Incontinence explained

Authored by Sue Lin Kalisch.

Anybody can experience incontinence, not just women who’ve given birth, and Incontinence has a range of symptoms which fall under the description of this condition, so many people may not even realise that they have an identifiable, and treatable condition. From getting up several times a night to go to the toilet, to leakage during weightlifting, that feeling that you’re not going to be able to hold your bladder as soon as you get home, to dribbling small amounts of urine after you’ve finished going to the toilet. These are all forms of incontinence, and can all be helped through Physiotherapy sessions with a specially trained expert.

Stress Urinary Incontinence (SUI) occurs when the bladder leaks small amounts of urine in response to increased abdominal pressure eg. Coughing, Sneezing, lifting, exercising, laughing. It commonly occurs in women after childbirth, men who’ve had prostate surgery, those with chronic cough due to illness, people with constipation, and those who are overweight. Essentially, the pelvic floor muscles are weakened, in most cases due to being stretched, and do not have the strength to keep the bladder neck lifted to prevent leakage.

Urge Urinary Incontinence (UUI)  is the sudden, and strong urge to urinate. It is often due to an overactive bladder. With normal bladder mechanics, the bladder muscle (detrusor) remains relaxed as the bladder starts to fill, and starting to stretch at about the halfway point. Normally, the body recognises this stretch reflex, but can continue to ‘hold on’ for a while.

In an overactive bladder, the stretch reflex comes on much earlier meaning that the bladder feels much more full than it actually is, and the contraction from the stretch reflex will cause you to really need to go, or even leak urine. This early stretch reflex will mean that you are voiding much smaller amounts, more frequently, this is turn can lead to a habit of ‘just in case’ toileting, which unfortunately serves to make the bladder more overactive. Many people with UUI with also experience Nocturia, or having to get up several times per night to urinate.

Urinary Retention, or Incomplete bladder emptying, often causes dribbling or leakage after going to the toilet, or in the early stages might be identified as ‘double voiding’. This is when a person goes to the toilet, but straight away feels that they need to empty their bladder again, without necessarily leaking.

The main causes of this can include an enlarged prostate, pelvic organ prolapse, neurological disease interfering with the messages to and from the bladder, and pelvic floor muscle dysfunction. Signs that your bladder may not be emptying completely include straining to urinate, or a poor stream, frequent UTI’s or cystitis, leakage at night, double voiding, and post toileting dribble, or dribble with position change.

All of these problems can be helped through assessment and treatment with a Physiotherapist who has the appropriate training in Women’s and men’s Health, and Continence. The treatment will differ for each client based on their specific needs, type, and severity of the problem.

Contrary to popular belief, you can’t just just prescribe ‘Kegel Exercises’ to fix Pelvic Floor Problems. Each client needs to have their symptoms and history taken, then an assessment of their bladder, and pelvic floor muscle function performed, usually with Real Time Ultrasound, to determine whether their problem stems from weakness, overactivity, over stretching, or a combination of these problems. From there, each client is given specific exercises to do, with individual goals and training targets based on their specific problems. This may involve relaxation exercises, strength training, endurance training, and stretching. Just like a gym rehab program, a pelvic floor exercise program is tailored to each individual’s needs for the best results.

Less commonly recognised is Functional Incontinence. This is where the individual may experience intellectual, physical, or environmental challenges which cause incontinence episodes for a person who has normal bladder function.

This includes;

  • Problems with walking, due to disease or physical disability
  • Struggling with clothing, aids, or appliances eg. removing a leg brace
  • Inability to access a toilet due to location, lack of accessible features such as hand rails, ramps, or absence of facilities
  • Language or communication difficulties eg. foreign language speaker, non verbal client
  • Problems with memory, or processing eg. dementia

Often this group of people with require a multidisciplinary approach, so working with Occupational Therapists, Care Givers, and other parties involved in their care is a must.

If you, or somebody close to you is experiencing any of these problems, help is available. Don’t be embarrassed, book an assessment with our Women’s Health trained Physiotherapist today, to start gaining control of this potentially disabling condition.

Sue Lin Kalisch

Senior Pilates Physiotherapist

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