By Shelley Prosko
Urinary incontinence is the inability to control the bladder. It is a striking fact that about 50% of women who experience incontinence do not even mention it to their physician (Burgio, 1994) perhaps because they are too embarrassed, or simply because they think it is normal to experience ‘a bit of leakage’ when they sneeze, cough, or laugh. Most women think that it is normal after pregnancy or with age. Or, that it is normal because their mom, sister, and friends experience a ‘bit of leakage’ too. But it is not normal. Yes, it is common, but not normal. More than 52% of women between the ages of 20-80 years old experience urinary incontinence at some point in their lives (Culligan & Heit, 2000). But, the good news is that urinary incontinence can be prevented and treated in most cases.
There are two main types of urinary incontinence: stress and urge.
Stress incontinence is what occurs when the pelvic floor muscles (PFM’s) have become too weak to stop the flow of urine during actions that put pressure or stress on the bladder, such as coughing, sneezing, laughing, twisting, or lifting. Pelvic floor weakness can result from the muscles being overstretched during childbirth or even from low estrogen levels, such as during menstruation or menopause.
Urge incontinence is when there is a sudden ‘urge’ to urinate with an inability to control the bladder. This happens when the pelvic floor muscles are chronically tense to the point of fatigue, and consequently give out at inappropriate times. If the PFM’s are consistently tense, without knowing how to relax, release, and control them, other problems in addition to urge incontinence can arise like low back pain, irritable bowel syndrome, interstitial cystitis, and painful intercourse.
It is important to know the difference between stress and urge incontinence, and know which one you have, in order to treat it effectively. It is also common to have a combination of the two.
There is a popular belief that Kegel exercises which consist of ‘squeezing’ the PFM’s will solve the leakage problems. However, this is not necessarily the case. If your incontinence is due to chronically tensed PFM’s that are fatiguing (urge incontinence), then simply performing Kegel exercises may actually be worsening your problem! Successful treatment for urge incontinence consists of learning how to release your PFM’s in conjunction with relaxed, diaphragmatic breathing. If your incontinence is PFM weakness due to being overstretched or inadequately activated, then correctly prescribed Kegel exercises can help. But Kegel exercises do not address all of the muscles that are important for a healthy pelvic floor. Kegels are still only a small part of the overall treatment of this dysfunction.
Treatment of stress incontinence will include how to activate, release, and control the PFM’s. PFM training with a physical therapist has been recommended for women suffering from stress urinary incontinence and for prevention of urinary incontinence during pregnancy and after delivery (Britnell, et al 2005). However, successful physiotherapy treatment protocols also include hip adductor and deep abdominal muscle strengthening, lumbar or core stability training, and prescription of exercises that address postural mal-alignment or hip tightness that may be contributing to pelvic floor weakness. Education regarding bladder irritants in the diet can also be included in your treatment plan.
Yoga and Pilates have also been shown to improve both types of incontinence due to their ability to address the above areas.
A physical therapist trained in this area will be able to help diagnose which type of incontinence you may have, and help develop an appropriate treatment plan. The treatment does not need to be invasive and usually consists of 4 to 6 visits. The assessment consists of a series of questions followed by a physical examination of hip, pelvis and abdominal strength, postural alignment, and flexibility testing.
Remember, incontinence is common, but it can be treated. You can continue to enjoy a high quality of life knowing you have confidence in controlling your bladder, whether you are a new mom, menopausal, or a retiree!
Shelly Prosko is a Registered Physiotherapist and Yoga Therapist at Sun City Physiotherapy Winfield. She can be contacted at the Winfield clinic (250.766.2544) or by email at winfield@suncityphysiotherapy.com.