Urinary Incontinence is the involuntary loss of urine. It is estimated that 10% of Canadians have urinary incontinence, 1 in 4 women and 1 in 9 men. Only 1 in 12 seek treatment because they are either too embarrassed or do not know that it can be treated. The 3 most common types are:
- Stress Urinary Incontinence (SUI): loss of urine due to an increase in intra-abdominal pressure such as coughing, sneezing, laughing, lifting, or exercise
- Urge Urinary incontinence (UUI): loss of urine associated with a strong, uncontrollable urge to urinate
- Mixed Urinary Incontinence (MUI): a combination of Stress and Urge Urinary Incontinence
The pelvic floor consists of several muscles that attach to the front, back, and sides of the bottom of the pelvis and sacrum. They act like a sling to support the organs above (bladder, uterus, and rectum). These muscles must be able to relax to urinate, and contract to stop the loss of urine. Weak pelvic floor muscles contribute to Stress Urinary Incontinence. When there is an increase in intra-abdominal pressure (cough/sneeze) it causes downward pressure on the bladder. If the pelvic floor is too weak to withstand the pressure it results in the involuntary loss of urine.
An over-active bladder contributes to Urge Urinary Incontinence. As your bladder fills with urine it begins to stretch. The bladder muscle (detrusor) will normally remain relaxed until the bladder is full, allowing you to hold onto the urine after the initial urge until you find a convenient time to get to the washroom. When the bladder is full the detrusor muscle will contract, as the pelvic floor muscles relax, to allow emptying of the bladder. With Urge Urinary Incontinence there is overactivity of the detrusor muscle in the bladder, causing the bladder to involuntarily contract before it is full. This will give you that sudden urge to use the toilet and may result in the loss of urine before you make it there.
Risk factors for Urinary Incontinence include being female, post-menopausal, over 40 years of age, having had more than one child, among others. Although age and childbirth are risk factors, it is NOT normal to have urinary incontinence as you age or after childbirth. Pelvic floor physiotherapy is 80% in treating urinary incontinence and should be the first line of defense, before surgical consultation. It is a misconception that nothing can be done about urinary incontinence. Pelvic Health physiotherapists have additional post-graduate training in the internal assessment and treatment of pelvic floor dysfunctions. The initial assessment starts with a subjective history to determine your present complaint, bladder and bowel symptoms, past medical history and gynecological history. This is followed by an external and internal vaginal and rectal assessment. The internal assessment is very important to determine the tone and strength of the pelvic floor musculature, to assess for areas of tension and pain, and to ensure exercises are being done properly.
An individualized treatment plan can then be devised to address any assessment findings and your goals with physiotherapy.
**Kegels are NOT always indicated for pelvic floor problems.