1 in 3 women over the age of 45 experience some form of urinary incontinence. There is a great misconception that leakage is a natural part of the ageing process and there is nothing that can be done about it. However, no-one should have to tolerate any form of urinary incontinence and there is actually lots we can do about it!
Urinary incontinence is the accidental or involuntary loss of urine, and can range from tiny leaks to a complete emptying of the bladder.
Risk factors for incontinence can include, pregnancy, pelvic floor trauma after vaginal birth, menopause, hysterectomy, obesity, hormonal changes such as menopause, urinary tract infections, chronic cough, constipation or high impact sport such as gymnastics, trampoline, cross-fit and hurdling to name a few.
Types of urinary incontinence vary, however there are two the main types:
Small amounts of leakage occur during increased intra abdominal pressure, such as sneezing, coughing, laughing, skipping, jumping or running. Basically when the pelvic floor structure has a sudden increase in load of which it cannot take.
This occurs when the detrusor (bladder) muscle contracts unexpectedly, causing a strong sense of urgency and can be accompanied by involuntary loss of urine. Sometimes urgency does not always lead to incontinence, but the sensation of needing to go can lead to small amounts of urine to pass when on the toilet. This can develop into frequency and urgency, also known as overactive bladder. Which means the detrusor muscle is contracting when it shouldn't be, giving you the over whelming sensation of urge to urinate when it doesn't need to.
What is the pelvic floor?
The pelvic floor is essentially a hammock of muscle, ligaments and fascia from the front of the pelvis to the back, and side to side. Functionally the pelvic floor supports the bladder neck and anus to help them stay closed. They actively squeeze when you cough/ sneeze/ lift to help avoid leaks from bladder or bowel.
Pelvic floor exercise are now regarded as the first stage of treatment for stress urinary incontinence. For many women, a regular and sustained pelvic floor strengthening program can improve or even entirely overcome the symptoms of stress incontinence. A pelvic floor muscle strengthening program can take 3 to 6 months to change the muscle contraction and its strength.
How do we find out if your pelvic floor is weak?
It is impossible to determine the strength of the pelvic floor without an internal examination using a device called a Peritron. This, along with a physical assessment will help to determine what muscles are either weak/long or overactice/short and will help direct treatment.
How can physiotherapy help?
Often women find it difficult to contract their pelvic floor muscles, 50% of women will be doing a pelvic floor contraction incorrectly when using a verbal instruction. An internal pelvic floor biofeedback assessment is usually needed to help retrain the pelvic floor muscles and ensure the correct contraction is happening. Your women's health Physio will be able to assist in correct activation, then direct you to the appropriate treatment technique.
There is a growing amount of evidence to show that pelvic floor exercise devices can help to achieve faster and more effective results for the pelvic floor. Bio feedback devices, vaginal weight and balls, or even electrical stimulation for very weak muscles can help stimulate the muscle's strength and bulk.
Treatment guidelines suggest that any women seeking professional help for stress urinary incontinence, try a regular and a sustained program of pelvic floor exercises before resorting to more invasive options such as surgery.
Studies by Moreno et al. (2004) and Dumounin (2014), showed that pelvic floor exercises are an effective and low cost treatment for stress urinary incontinence. Furthermore in the most recent guidelines from the American College of Physicians (2014) stated that pelvic floor strengthening exercises have a high quality evidence base for stress urinary incontinence.
Practical tips for managing incontinence
Although a physiotherapy assessment and management plan is the most effective treatment, there are other practical ways in which you can help your incontinence.
Fluid intake. Most women wil reduce their intake in an effort to avoid toileting, however this can actually place more stress on the bladder leading to worsening urge incontinence. Try instead, to sip small amounts regularly. Urologists recommend 80-100mls/hour.
Try reducing caffeine and acidic drinks. Caffeine is a diuretic and can cause dehydration if not balanced with water and acidic drinks may irritate the bladder.
Schedule your toilet breaks. Keep a bladder diary and work out how often you go and try to schedule these at routine intervals during your day.
If you are experiencing urinary incontinence or other pelvic floor dysfunctions please contact our certified Women's Health Physiotherapist, Jessica Findlay for an appointment today.
1) Nonsurgical Management of Urinary Incontinence in Women: A Clinical Practice Guideline From the American College of Physicians. (2014). Annals of Internal Medicine, 161(6). doi:10.7326/p14-9034
2) Dumoulin, C., Hay-Smith, J., Habée-Séguin, G. M., & Mercier, J. (2014). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women: A short version Cochrane systematic review with meta-analysis. Neurourology and Urodynamics, 34(4), 300-308. doi:10.1002/nau.22700
3) Moreno et al. (2004) Clinical and Experimental Obstetrics and Gynecology [01 Jan 2004, 31(3):194-196]