Urinary incontinence – the involuntary loss of bladder control – is experienced by 1 in 3 women, and can often be quite embarrassing. An important note to remember is that urinary incontinence is a sign or symptom and it is not a disease in itself. It is not something that you have to live with. In fact, physiotherapy can help up to 70% of women affected.
Types of Urinary Incontinence
- Urge Incontinence – a sudden urge to urinate followed by involuntary loss of urine
- Stress Incontinence – a loss of urine on exertion. Women commonly cite coughing, sneezing, laughing, jumping, running etc as triggers.
- Mixed Incontinence – a combination of both urge and stress incontinence
What causes Urinary Incontinence?
Urinary Incontinence may be caused by a number of issues, commonly including:
Pregnancy/Childbirth – Hormonal changes during pregnancy, and also the increased pressure on the pelvic floor due to the growing fetus can lead to incontinence issues. Childbirth can also contribute to these issues, as the pressure on the pelvic floor may cause damage to the surrounding muscles and nerves. If you had an episiotomy, or suffered tears during the birthing process there may also be a weakness in the pelvic floor.
Age – As we age, the strength of the pelvic floor muscles may be reduced. Our bladder capacity also decreases, which means we may find ourselves going to the toilet more often.
Menopause – The decreased production of estrogen after menopause, a hormone that helps keep the lining of the bladder and urethra healthy, can also contribute to incontinence issues.
Weight – Being overweight may also cause urinary incontinence due to the increased pressure on the pelvic floor muscles.
Other diseases – Diabetes or other neurological conditions such as MS, Parkinsons, spinal cord injury etc. may also cause issues with bladder control.
There are also other factors which made contribute to the issue, or cause you to suffer a temporary loss of control. These may include:
Constipation – The rectum and the bladder share many of the same nerves. As such, if you suffer with constipation, the pressure on these nerves causes them to become overactive and may lead to increased urinary frequency. Straining during bowel movements can also increase pressure on the pelvic floor muscles.
Medication – Some medication including heart and blood pressure medications, sedatives, and muscle relaxants can cause increased frequency also.
Diet – Certain foods and drinks can stimulate the bladder and trigger incontinence. Common triggers include caffeine, alcohol, carbonated drinks, artificial sweeteners, chilli peppers etc.
What can Physiotherapy do?
The aim of physiotherapy is to restore control over the pelvic floor. We work to teach you correct methods of control over bladder and bowel, and provide helpful tips for managing your symptoms.
Exercise: Pelvic Floor Elevator
A nice simple exercise to start with to activate your muscles is to imagine your pelvic floor is an elevator, and to try and take the lift up and down to different floors.
- Start by lying comfortably on your back, knees slightly apart and bent, feet flat on the bed.
- Breathe in deeply through the nose and then all the way back out through your mouth.
- Let’s start by taking the lift to the first floor. As you exhale, gently tighten the back passage first, gently drawing in the lower abdominal muscles and lifting to the first floor (imagine you are trying to hold back wind or urine)
- Hold at first floor for 5 seconds initially, aiming to build up to 10 seconds. Breath normally once contracted and try not to clench your buttocks or legs
- Release the hold completely, all the way back to ground level.
- On the next exhale, try to lift to the second floor this time. Again holding for 5-10 seconds before releasing all the way back to ground level.
- Next time, try to lift to the third floor repeating as above.
- Repeat to each floor, holding each repetition up to 10 seconds.
- Remember correct breathing and releasing completely to ground level between each contraction is very important
Once you have the correct technique for pelvic floor activation, your Physiotherapist will progress the exercises to further increase strength and add functional movements. Simple exercises such as the bridge, squat, and lunge can activate your pelvic floor muscles up to 56% more than a stand alone ‘kegel’ exercise.
Tips for Managing Symptoms
- Avoid going for a ‘just in case’ pee as this can teach the bladder bad habits. We need to take control of the bladder, and gain confidence
- Practice pelvic floor contractions 2-3 times/day as described above. Try to increase the length of the hold to increase endurance. You can also incorporate strong ‘quick flicks’ at the end of the exercise until the muscles get tired.
- Drink 1.5 to 2 litres of water per day, taking small sips regularly and trying to avoid large quantities of fluid at once
- Avoid bladder stimulants such as caffeine, alcohol and acidic foods
- Avoid constipation and straining by introducing more fibre to your diet
- Using a step under your feet while sitting on the toilet can aid bowel movements
- Avoid hovering over the toilet when urinating, as the pelvic floor muscles will not be able to relax in this position
- Maintain a healthy weight to reduce the pressure on the pelvic floor
- Practice ‘The Knack’ – doing a quick pelvic floor contraction before you sneeze or cough can prevent any leaks
If you have trouble making it to the toilet in time (urge incontinence), retraining your bladder can help improve your symptoms. Urge incontinence is due to over-activity of the bladder. It sends a strong signal to the brain it wants to empty. The bladder squeezes to empty and the pelvic floor is not strong enough to resist the urge and often you can’t make it to the toilet on time.
To retrain your bladder, after feeling the urge to urinate try to hold on for a few minutes longer than you normally would. Try to follow the ‘urge curve’ as seen below in the diagram and use distraction techniques such as counting backwards in 7s, or giving yourself a small task such as replying to an email.
Trying these simple tips may give some relief from your symptoms, but if the problem persists please see a Chartered Physiotherapist with experience in Women’s Health. And remember – incontinence is not something that you have to live with forever.