Women’s Health: Incontinence Treatment & Pelvic Floor Physical Therapy
- Types of incontinence, their causes and aggravators
- Treatment options and strategies available
Incontinence is considered to be any involuntary passing of urine, stool, or gas, and it is incredibly common. According to the Canadian Urinary Bladder Survey, 16% of women aged 18-40 and 33% of women aged 41-64 report having experienced some type of incontinence. One common cause of incontinence is pelvic floor dysfunction. In women, this commonly happens during pregnancy, after childbirth, during menopause, or with advancing age. During breastfeeding and menopause, specifically, there can be changes in estrogen levels in the body. Variations in estrogen production can affect pelvic floor muscle strength, which can be associated with incontinence.
There are two main types of incontinence: stress and urge. It is possible to have mixed incontinence, in which someone has both stress and urge incontinence together. Commonly prescribed as a treatment method are Kegel exercises, made popular by Arnold Kegel, a gynecologist who taught at the Keck School of Medicine at the University of Southern California.
Why does it occur?
Typically, the pelvic floor muscles are able to withstand increased pressure within the abdominal cavity, maintaining continence by generating what we call “closure pressure.” When the pressure in the abdominal cavity is greater than the closure pressure, leakage occurs. Low estrogen levels that occur during menopause or while breastfeeding can also affect the strength of your pelvic floor muscles.
When does this commonly happen?
While running, jumping, laughing, running, lifting, coughing, sitting to standing, or other strenuous activities or movements.
Why does it occur?
Urge incontinence happens when there is a sudden strong urge to go to the washroom. This can happen anytime, whether your bladder is full or not. Sometimes the signals between the brain, bladder, and pelvic floor muscles that usually keep the urine inside the body, will get mixed up and cause dysfunction. This can be referred to as overactive bladder, and can lead to a constant urge to go to the washroom, even when the bladder isn’t full.
What can it be accompanied by?
This may be accompanied by repetitive urgency, which means frequent visits to the washroom. Often patients find there is only a small amount of urine voided, or that they don’t actually need to go at all, even though they are feeling an urge to go.
How can one treat incontinence?
Stress incontinence, urge incontinence, and frequency can all be treated with the help of a Pelvic Floor Physiotherapist. Treatment may include pelvic floor muscle retraining, education, and behavioural changes such as adjusting washroom habits and fluid intake.
Note: If you are experiencing sudden onset of increased urgency or frequency, or notice pain with urination or blood in your urine, we recommend that you see your doctor immediately before visiting your pelvic floor physiotherapist to rule out any other potential causes.
Alewijnse, D, Metsemakers, JFM, Mesters, IEPE and van den Borne, B (2003). Effectiveness of pelvic floor muscle exercise therapy supplemented with a health education program to promote long‐term adherence among women with urinary incontinence. Neurourology and Urodynamics. 22(4): 284-295.
Bo, K. (2004). Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work? International Urogynecology Journal. 15(2): 76-84.
Written by Melina Mirzaei