Bladder Problems – Urinary Incontinence
Urinary incontinence is the unwanted loss of urine at the wrong time or the wrong place. It can be just a few drops or enough to run down your legs or wet the floor.
There are many myths surrounding urinary incontinence – such as it’s an inevitable part of aging, or to be expected after childbirth. However, urinary incontinence can affect anyone of any age, of either sex. It’s estimated to affect 1 in 4 women at some point in their lives, 1 in 10 men and 1 in 5 seniors.
Stress Incontinence: This is the most common type of urinary incontinence. It is a loss of small to moderate amounts of urine with exertion – with coughing, sneezing, jumping, running, laughing, changing position etc Often this is due to weakness of the pelvic floor muscles, in women following childbirth or after the menopause, with men it is a common problem after prostate surgery.
Urge Incontinence: This is a loss of urine (sometimes large amounts), following an urgent need to empty the bladder. The urge can be extremely strong and impossible to ignore. People suffering from urge incontinence often need to go to the washroom very frequently during the day and sometimes frequently at night too. They will typically plan their days around finding the next washroom.
Overflow Incontinence: A loss of urine due to over-filling of the bladder because the bladder is unable to empty properly. The bladder may be unable to empty because of an obstruction (e.g. enlarged prostate, scar tissue, constipation), or because the bladder muscle can’t work effectively enough to squeeze the urine out. There may be difficulty starting the flow, a weak stream, straining to empty, or a constant dribble.
Functional Incontinence: A loss of urine due to physical problems preventing the person from reaching the washroom in time.
Mixed Incontinence: A combination of stress and urge incontinence.
PHYSIOTHERAPY TREATMENT OF INCONTINENCE
Physiotherapy is always carried out in a private treatment room, always with the same Physiotherapist, providing sensitive, professional treatment. It starts with a thorough assessment. You will be asked detailed questions about your bladder control, your medical and surgical history, pregnancies and births, your diet and lifestyle. A physical examination will then follow, which may include looking at your posture, back, abdominal muscles and likely an internal examination.
Once the examination is complete, a discussion follows, explaining the findings and exploring treatment options. It is a good opportunity for you to ask questions to gain a better understanding of your problems.
The goal of Physiotherapy is to teach you to regain control of your bladder. Treatment will always involve a lot of education, to teach you simple measures which can make a big impact on your bladder control.
Treatment is often focused around the pelvic floor muscles – the sling of muscles which help to support and control the bladder. You will be taught how to identify them, how to tighten them (Kegel exercises) and how to use them functionally to help keep you dry.
Computerized biofeedback is a very useful tool in teaching pelvic floor muscle awareness. Through the use of carefully placed electrodes, you are able to see, on a computer screen, the effect of tightening your pelvic floor muscles. Being able to see when the muscles are working effectively teaches you how to control muscles that you may previously have been unaware of.
Other techniques may include bladder retraining, posture re-education, exercises for the abdominals and other ‘core’ muscles. A home exercise program will always be an important part of your treatment.
Sometimes there may be a combination of bladder problems and pelvic pain, for instance with interstitial cystitis, or if there is some scarring in the vagina or pelvic floor muscles following childbirth. Treatment will then focus on both the bladder problems and the pain (see chronic pelvic pain for more information).
Throughout treatment you are given support and encouragement as you begin to learn and use new techniques to gain control of your bladder.
Caroline Allen P.T.
Registered Physiotherapist