By Anita Vandenberg

Many of our patients have questions about urinary incontinence, as it is a problem that affects many women, particularly women who have had children. Here I answer a few common questions.

1) What is urinary incontinence?

Incontinence is a storage symptom defined as “the complaint of an involuntary loss of urine that is a social or hygienic problem”. That means any amount of urine that leaks out when you don’t want it to is incontinence. There are different types of incontinence, these are the most common:

• Stress Incontinence: The leakage of urine when you increase intra-abdominal pressure, which exerts force onto the bladder such as sneezing, coughing, lifting, or exercising.

• Urge Incontinence: The leakage of urine that happens with a sudden, uncontrollable need to urinate. Also known as an ‘overactive bladder,’ since individuals with urge incontinence may need to urinate frequently.

• Mixed Incontinence: The most common form of incontinence, which is a combination of both Stress and Urge incontinence.

2) I thought incontinence was a normal part of having children and of aging?

It is a misconception to think that it is normal to have urinary leakage after childbirth, although it is common. 50% of women at some point in their life will experience urinary incontinence and 33% will develop regular problems. 3.3 million Canadians suffer from incontinence and only 1 in 12 people seek out treatment because they are embarrassed to talk about it, or don’t know that help is available.

3) How did I develop incontinence?

It is often due to weakening or poor timing of the pelvic floor muscles. Sometimes during labour and delivery, or a pelvic surgery such as a hysterectomy, there can be damage to these muscles. Risk factors include; female, obesity, post-menopause (hormone changes), pregnancy and childbirth, having given birth to more than one child, childbirth trauma (forceps, tearing), gynaecological or urinary surgery, chronic illness, medication, smoking and chronic straining.

4) How can physiotherapy help with urinary incontinence?

Pelvic Health Physiotherapy is 80% effective for treating urinary incontinence and research shows that physiotherapy involving internal assessment and treatment should be the first line of defence for urge and stress incontinence. Pelvic Health Physiotherapists have taken specialized training to complete an internal evaluation and design a treatment program that is individualized to your needs, which may include addressing pelvic floor muscle weakness, tightness or both. Physiotherapy can save you money and embarrassment by allowing for fewer use of pads, decreasing your use of medications for incontinence and giving you the confidence to return to the activities you enjoy.

5) How would you assess my pelvic floor?

We take a detailed history by asking about your symptoms, fluid intake, any previous pregnancies/surgeries/injuries and other medical conditions. We then provide education on where your pelvic floor muscles are located and how your posture directly affects the activation of these muscles. An external exam is then conducted, which looks at your core stability including whether an abdominal separation (diastasis) is present. The next step is an internal pelvic exam involving observation, and palpation (feeling) of the soft tissue and muscles outside and inside the vagina and rectum. We assess the pelvic floor muscle's tension, strength, power and endurance, and the presence of tone or trigger points in the muscles.

6) What does Pelvic Health Physiotherapy Treatment involve?

• Education about the anatomy of the pelvic floor muscles and how they work together with three other deep core muscles (diaphragm, transversus abdominis and multifidus) to help resolve your incontinence;

• Advice about foods and drinks to avoid that may cause an irritation of the bladder;

• Advice about how to modify behaviours that may aggravate your symptoms;

• Techniques to help you find your pelvic floor muscles and to learn to use them correctly, which may include strengthening and/or releasing these muscles;

• Strategies to decrease urinary urgency and frequency.

7) I’ve never heard of internal Pelvic Health Physiotherapy-- is this area of physiotherapy new?

Pelvic Health Physiotherapy for women’s health concerns has been available for many years and is evidence-based. In 2012 physician delagation was removed and anyone can now see a Pelvic Health Physiotherapist without a referral from their MD. All physiotherapists at PhysioExcellence have been clinically trained to perform vaginal and rectal exams, to provide treatment, and have received the mandated educational requirements in Canada and are rostered with The College of Physiotherapists to perform internal assessment and treatment.

8) Why hasn't years of kegel exercises helped my incontinence?

30-50% of women are doing kegels (pelvic floor muscle training) incorrectly. Also, it is important to know that kegels are not always the answer to incontinence, even when performed correctly. Pelvic floor muscles can be tight (just like any other muscle in our body), which can cause incontinence. The only way to know if your pelvic floor is tight or weak or both, is to have an internal assessment conducted by a trained Pelvic Health Physiotherapist who can guide you through an exercise program suited to your individual needs.

9) What can I do to help myself?

Maintaining a healthy and strong pelvic floor is very important for staying in control and remaining continent for life. Some strategies to help you improve and keep your pelvic floor muscles strong and healthy are:

• Avoid constipation.  Repeated straining is similar to mini childbirth for your pelvic floor, which can cause these muscles to become weak over time;

• Drink plenty of water. Take your weight in pounds, divide by 2 then divide by 8 and this will give you the amount of water in cups (250 ml) you should drink daily. Increasing this amount by 2-4 cups is recommended if you are breastfeeding, exercising or during exposure to extreme heat. Drinking less than this amount makes your urine more concentrated and can increase certain types of incontinence and cause you to have increased frequency and urgency of urinating;

• Learn to wait until your bladder is full and train it to hold at least 350 ml of urine before going to the washroom. This means using the toilet about 6-8 times a day.  Avoid making toilet trips "just in case";

• Learn to tighten your pelvic floor muscles before you cough, sneeze or lift heavy items;

• Practice releasing (or lengthening) your pelvic floor muscles with the Core Breath from Bellies Inc. 

• Exercise your pelvic floor. Ask your Pelvic Health Physiotherapist how to do these exercises correctly. Internal exams are the gold standard for ensuring proper exercise of your pelvic floor are completed correctly.

Remember, it is never too early or too late to get your pelvic floor assessed by a physiotherapist. As Pelvic Health Physiotherapists, we not only assess and treat incontinence but also pelvic pain, pelvic organ prolapse and Diastasis Rectus Abdominis. We can also help prepare you during pregnancy for labour and delivery.