What is it?
Urinary incontinence is a loss of bladder control that can lead to the leakage of urine. The two types of incontinence that will be discussed in this blog are stress incontinence and urge incontinence. For a complete list of types of incontinence, follow this link.
Stress incontinence is the leakage of urine while doing activities like running, weight lifting, and even coughing. Stress incontinence is common in women, and even more common in women who have had children. However, there is a myth that leaking urine after giving birth is normal. This is not normal!
Urge incontinence occurs when you experience a sudden urge to urinate which is often difficult to control and may result in the leakage of urine. This can be stressful for many people as they rush to find the nearest bathroom.
What CAUSES IT?
Stress incontinence is often due to weakness in the muscles that control the exit of urine from the bladder. These muscles are known as the pelvic floor muscles. The pelvic floor can be thought of as a hammock that supports the bladder, rectum, and uterus (in women). For women who have been pregnant, these muscles can get stretched or injured, causing them to weaken. These weakened muscles no longer have the strength to prevent urine from exiting the bladder, resulting in leakage during exercise for example. For men, poor general health and surgery or radiation for prostate cancer are risk factors for urinary incontinence.
Urge incontinence is often due to poor bladder training. That is, the habits we develop around going to the bathroom can lead to poor control of our bladder. For example, going to the bathroom “just in case” on a regular basis, can lead to your bladder “becoming smaller”. In other words, your bladder normally has a limit to how much urine it can hold and if you are regularly going to the bathroom before that limit is reached, your body will think that its limit is actually smaller than it really is. This results in your body sending you a signal that you have to go the bathroom before your bladder has reached its true limit. Another example of urge incontinence is the “key in door effect”, or the sudden feeling of having to use the bathroom as you get to your front door. If either of these scenarios occur on a regular basis, it can lead to changes in your bladder and present as urge incontinence.
How can physiotherapy help?
In 2018, the Cochrane Review (the highest level of scientific evidence) recommended the use of physiotherapy in the form of pelvic floor muscle training (PFMT) as the first line of treatment for stress and urge urinary incontinence. They went so far as to state that they “can be confident that PFMT can cure or improve symptoms of stress urinary incontinence and all other types of urinary incontinence”.
What is pelvic floor muscle training (PFMT)?
Pelvic floor muscle training is exactly what it sounds like; strengthening the muscles of the pelvic floor. A commonly used exercise is the kegel, or the contraction of the pelvic floor. A common cue for contracting the pelvic floor is to perform the action that stops you from passing gas. While this sounds easy enough, simply doing kegels all day will not solve your incontinence. How do you know if you’re doing them correctly? How long do you hold them for? How hard should you squeeze? Is strengthening alone the only way to treat incontinence?
These are all great questions and are best answered by a Physiotherapist with advanced training in this area.
Written by: Sean Lee, Registered Physiotherapist and Pelvic Floor Physiotherapist.