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Useful resources for women dealing with urinary incontinence.
Information about the author, Kelli Berzuk.
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How do you prevent bladder control problems? What can be done to treat bladder control difficulties? How do you cure bladder control problems?

Book Review

“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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