WHAT IS URINARY INCONTINENCE?

The loss of bladder control leading to urine leakage.


MYTH BUSTERS:

1.  It is normal to have urinary incontinence after childbirth

FALSE – although it is common (your pelvic floor has just endured a lot during pregnancy and birth) it is not normal…it is a sign that you need to do some work to improve the function of your pelvic floor

2.  It is normal to have urinary incontinence as you age

FALSE – although it becomes more common as we age, it is not normal. As we get older we start to lose muscle mass and strength. Your pelvic floor is not an exception. We all know how important it is to stay active as we age to stay healthy and keep our muscles strong. Your pelvic floor muscles also need some love and attention to keep doing their job but we generally don’t think about this area when we think about exercise.

3.  There is nothing you can do about it once you start to experience urinary incontinence

FALSE – Pelvic Health Physiotherapists are here to help! They are specialized medical professionals who treat and assess the pelvic floor muscles. Read more below!


DID YOU KNOW….

  • 3.5 Million Canadians have Urinary Incontinence (1 in 4 women and 1 in 9 men)
  • 50% of women at some point in their life will experience some urinary incontinence
  • 33% of these women will develop regular problems
  • 50% of nursing home residents are incontinent and this is often one of the factors that leads to their admission to care in the first place
  • The cost associated with bladder problems is staggering….the estimated direct and indirect costs associated with urinary incontinence in Canada in 2014 was over $5 billion per year
  • An average individual suffering with urinary incontinence spends $1400- $2000/year on incontinence supplies alone

incontinence padsAs so many people experience urinary incontinence at some stage in their lives this has become a huge money making industry for some companies. Many have tried to capitalize on this by selling products to “help” you with this problem. You have probably seen the commercials on TV and ads in the paper or magazines for incontinence pads or medications. You have likely noticed these products stocked on the shelves at your local drug store or grocery store. There is a huge market for these products because such a significant proportion of our population suffers with incontinence. However, what these companies don’t want you to know is that this problem is completely treatable meaning you don’t need to rely on these products.

The FIRST LINE OF DEFENSE for management and treatment of urinary incontinence is Pelvic Floor Physiotherapy. However, as this problem can be an embarrassing thing to discuss with your friends, family or even doctors, many people don’t know there is anything they can do about it or that there are medical practitioners who specialize in its treatment. This is why so many people end up suffering with this and spending an exorbitant amount of money buying incontinence related products and dealing with this issue the rest of their lives. We are here to tell you that you can get control of these symptoms with a little bit of education and some simple exercises. We are here to help!


TYPES OF INCONTINENCE

There are many different forms of incontinence and different reasons for each of them. The most common types are:

1. Urge Urinary Incontinence – this is when you feel a strong urge to pee and lose control before you are able to get to the washroom. This can be a small or large loss of urine but is more often than not, a larger loss.

2. Stress Urinary Incontinence – This is a loss of urine due to an increase load/pressure (i.e. a loss of urine when you sneeze, cough, jump or lift). This loss is usually a small amount of urine. However, just because the loss is small doesn’t mean the problem is small or that you shouldn’t be working to correct it. It is a sign of your system not working to its full capacity. All too often we hear from our patients “yes I leak a little but it is just a really small amount so it isn’t a big deal”. Even though it may not be a huge bother to you at this stage not addressing it may lead to bigger problems down the road so it’s ideal to correct it when the problem is small.

3. Mixed Incontinence – Urine loss associated with Stress (increased pressure to the system) AND Urge. You can have both different forms at the same time it doesn’t just have to be one.

 

IT’S NOT ALL ABOUT STRENGTH!

Another common misconception is that if you suffer with incontinence, you always have to strengthen your pelvic floor. All too often the individuals who do muster the courage to bring this up with a medical professional are advised to simply do some pelvic floor strengthening exercises or Kegels. Just this general advice, without being assessed or any further questions!

Often patients are not shown how to do these properly; they are not checked that they have been performing them correctly or provided with proper dosing (repetitions and sets). Imagine seeing a personal trainer, and without checking your strength or if you are able to perform the exercise properly, they point to a machine and tell you to use it without any further guidance? This would not happen as it would be unsafe and you would feel at a loss of what to be doing. So why is this acceptable when providing an exercise to the pelvic floor?

These muscles do play a sphincteric role (tightens to close an opening), so their strength and ability to contract quickly when needed is important for continence. However, it’s LESS about strength and MORE about control. You can have a strong pelvic floor but still have incontinence. Some types of incontinence have more to do with overactive muscles then weak ones (sometimes seen with urge incontinence). If this is the reason for your incontinence, then strengthening or trying to contract your pelvic muscles to make it to the washroom might have the opposite effect you want it to. This is why having a thorough assessment completed is important and will determine how successful your are in managing your symptoms.


WHAT DOES A PELVIC HEALTH ASSESSMENT INVOLVE?

*  A specialized physiotherapist will take a detailed history and help you complete outcome measures to fully understand your symptoms
*  A physical exam where the therapist will look at different areas that can affect your pelvic floor muscles and function. This may include a postural assessment, screening of the low back and hips, looking at your core strength/function and of course an assessment of your pelvic floor
*  As most of your pelvic floor muscles are internal (inside your pelvis) an internal exam is needed to truly assess these muscles. This will involve a therapist palpating these muscles digitally (with their finger) to feel for tension/pain and also to assess their strength
*  Once the therapist has a thorough understanding of your presenting problems and has been able to determine the strength and ability of your pelvic floor to relax, they educate you on what you need to be doing to start to get control of your symptoms. This will involve some individualized exercises and techniques for you to start implementing at home and a plan of care going forward as needed.


Some Ways Pelvic Health Physiotherapists might help you to gain control over your bladder:

  • Bladder diaries/bladder retraining
  • Strengthening exercises
  • Relaxation techniques
  • Manual therapy (hands on treatment) to help stretch/relax overactive muscles
  • Education/advice on behavioural modifications such as: intake of bladder irritants/water, toileting habits
  • Delay tactics to help get you to the washroom without urine loss
  • Acupuncture

 

** what strategies are used will depend on the assessment as not all of these will be appropriate for everyone. This is why an internal assessment is important to create an individualized treatment plan

If you are experiencing any of the symptoms discussed above please reach out and book an assessment with a Pelvic Health Physiotherapist. We are here to help.
You can regain control over your bladder symptoms!
Click here to learn more about our Pelvic Health Physiotherapy Program.

 

References:

1. Incontinence: A Canadian Perspective (The Canadian Continence Foundation)
2. Canadian urinary bladder survey 2003
3. Hunskaar, S. Epidemiology and Natural HIstory of Urinary Incontinence. Int Urogynecol J Pelvic Floor Dysfunction. 2000; 11(5): 301-19