What is incontinence?
Incontinence typically refers to the involuntary loss of urine from the bladder. Fecal incontinence is also possible. This occurs when there is an involuntary loss of liquid or solid stool or the inability to control gas or flatus.
What causes incontinence?
There are five main types of incontinence:
Stress incontinence: the involuntary loss of urine in response to increased intraabdominal pressure. Often this occurs with coughing, sneezing, jumping or running.
Urge incontinence: the sudden loss of urine following a strong urge that cannot be controlled. For example, incontinence that occurs when you turn on running water or when you are approaching the toilet but cannot hold off until you disrobe and sit down.
Mixed incontinence: a mixture of both stress and urge incontinence is present.
Overflow incontinence: when a bladder that is always full, causes leakage to occur. Enlarged prostate, diabetes and spinal cord injuries can cause this type of bladder control problem.
Functional incontinence: when people have a condition that makes it hard to get to the bathroom quickly enough before leakage occurs. These people may have regular bladder control, but an alternative condition makes it difficult for them to get to the bathroom in time to empty their bladder. For example, arthritis in your fingers may make it hard to unbutton your pants in time before you lose control of your bladder.
Up to 10% of the Canadian population experience some form of incontinence. That means that approximately 3.5 million Canadians experience this at some point in their lives. 1 in 4 women are incontinent. 1 in 9 men are incontinent. However, only 1 in 12 people seek out treatment because they are embarrassed to talk about it, don’t know that help is available, or believe it is a ‘normal’ part of life.
Unfortunately, incontinence can have huge social and emotional consequences. It can lead to decreased self-esteem, depression, isolation and impeding social and physical activity.
How can Physiotherapy help my incontinence?
Often times we believe that incontinence is due to weakness of the pelvic floor muscles. More often than not people are advised to perform Kegels, or pelvic floor contractions, to help manage their incontinence. However, incontinence can be caused by many different factors, including pelvic floor muscle weakness, pelvic floor muscle hypertonicity (or increased tension in the muscles), pelvic organ prolapse(s), prostatitis, damage to pelvic floor nerves, or mobility issues affecting your ability to get to the bathroom in time.
Physiotherapy has many options to decide on how to treat your case experiences specifically. These may include, but are not limited to, exercises to address the strength and endurance of your pelvic floor and surrounding core muscles, breathing exercises, addressing postural issues that may be related to your incontinence, keeping a bladder diary, performing strengthening exercises in functional and dynamic positions and timing or scheduling trips to the bathroom.
Current literature states that pelvic floor strengthening and retraining taught by a specialized physiotherapist using internal assessment and treatment techniques should be the first line of defense against incontinence. This means that pelvic floor rehabilitation should be trialed before someone considers surgery.
What are the best exercises to help with my incontinence?
The best exercises for you will depend on the type of incontinence you experience, as well as why you are experiencing it. For example, those with a weak pelvic floor will need to focus on strengthening their pelvic floor muscles with exercises, such as Kegels. However, those who are hypertonic in their pelvic floor muscles need to learn how to relax their pelvic floor with relaxation/stretching and breathing exercises before they will likely see an improvement in their symptoms.
Once more information is known about your specific experiences with incontinence and a thorough assessment has been performed, a tailored program will be devised to help you manage and improve your incontinence symptoms.
What can I do to treat my incontinence at home?
Once it is determined the type and reason for your incontinence, there are many things you can do to treat the incontinence at home. Below are just two examples of typical home programs we will prescribe for people experiencing incontinence.
If you have weak pelvic floor muscles, focusing on strengthening and improving the coordination of the muscles will be your primary focus. This will include strengthening your pelvic floor muscles, surrounding core muscles and gluteus muscles. It will also be important to be working on the endurance and quick contractions of the pelvic floor muscles.
If you have a hypertonic or tight pelvic floor, focusing on stretch/relaxing your pelvic floor muscles will be the primary focus. This will include not performing Kegel exercises, but rather focusing on diaphragmatic breathing and hip and pelvic floor muscle stretching
To get you started, check out the following exercise link:
Please keep in mind that these exercises were designed as a place to start to address your symptoms. These exercises should not be performed or continued if they cause or increase your pain in any way. Using these exercises for self-management of your symptoms does not replace the value of being assessed by a Health Professional. If you find you need help, let a Strive Pelvic Health Rehabilitation Physiotherapist help you, book your time today!
BPHE, BSc, MScPT
Pelvic Health Rehabilitation
Stephanie has curated a Physiotherapy tool box that allows her multiple points of view to meet her patients’ needs. She has taken courses in the McKenzie Method for assessing and treating spinal conditions. She has completed mat and reformer Rehabilitative Pilates courses through Stott Pilates, training she uses to create customized exercise programs. Understanding the roll of the pelvic floor in the effective treatment of low back pain, sacroiliac joint dysfunction, bowel and bladder dysfunction and during a women’s journey from pre-natal to post-natal, she has completed Pelvic Health Rehabilitation courses. She is qualified to perform internal assessment and treatment of the pelvic floor.