“I Laughed So Hard I Peed My Pants!” - A Woman’s
Essential Guide for Improved Bladder Control
Kelli Berzuk
By Penny Wilson, BSR
You will never forget the title of this book! It is an
exclamation that the author, Kelli Berzuk, has heard many
times from her female patients. She uses it with humour and
also to make the point that incontinence is common. Berzuk has
dedicated her career as a physiotherapist to dispelling the
myth that incontinence is normal and to treating this problem
that affects 1 in 4 women.
This book is a self-help guide for women with bladder
control problems. The author takes a sensitive issue and
writes about it in an approachable, matter-of-fact way. After
reading the foreword, you already feel encouraged and
motivated to begin dealing with this problem. Although it is
written for the consumer, it is also a useful book for any
health care provider to gain an understanding of incontinence
and the available treatment options, including physiotherapy.
I especially liked the layout. The author has clearly put a
great deal of thought into making her book user-friendly. At
regular intervals throughout the book, there are lined pages
for making notes. Each chapter summarizes key points and
contains a “Did You Know?” box that focuses on pertinent
facts. The author often includes a “Physiotherapist’s
Viewpoint,” in which she uses her clinical experiences to
expand on a particular point. Besides providing useful tips,
this anecdotal information confirms to the client-reader that
she is not alone in living with these problems.
There are 29 chapters, with each addressing and expanding
on one point. By presenting the material in a simple,
methodical fashion, new information is acquired with ease.
Simple illustrations are used effectively. The author begins
with how to recognize bladder control problems. She explains
the most common causes for incontinence, highlighted by basic
anatomy and physiology of the urinary system and pelvic floor.
Most of the book is dedicated to methods of resolving
incontinence.
In just over 200 pages, I Laughed So Hard I Peed My Pants
is delightfully comprehensive. Berzuk leaves no stone unturned
when it comes to physiotherapy for incontinence. In her
down-to-earth manner, for example, she addresses the sexual
function of the pelvic floor. She even discusses incontinence
during sexual activity, a common problem that women usually
suffer in silence. Many women will breathe a sigh of relief to
learn about resolving such issues.
The author devotes six chapters to pelvic floor muscle
retraining. This might seem excessive, but it is not. One key
point is provided in each chapter. Wisely, the author begins
with “Why Exercise a Muscle?” Many people mistakenly believe
that if they walk regularly or stop and start their flow of
urine when voiding, these routines will be enough to maintain
a strong pelvic floor. The author explains the benefits of
doing specific, graded exercises for the pelvic floor.
It is a challenging task to teach pelvic floor exercises
from a book. The author does an admirable job, offering many
suggestions to assist the reader in locating her own pelvic
floor. From the knowledge we have to date, there is little
information to establish protocols for pelvic floor
retraining. The author encourages the reader to isolate the
pelvic floor, minimizing any lower abdominal activity. I think
this is prudent in teaching the technique from a book. Often
novices mistakenly substitute the lower abdominal muscles for
the pelvic floor. When working one to one with a patient, it
is possible to teach them to use the lower abdominal muscles
to enhance their pelvic floor contraction. But this is best
taught in the clinic.
Chapter 12, “Proper Pelvic Floor Exercises,” includes a
diary to record and encourage consistency in doing the
exercises. The author recognizes the challenges that patients
face in doing these exercises. To help, she suggests a “Red
Dot” program. By placing red dots on a wristwatch or computer,
the client is reminded to do a set of exercises (which take
just over 1 minute) each time she sees the dot. You know this
author has experience when she suggests changing the location
of the dots every 2 weeks to avoid adaptation! In addition to
learning how to exercise the pelvic floor, the reader is
taught how to progress the exercises, how to use the muscles
functionally, and how to retrain related accessory muscles.
It is clear that the author appreciates the challenges of
motivating clients when it comes to adding new exercises to
their daily routine. To ensure the greatest success, she
always explains not just “how” but also “why.” She ensures
that the reader understands the reasons for her suggestions
and the expected outcomes. The reader is advised to appreciate
small improvements in bladder control. This is so important
with pelvic floor retraining. By taking stock of seemingly
minor but positive changes, motivation continues, and success
is more likely.
This book does a remarkable job of promoting physiotherapy
in women’s health. The author suggests seeking help from a
physiotherapist with postgraduate training in pelvic floor
dysfunction if the reader is unsure about how to do the pelvic
floor exercises. She provides information on resources to
locate a physiotherapist with this interest and expertise and
prepares readers regarding what to expect when they visit a
physiotherapist for their problem with incontinence. She does
our profession a service by promoting our scope of practice.
Berzuk’s empathy for her readers is obvious throughout. She
understands what it is like to live with incontinence, and she
appreciates the challenges involved in regaining bladder
control. Readers will feel that the author is sitting beside
them through every chapter. She informs and encourages with
respect and a positive attitude.
Many women believe that they just have to live with leaking
urine. If you, as a physiotherapist, place a copy of I Laughed
So Hard I Peed My Pants in your waiting room, you might
provide someone with the tools to begin resolving her
incontinence. And when the book arrives, take a look at it
yourself. There are so many simple ways in which a
physiotherapist or other health care provider can help a
person with incontinence. Just having the book in your office
will assist your clients in broaching the subject. As the
author states in Chapter 1, “It is time to take control over
your bladder.”
By Penny Wilson, BSR Continence Clinic, BC Women’s
Health Centre, Vancouver, BC
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