INCONTINENCE

Urinary incontinence is the involuntary loss of urine at an inappropriate time or place – this can vary from just a few drops every now and then to full bladder leakage.

  • Approximately 1 in 3 women have some degree of urinary incontinence.
  • In women aged 45-60 years old this number increased to 50%
  • Approximately 13% of men have urinary incontinence
  • Not all incontinence is the same! There is stress urinary incontinence and urge urinary incontinence, which are then divided into even more subcategories depending on the cause or dysfunction. 

Treatment can only be truly effective when the correct dysfunction is identified. So, if you have tried to self treat incontinence, and haven't been successful, don't despair! There's a good chance you haven't tried everything yet. And with a thorough assessment, we can come up with a treatment plan designed to address your dysfunction.

Incontinence can also refer to anal incontinence. To read more on this disorder, please see Anorectal Dysfunction.

STRESS INCONTINENCE

This is defined as "involuntary loss of urine on effort or physical exertion, or on sneezing or coughing"

  • This is the most common type of incontinence and the one most people are familiar with
  • Can be varying amounts of leakage that occur with effort ie, jump, bend, lift, run, cough
  • Associated with an outlet closure problem ie, pelvic floor weakness, urethral instability, or prolapse
  • This is NOT associated with a 'weak bladder'

The approach to treating stress incontinence is very much defined by the dysfunction leading to the incontinence; do you have a weak pelvic floor? Poor urethral closing pressure? Pelvic organ prolapse causing a loss of support to the bladder, or pressure of a prolapsed rectum on the bladder? Chronic constipation or a large cyst putting pressure on the bladder? Or have you perhaps simply lost the coordination of contracting to brace against a cough? The effectiveness in treating stress incontinence is determined by how effectively and specifically we are addressing the cause of the dysfunction.

URGE INCONTINENCE

This is "involuntary loss of urine associated with urgency"

  • There is often a strong urge to go but you don't not make it to the toilet in time
  • Also associated with frequency – needing to go more often or getting up in the night to go
  • Common triggers include - seeing the toilet, getting the key in the door or running water
  • Can be caused by a sensitive or 'overactive' bladder or by poor bladder and fluid habits

Again treatments will vary greatly depending on the presentation and cause. Frequently there are some lifestyle or behavioural changes that can have a significant effect on this symptom of urgency, sometimes there is an anatomical or structural reason contributing to or causing the urgency, and the treatments can vary greatly here too.

HOW PHYSIOTHERAPY CAN HELP!

A pelvic health physiotherapist can diagnose which type of incontinence you have and treat accordingly – 70% of women with incontinence will get significant improvements with appropriate treatment! The art is in identifying the underlying causes (or causes), and applying the right treatment options.

A full assessment of the pelvic floor can identify not only general muscle weakness, but also the co-ordination and timing ability of the muscles to contract when there is increased pressure (such as a laugh or cough). Research has shown that up to 50% of women perform a pelvic floor contraction incorrectly if they are only given verbal cues. An internal pelvic floor examination is used so the therapist can ensure a correct and effective pelvic floor contraction can be achieved, but also to look for changes to structural support which may be contributing. Following this assessment, your diagnosis will be discussed, along with a range of treatment options to see what will be most comfortable for you. An individualised pelvic floor retraining programme (if appropriate) can also be commenced.

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