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Physiotherapy & Rehabilitation

Urinary Incontinence

Urinary Incontinence

What is Urinary Incontinence?

Female urinary incontinence refers to the involuntary loss of urine, whether it be a small drop or complete emptying of the bladder.  It is often experienced during pregnancy and after childbirth as well as later in life with menopause, but it should NOT be considered normal.  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.  Women are frequently advised to do Kegels or pelvic floor strengthening exercises when these symptoms occur.  These exercises are effective when done properly, but the location of the muscles makes it difficult for us women 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: 

Tightness issue: 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 as a result 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:

  • Stress incontinence refers to the accidental leakage of urine that occurs when we have an increase in intra-abdominal pressure. This occurs with activities such as sneezing, laughing, coughing, running, or lifting.
  • Urge incontinence is also known as overactive bladder syndrome.  This refers to the sudden, uncontrolled need to void.  Leakage occurs before reaching the toilet, and maybe even before reaching the bathroom. It is often associated with triggers and behaviors (e.g. hearing the sound of water running, cold, being close to a bathroom, putting our key in the front door).
  • Mixed incontinence is when a person has both urge and stress incontinence.  It is very common for a person who has or urge incontinence to develop the other over time.
  • Overflow incontinence is when an overfull bladder constantly leaks.  It can be due to a blockage at the urethra, weak or decreased contractility of the bladder, neuropathy from diabetes or other diseases (e.g. multiple sclerosis or Parkinson's), or an injury to the nerves that affects the bladder.
  • Functional incontinence is the inability to get to the washroom in time due to physical, functional, or cognitive limitations.
  • Coital incontinence (CI) is urinary leakage that can occur during intercourse. There are two different categories based on when urinary leakage occurs: incontinence with penetration and incontinence with orgasm.  Each has different reasons for occurring; incontinence with penetration is strongly linked to stress urinary incontinence (SUI), while incontinence from orgasm is strongly correlated to overactivity of the bladder muscle.  Both are related to weakness involving the pelvic floor muscles.

How Can Donna Sarna Physiotherapy Help?

At Donna Sarna Physiotherapy & Rehabilitation, a pelvic floor assessment is a two-part process with a global approach taken both with assessment and with treatment. During the assessment process, a detailed history as well as an internal and external evaluation will occur incorporating not just the pelvic floor, but also assessment of posture, breathing, as well as range of motion and strength of the torso, back, hips, pelvis and lower extremities.   Examination of the associated musculature and fascia as well as the nerves and joints is also included. The pelvic floor component will include an external evaluation of the skin and connective tissue in the  perineal and genital area as well as an internal examination of the vagina and possibly the anal canal if indicated. The pelvic floor muscles and sphincters are tested for muscle tone and  tightness, strength, endurance, trigger points, and tissue integrity. The pelvic floor is also assessed in conjunction with the rest of the core to ensure that timing of activation  and sequencing of  the muscles is optimal. Position of the pelvic organs and integrity of their supporting ligaments and fasciae are also evaluated. You are always welcome to have a trusted individual present during assessment or treatment.

An individual treatment plan is developed based on the assessment findings and may include education regarding posture, breathing, proper toileting techniques, bladder training/urge delay techniques, organ prolapse reduction techniques, bladder irritants, perineum care, perineum support and evacuation techniques and abdominal massage. Manual techniques including myofascial release, mobilization, visceral manipulation and biofeedback will also be utilized as a component of the treatment plan. An individualized home exercise program will also be provided to release and/or strengthen with a whole body approach to include the pelvic floor, but not specific to.  Other modalities such as electrical  muscle stimulation (EMS), transcutaneous electrical nerve stimulation(TENS), biofeedback, ultrasound and acupuncture may also be included as components of the treatment plan.