Urinary incontinence — loss of bladder control — is a condition that affects up to 50% of women during their lifetime. The prevalence of urinary incontinence increases with age, and physical, social, and psychological well-being can be negatively affected. It can be extremely embarrassing for those who experience it. Therefore, many women (25-61%) avoid seeking help. Many women also believe it is a normal consequence of aging or delivering babies and do not discuss their symptoms with their care teams.

Pelvic health physiotherapists are experts in the treatment of these pelvic floor symptoms. They undergo extensive post-graduate training to help manage this personal, often complex, and emotional issue. 

What Are the Different Types of Bladder Leakage?

The two most common types of urinary incontinence are stress incontinence and urge incontinence, or a mixture of the two — mixed incontinence.

Stress incontinence is the involuntary loss of urine with increases in physical exertion such as cough, sneezing, laughing, and exercise (jumping, weights, running). Pressure increases within the tummy (intra-abdominal pressure) cause “stress” or pressure on the bladder, neck of the bladder, and pelvic floor muscles. A weakened continence mechanism can cause loss of urine. Many women with this type of incontinence will reduce exercise, unfortunately adopting a less active lifestyle which can further compound the issue.

Urge incontinence is the involuntary loss of urine with high urges to urinate that cannot be delayed or postponed. For example, leaking en route to the bathroom or with triggers such as running water and turning the key in the door (triggers can differ for everyone). This type of incontinence poses severe distress to those who experience it, as it can impose many restrictions on their lifestyle. Many women will practice toilet mapping to avoid embarrassment and limit their social life due to fear of leaking.

This type of incontinence is usually caused when the bladder squeezes or contracts at the wrong times, which can occur irrespective of how much urine is in the bladder.

There are also other types of urinary incontinence, such as overflow incontinence and functional incontinence. Overflow incontinence refers to constant or frequent dribbling of urine. Functional incontinence refers to leakage due to a physical or mental impairment that prevents you from getting to the toilet on time.

Risk factors include age, obesity, family history, menopausal symptoms, and medical conditions, such as diabetes or multiple sclerosis, as well as smoking and urogenital microbiome.

How Can Physiotherapy Help?

Firstly, what does the research say? A Cochrane review (the highest form of scientific evidence) in 2018 recommended physiotherapy, in the form of individualised pelvic floor muscle training, as first-line treatment for incontinence. The International Incontinence Society also recommended pelvic floor muscle training (under the supervision of a pelvic health physiotherapist) for at least three months as first-line treatment for urinary incontinence with proven positive results (level 1 evidence).

What Are the Pelvic Floor Muscles, and How Are They Trained?

The pelvic floor muscles are a sling or group of muscles that span the whole base of your pelvis, attaching from your pubic bone to your tailbone and both sitting bones. They wrap around your orifices — anus, urethra, and vagina and act like a sling or a hammock supporting your pelvic organs (bladder, bowel, and uterus). They have a crucial role in supporting the bladder and maintaining continence. 

Pelvic floor muscle training will involve an initial assessment of the muscles for strength, endurance, coordination, and relaxation. Based on this, an individualised program is provided to work on any deficits in strength, tone and coordination. There are also in-home pelvic floor training devices that we may recommend if suitable. These are in the form of an intra-vaginal device that can provide feedback on pelvic floor muscle contraction or can stimulate the muscle itself to contract. The research is limited on their efficacy, but there is some promising evidence of improvement in women with mild to moderate incontinence.

What Other Physiotherapy Treatment Is Involved?

In addition to pelvic floor muscle training, a complete assessment of the whole female body is performed with an analysis of symptomatic movements. This way, muscle imbalances within the hips, pelvis, and abdominal muscles can be addressed with specific exercises. There are lots of treatment strategies that are available to combat leaking with particular movements.

For example, if a box jump causes symptoms at a certain point, we can try techniques like varying breath, step width, and height of the box or only working on jumping down initially, to name a few. My treatment approach is to empower women to manage and improve their condition. While some activities may need to be altered and scaled back initially, if your goal is to box jump without leaking, that is what we work towards in every session.

Other non-surgical options are intra-vaginal pessaries. These are silicone-based devices that come in different shapes and can be inserted/fitted by a trained medical health professional. Pessaries can support the bladder neck and help maintain continence. We also may recommend over-the-counter options such as an incontinence tampon that can be used for 12 hours, or a reusable pessary that can be used during certain symptomatic activities. 

Furthermore, depending on the symptoms described, we can provide bladder training and lifestyle advice. Addressing any issues with the bowels, especially constipation, is a must, as constipation can exacerbate incontinence symptoms.

We also refer you to the necessary professionals that may help — a urologist, family practitioner, OBGYN, or psychologist, if required to address any underlying issues that may be causing or impacting urinary incontinence. Medical treatment — medication, surgery, and other treatments may be necessary if conservative treatment does not provide symptomatic relief. However, studies have shown that pelvic floor physiotherapy has a success rate of up to 75% in women experiencing urinary leakage.

There is so much help available if you are living with urinary leakage. Let us break the taboo and begin talking about these symptoms openly and candidly!

Neasa Barry is a Pelvic Health Physiotherapist at Heal Hub Rehabilitation CentreVisit @herphysio and @healhub_rehab for more details.

This article is for informational purposes only. It is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. To the extent that this article features the advice of physicians or medical practitioners, the views expressed are the views of the cited expert and do not necessarily represent the views of The Gaggler.