Urinary incontinence — the loss of bladder control — is a common and often embarrassing problem. The severity can range from occasionally leaking urine when you cough or sneeze to having an urge to urinate that's so sudden and strong you don't get to a toilet in time.
Statistics show that between 10-30% of women between the ages of 20-55 have experienced urinary incontinence and 1 in 5 women over the age of 45 suffer from urinary incontinence, but only 1 in 12 are known to health care workers.
Pelvic Floor Exercise
People are frequently advised to do Kegal or pelvic floor strengthening exercises when symptoms occur. These exercises are effective when done properly, but the location of the muscles makes it difficult for us to judge on our own if we are doing the exercises correctly. The exercises may not be as effective, despite best efforts, for several reasons including:
The pelvic floor muscles may be too tight. Muscles, to activate or contract optimally need to be relaxed and at a good length.
If we participate in pelvic floor strengthening exercises or Kegels with a tight, non-relaxed pelvic floor or participate in the exercises incorrectly, the muscles may become even tighter. This can lead to more issues with leakage as well as the development of pain.
Activation and symmetry issue
The muscles are not being activated at all, or only some of the muscles are contracting while the others are underperforming or not activating at all, despite best efforts.
This can occur because of a tear or an episiotomy or even as a result of hip, low back and/or dysfunction of the pelvis whether it is due to tightness or weakness. This lends itself to asymmetrical activation.
Participating in pelvic floor exercises in this situation often strengthens the already strong muscles promoting further asymmetry and potentially further dysfunction.
Timing and/or sequencing issue
Leakage may be due to a timing issue, not necessarily a strength issue. The pelvic floor muscles may not be activating quickly enough or in proper sequence with the other core muscles to balance the change in intra-abdominal pressure that occurs with activities such as coughing, sneezing, laughing, heavy lifting or jumping.
Participation in Kegels alone often does not address this issue.
Types of Urinary Incontinence
Urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy.
You have a sudden, intense urge to urinate followed by an involuntary loss of urine. You may need to urinate often, including throughout the night. Urge incontinence may be caused by a minor condition, such as infection, or a more severe condition such as a neurological disorder or diabetes.
You experience frequent or constant dribbling of urine due to a bladder that doesn't empty completely.
A physical or mental impairment keeps you from making it to the toilet in time. For example, if you have severe arthritis, you may not be able to unbutton your pants quickly enough.
You experience more than one type of urinary incontinence — most often this refers to a combination of stress incontinence and urge incontinence.
What to Expect at Your Visit
Your assessment starts with your story. A review of your description of your symptoms and concerns, medical and surgical history, your lifestyle, functional abilities (and limitations), social or emotional issues and your personal goals you would like to achieve with therapy.
Specific questions depending on your issues may include:
Leakage of urine or stool (When does it occur? Volume of urine lost?)
Pelvic/hip/low back pain
Menstrual history/Menopause history
These are very personal and sensitive questions for most; rest assured your comfort and consent are of the utmost importance.
The Physical Examination
The physical examination includes a whole-body assessment. The assessment will aim to find the underlying causes for the incontinence to determine where to focus treatment.
Components will include:
Range of motion of the back and hips
Core strength assessment
Observations of the abdominal wall and perineum
An intravaginal and/or rectal examination of the perineum
The methods used are always based on your comfort and consent. I will discuss all options with you during your assessment.
You should expect to come away from the assessment with knowledge of your condition and a treatment plan. You will be shown techniques to use at home for symptom reduction as well as suggestions for improving your posture and motor recruitment strategies.
Subsequent treatment will address all the deficits found in this initial assessment with the aim being to provide you with the knowledge and tools to improve your urological function.
Should you need, I often work closely with urologists, gynecologists, physiatrists, colorectal surgeons, family doctors, sexual health therapists and psychological counsellors in order to create a comprehensive treatment plan to restore health.