Incontinence

IS YOUR BLADDER RUNNING YOUR LIFE?

Urinary incontinence is a common problem that affects both men and women, though it is more common in women. It is estimated that 10-30 per cent of all women experience incontinence at some point in their lives. It can be a distressing and embarrassing condition that affects many aspects of your life: work, social activities, recreation, travel and intimacy. Whatever the cause, incontinence is often successfully treated with physiotherapy.

What Is Incontinence?

Urinary incontinence means any involuntary loss of urine. According to the Canadian Continence Foundation, 1.5 million Canadians are incontinent.

There are three different types of incontinence:

  • Stress Incontinence, the most common, occurs when urine leaks from the bladder when pressure is applied to it suddenly. Activities such as coughing, sneezing, running or sexual intercourse can put pressure on the pelvic floor muscles, which may also be stressed by obesity and constipation;
  • Urge Incontinence, is the inability to control urine leaking from the bladder when the ‘urge’ to urinate occurs; and
  • Mixed Incontinence, which occurs when Stress and Urge Incontinence appear at the same time or in different circumstances.

How Can Physiotherapy Help?

It’s important for men and women of all ages to maintain pelvic floor muscle strength. Exercises for the pelvic floor, prescribed by a physiotherapist with training in this area, have numerous benefits including maintaining continence, helping the bladder to hold on after getting the urge to urinate, and increased satisfaction in sexual relationships. A physiotherapist will design an exercise program for the individuals’ specific problem, involving muscle re-education, bladder retraining and strengthening of the pelvic floor muscles. If the muscles are very weak, a physiotherapist may also use EMG/biofeedback or electrical stimulation of the pelvic floor muscles

Urinary incontinence in women usually occurs at two times in a woman’s life – at childbirth and then again at menopause. At child birth there may be overstretching or trauma to the floor.

At menopause, the pelvic floor muscles change and may weaken. As women age, it is important to keep the pelvic floor muscles strong. A pelvic floor exercise routine helps to minimize the effects of menopause on pelvic support
and bladder control.

A physiotherapist can teach strengthening of the pelvic floor muscles, which can help to reverse the process. They will evaluate the strength of the pelvic floor muscles, severity of the incontinence, identify treatment goals, and make sure the client understands the treatment process. Physiotherapists may also make recommendations for lifestyle changes that will help the bladder be less irritable, such as:

  • Bracing the pelvic floor muscles before you cough, laugh or sneeze;
  • Avoiding common bladder irritants, such as caffeine, alcohol and cigarettes;
  • Keeping a bladder diary to promote normal urinating habits;
  • Lifting and moving correctly;
  • Dietary management;
  • Exercising correctly and avoiding improper sit-up techniques; and
  • Postural and lower abdominal re-education.

The following two exercises are recommended by physiotherapists to strengthen your pelvic floor muscles. In both exercises, the muscle that gives a feeling of holding urine are tightened. Aim to do these at least three times a day and try to feel a lifting or “pulling-up” into the body as you do them.

  • Tighten as quickly and strongly as you can, then release. It’ll take about a second to pull up and maybe two-to-three seconds to release. Work up to 30 in a row.
  • Tighten up, hold on and continue to pull up. Work up to 10 sets of 10-second holds. These are easiest to do sitting or lying down, but you can progress to doing them while standing or walking. It is important to progress them to functional use.

These exercises can be done during daily activities, such as sitting in a meeting, while stopped in your car at a traffic light or when talking on the phone – no one will notice that you’re doing them.

How do I find a physiotherapist?

Finding a physiotherapist may vary from province to province. Here are some suggestions:

  • Check the yellow pages of your local telephone book for listings of physiotherapists and physiotherapy clinics. You can make an appointment with a physiotherapist directly anywhere in Canada.
  • Ask for a recommendation from your family doctor. While a direct referral is not necessary, your physician may be able to suggest a physiotherapist for your particular concern. Further, while many physiotherapy services are covered by provincial health care plans, Workers Compensation plans and private insurance, some insurance plans require a doctor’s referral for reimbursement.
  • Visit the web site of the Canadian Physiotherapy Association at www.physiotherapy.ca to access our “Find A Physiotherapist” directory and to find out more information about physiotherapy. The CPA web site can also link you to resources for finding physiotherapists through provincial association branches and regulatory colleges.