Compiled by our Senior and Women's Health Physiotherapist Michelle Gall.
Stress incontinence is probably the most well-known of the pelvic floor disorders; it is defined by the International Continence Society as “involuntary loss of urine on effort or physical exertion, or on sneezing or coughing”. Many women may know it as leakage of urine when you laugh, cough, run, jump or even pick up your kids.
When you do any of these activities above there is an increase in the pressure inside your abdomen causing increased in force pressing on your bladder. To counteract the force on the bladder there needs to be enough ‘closing pressure’ at the urethra which is the exit tube from the bladder. Leakage occurs when the urethral closing pressure cannot stay high enough during increases in intra-abdominal pressure such as when you cough.
The pelvic floor muscles play a significant part in keeping the urethra closed at these times of increased pressure. It does this by providing a lifting action to the bladder and bracing the firm fascia that sits behind the urethra to keep it closed. A strong pelvic floor will cause the front of the urethra to be squeezed shut against the strong wall of pelvic floor behind it when the increased pressure hits. Imagine stepping on a hose and the hose is squeezed closed against the firm ground underneath it and the water stream is stopped. A poor functioning pelvic floor would be like standing on a hose that was sitting on a trampoline…
A full assessment of the pelvic floor can identify not only general muscle weakness (ie can you get a contraction at all), but also the co-ordination and timing ability of the muscles to contract when there is increased pressure (ie. during a cough or laugh). 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.
Following this assessment, an individualised pelvic floor retraining programme can be commenced. In the case of stress incontinence learning a technique called ‘The Knack’ is also an important component of the treatment; this is the ability to hold the contraction during times of increased pressure.
A review of relevant research in 2010 concluded that supervised pelvic floor muscle training is recommended as the first-line conservative management for urinary incontinence with many women reporting they were cured or improved and had better quality of life.
So if you have come to accept a bit of a leak when you lift your little one as just ‘one of those things that comes with having children then think again, it is very much one of those things that your physio can help with!