Stress and urge incontinence

It is a fact that almost 50 per cent of all women experience urinary incontinence (the inability to control the bladder) at some point in their lives. Many women do not even mention it to their physician perhaps because they are too embarrassed, or simply because they think it is normal to experience ‘a bit of leakage’ when they sneeze or laugh.  Or, that it is normal after pregnancy or with age. But it is not normal.  Yes, it is common, but not normal.  Although it is less common in men, they can also experience incontinence.  Urinary incontinence can be prevented and treated in most cases.

The two main types of urinary incontinence are stress and urge.  It is important to know the difference between the two, and know which one you may have, in order to treat it accurately. However, it is common to have a combination of the two as well.

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.

Many people believe that the popular 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! Learning how to release your PFM’s in conjunction with diaphragmatic breathing would be more beneficial for someone with urge incontinence. If your incontinence is PFM weakness due to being overstretched or inactivated, then correctly prescribed Kegel exercises can help.  But this is still only a small part of the overall treatment of this dysfunction.  There are 16 muscles that make up the pelvic floor.  Kegel exercises address only a small number of these.

Treatment of incontinence may begin by learning how to activate, release, and control the PFM’s through diaphragmatic breathing training.  Successful physiotherapy treatment protocols also include hip adductor and deep abdominal muscle strengthening, lumbar or core stability training, and prescription of exercises addressing any postural mal-alignments or hip tightnesses that may be contributing to pelvic weaknesses.  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 would be able to help diagnose which type of incontinence you may have, and help develop an appropriate treatment plan.  Treatment need not be invasive and usually consists of 4 to 6 visits.  The assessment typically consists of a series of questions followed by a physical examination of postural alignment, hip, pelvis and abdominal strength and flexibility testing.  Although incontinence is common, it can be treated.  So whether you are a new mom, a retiree, male, or female, you can still continue to enjoy a healthy lifestyle knowing you have confidence in controlling your bladder!

 

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.  This topic will be presented, free of charge, at the Sun City Winfield location at 7pm on Tuesday, April 26.  Please call the clinic to reserve your spot!

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