Urinary incontinence is a common problem that affects both men and women, though it is more common in women.

It is estimated that 10-30 per cent of all women experience incontinence at some point in their lives. It can be a distressing and embarrassing condition that affects many aspects of your life: work, social activities, recreation, travel and intimacy. Whatever the cause, incontinence is often successfully treated with physiotherapy.

What is incontinence?

Urinary incontinence means any involuntary loss of urine. According to the Canadian Continence Foundation, 1.5 million Canadians suffer from incontinence. There are three different types of incontinence:

• Stress Incontinence, the most common, occurs when urine leaks from the bladder when pressure is applied to it suddenly. Activities such as coughing, sneezing, running or sexual intercourse can put pressure on the pelvic floor muscles, which may also be stressed by obesity and constipation;
• Urge Incontinence, is the inability to control urine leaking from the bladder when the ‘urge’ to urinate occurs; and
• Mixed Incontinence, which occurs when Stress and Urge Incontinence appear at the same time or in different circumstances.

Physiotherapy can help

Urinary incontinence in women usually occurs at two times in a woman’s life – at childbirth and then again at menopause. At child birth there may be overstretching or trauma to the floor. At menopause, the pelvic floor muscles change and may weaken. As women age, it is important to keep the pelvic floor muscles strong.

It is important for women, and men of all ages, to maintain pelvic floor muscle strength. Exercises for the pelvic floor, prescribed by a physiotherapist with training in this area, have numerous benefits including maintaining continence, helping the bladder to hold on after getting the urge to urinate, and increased satisfaction in sexual relationships.

Physiotherapy sessions may involve muscle re-education, bladder retraining and strengthening of the pelvic floor muscles. If the muscles are very weak, a physiotherapist may also use EMG/biofeedback or electrical stimulation of the pelvic floor muscles.

Pelvic floor exercises

A pelvic floor exercise routine helps to minimize the effects of menopause on pelvic support and bladder control. A physiotherapist can teach strengthening of the pelvic floor muscles, which can help to reverse the process. They will evaluate the strength of the pelvic floor muscles, severity of the incontinence, identify treatment goals, and make sure the client understands the treatment process.

The following two exercises are recommended by physiotherapists to strengthen your pelvic floor muscles. In both exercises, the muscles that give you the feeling of holding urine are tightened. Aim to do these exercises at least three times a day, and try to feel a lifting or “pulling-up” into the body while you do them.

• Tighten as quickly and strongly as you can, then release. It will take about a second to pull up and maybe two-to-three seconds to release. Work up to 30 in a row.
• Tighten up, hold on and continue to pull up. Work up to 10 sets of 10-second holds. These are easiest to do sitting or lying down, but you can progress to doing them while standing or walking. It is important to progress them to functional use.

These exercises can be done during daily activities, such as sitting in a meeting, while stopped in your car at a traffic light or when talking on the phone – no one will notice that you’re doing them.

Lifestyle changes

Physiotherapists may also make recommendations for lifestyle changes that will help the bladder be less irritable, such as:

• Bracing the pelvic floor muscles before you cough, laugh or sneeze;
• Avoiding common bladder irritants, such as caffeine, alcohol and cigarettes;
• Keeping a bladder diary to promote normal urinating habits;
• Lifting and moving correctly;
• Dietary management;
• Exercising correctly and avoiding improper sit-up techniques; and
• Postural and lower abdominal re-education.

The Canadian Physiotherapy Association (CPA) represents physiotherapists, physiotherapist assistants and physiotherapist students across Canada. CPA members are rehabilitation professionals dedicated to the health, mobility and fitness of Canadians.

Physiotherapists are primary health care professionals who combine their in-depth knowledge of the body and how it works with specialized hands-on clinical skills to assess, diagnose and treat symptoms of illness, injury or disability.

More than 20,000 registered physiotherapists work in Canada, in private clinics, general and rehabilitation hospitals, community health centres, residential care and assisted-living facilities, home visit agencies, workplaces, and schools.

The CPA presents its educational references as a public service and for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The opinions expressed do not necessarily represent the opinions of the CPA membership.