Urinary incontinence is any involuntary leakage of urine, no matter how small, and can be divided into different categories. The most common types are:
- stress
- urge
- mixed
Stress incontinence is defined as leakage of urine, usually small amounts, when abdominal pressure is increased. This includes things such as leaking when coughing, sneezing, laughing, changing positions, lifting, or jumping. Urge incontinence is loss of urine, either large or small amounts, after a strong and sudden need to void. In these instances, people often struggle to delay voiding and the urge may come quickly and often. Mixed incontinence is a combination of both stress and urge incontinence.
The most important thing to note about all three of these types of incontinence is that it’s not “normal” and you don’t have to live with it. Pelvic Health Physical Therapy has been extensively researched and has been proven very effective in reducing and/or eliminating incontinence. What does this mean?…we can help you!
Pelvic Health Physical Therapists have advanced training in assessing and treating the muscles, nerves, and joints of the pelvic region. Many people believe they just need to perform Kegels. The problem with this, is that Kegels may or may not be appropriate and if they are, there is a strong likelihood they are being preformed wrong. A Pelvic Health Physical Therapist can, and should always, perform an internal evaluation (vaginal and/or rectal). This is the only way to access and assess the pelvic floor musculature. If this exam is not done, they cannot give you accurate information as to the function of the pelvic region.
Each client is unique and has different needs, but here are some general tips and tricks to try if you’re experiencing these issues:
- Address any constipation issues. Straining from constipation is incredibly hard on pelvic floor function. It encourages these muscles to work in a suboptimal way, can negatively influence the natural reflex loops, and may even cause structural damage to the nerves or muscles. When you get the urge for a bowel movement, do not put it off! Unlike urination, this urge will go away and constipation will worsen. General tips to ease constipation include: drinking plenty of water, slowly increasing fibre intake, and getting plenty of exercise (at least a half hour walk daily).
- Eliminate any bladder irritants. Both urge and mixed incontinence can be worsened by substances that irritate the bladder. Attempt to decrease or eliminate smoking, caffeinated or carbonated beverages, spicy foods, tomato based products, artificial sweeteners, food colourings, and artificial flavours. People with bladder control issues often try to manage by cutting back on fluid intake. They often assume if they drink less, they will have to pee less— don’t do it! By limiting water intake, the urine will actually become more concentrated which will irritate the bladder and will actually worsen incontinence.
- Urinate only when you truly need to; avoid “just in case” pees. By voiding before the bladder actually needs to, you are training the muscle of the bladder and the reflexes associated with it, that it is normal to go before the bladder is full. This will lead to the urge to go more often, and in turn, increase the risk of incontinence.
- Keep active! Often people will begin to limit their exercise due to leakage. Over time this will actually weaken muscles and worsen the effects of incontinence, as well as having a detrimental effect on your overall health.
- Have a proper, internal, pelvic floor assessment. We can’t stress this enough. Often, clients will have tight, short muscles throughout all or part of their pelvic floors. These muscles must be identified and lengthened prior to beginning to strengthen. When beginning Kegels, it is very important for an internal examination to ensure that they are being performed properly. Research proves that simple verbal or written instructions do not constitute adequate training for a Kegel exercise program (Bump et al, 1991). Even the Society of Obstetricians and Gynecologists of Canada recommends that proper performance of Kegel exercises should be confirmed by digital vaginal examination. Meaning, internal examination is the only way to teach, ensure understanding, and give feedback to clients about their pelvic floor muscle activation.
Pelvic floor muscle retraining is considered the first-line treatment for stress and mixed incontinence in women (Level 1, Grade A evidence)(2009 ICS Conference)(Cochrane Collaboration 2014) and now it is available right here in Swift Current with STRIDE physical therapists! I don’t know about you, but I would jump on that — and you will be able to jump (without peeing), when you’re done!
References:
Bump, R.C., Hurt, W.G., et al. (1991) Assessment of Kegel Pelvic Muscle Exercise Performance after Brief Verbal Instruction. American Journal of Obstetrics Gynecology, 165, 322-329.
Dumoulin C, Hay-Smith EC, Mac Habée-Séguin G. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews 2014, Issue 5. Art. No.: CD005654. DOI: 10.1002/14651858.CD005654.pub3
Pelvichealthsolutionsca. (2016). Pelvic Health Solutions. Retrieved 14 October, 2016, from http://pelvichealthsolutions.ca