned further and further into the vaginal space.

All surgeries for urinary incontinence attempt to create an artificial kink, or angle, in the urethra or bladder neck. Incontinence procedures are among the most devastating of pelvic surgeries, routinely leaving women unable to completely empty their bladder. Life-long self-catheterization, urinary tract infection, and bladder pain syndrome become endemic.

At Whole Woman® we understand how the urinary continence system is restored to health. Whether a woman is experiencing loss of urine when she coughs or sneezes (stress urinary incontinence), or not being able to make it to the toilet in time (overactive bladder), revolutionary Whole Woman® techniques work to stabilize and reverse these common symptoms.

For all the years that women have been kegeling to no avail, a model of urinary incontinence based on bipedal human development has been missing from medical textbooks. That model is now available and helping women throughout the world successfully resolve the symptoms of urinary incontinence naturally.

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