Urinary Incontinence

What is urinary incontinence?

Urinary incontinence comes in a few forms: stress urinary incontinence, frequency or urge incontinence and ‘mixed incontinence.’ Stress urinary incontinence (SUI) is a leakage of urine when there has been a physical exertion like laughing, coughing, jumping or running, though it can occur at other times as well. Frequency or urge incontinence is a leakage of urine when you feel an urge to pee – imagine you’re on your way to the bathroom and you leak a bit (or a lot). Mixed incontinence is just as it sounds, a combination of the types. Interestingly, one can have urinary frequency without having any incontinence associated, where you need to pee an abnormal number of times a day (over 10 times).

What Are the Symptoms?

Symptoms of urinary incontinence can vary if there are other coexisting issues present. The main thing as that you leak urine, whether its a lot or a little, and regardless of what has caused it.

Associated symptoms can include:

leaking urine after finishing up at the toilet (also known as a post void drip)
incomplete bladder emptying
a sense of needing to pee when you’re walking or running
pelvic organ prolapse – feeling a lump or bulge in your vagina or a sense of pressure/heaviness particularly when walking or running
dysfunctional pelvic floor muscles (both weak and tight muscles can cause incontinence)
difficult bowel movements
lower back or pelvic pain
DRA – diastasis recti abdominis – stretching of the connective tissue down the centre of your belly

Is it normal?

Urinary incontinence is not a normal part of pregnancy, your postpartum recovery or the rest of your life. It is common, yes, but not normal.

55% of women over the age of 65 are incontinent
85% of women will experience incontinence in their last trimester of pregnancy
If you are incontinent 12 weeks postpartum, without treatment, you are 92% likely to still be incontinent 5 years later!

These statistics can be changed! Many women are unaware that physiotherapy can help them regain their continence.

Is it Treatable?

Absolutely. Urinary incontinence is the #1 reason someone will seek the help of a pelvic health physiotherapist. Thankfully, the evidence is there to back up the role of a physiotherapy in the treatment of incontinence, so much so that the conservative treatment a pelvic health physiotherapist can provide has been found to be more effective than surgery.

Is it Preventable?

Mostly. There are certain things that no amount of pelvic floor strengthening or activity modification can change, the effect of pregnancy on the body is one. Well-timed physiotherapy intervention performed by a specially trained pelvic health physiotherapist can absolutely optimize the strength and function of the pelvic floor and whole body system to maintain continence as much as possible as your body continues to change during the course of pregnancy. Speaking specifically about pregnancy-related incontinence, once the baby arrives the real work can begin and any associated incontinence can be prevented and treated. Unfortunately the weight and pressure of a growing baby can overpower even the strongest pelvic floor muscles!

How Physiotherapy Can Help

Pelvic Health Physiotherapists are indispensable for the treatment of incontinence. Their specialized training in both internal and external assessment and treatment techniques allows them to individualize treatment programs for each client the see. Commonly there are two phases of treatment: the first is a short-term action plan to reduce symptoms and start re-gaining function, the second is a long-term plan to maintain continence as you return to your normal activities such as running, weightlifting or anything else you want to do!

Typical treatment for incontinence includes:

Optimizing breathing strategies to reduce pressure on a weak pelvic floor
Developing a pelvic floor muscle treatment program that targets all aspects of the muscle system (flexibility, speed, endurance and strength)
Developing an exercise program to return the coordination of the core and pelvic floor muscles, which are meant to work together
Correcting any problematic movement strategies or postural habits that can negatively impact pelvic floor function
Advising on best-practices for bowel and bladder emptying
Discussing activity modification and demonstrating how to perform tasks to avoid symptoms
Assessing and treating any coexisting issues like pelvic organ prolapse, diastasis recti abdominus or back pain
Educating on how to prevent secondary issues from developing as a result of dysfunctional pelvic floor muscles
Developing a return-to-activity plan to get you back to your regular activities, symptom-free