Urinary incontinence can come at any age and for a multitude of reasons but not always birth related or because of an underactive pelvic floor, much to everyone's surprise. There are a few different types of urinary incontinence, each with a different set of symptoms and each needing individual assessment mainly due to the fact that each human has a different body/life they’re bringing to the table with unique circumstances and goals. This is why a one size fits all treatment, as common as leaking is, is not useful to anyone.
The most common types of urinary incontinence are:
Stress
Urge/urgency
Mixed (a bit of both)
Stress urinary incontinence is when the pelvic floor is put under stress, as the name suggests, but cannot manage that stress and so urine leaks through. This stress can be anything from a sneeze to a sprint and everything in between like jumping, coughing, laughing. A common complaint is on the trampoline. Usually this is due to dysfunctional pressure management in the abdomen or overactive abdominal muscles. The pressure goes for the path of least resistance which is usually the pelvic floor in females. This can point to an overactive pelvic floor but is not always the case and usually more to do with abdominal muscles and dysfunctional breathing. This can be experienced at any age due to the high level of young athletes and an over-cued “core” in exercises throughout a lifetime. It is a learnt thing to over activate the abdominal muscles and create this pressure in the abdomen. It is also quite common post abdominal or pelvic surgery or with chronic abdominal or pelvic pain e.g. endometriosis and IBS.
Urge urinary incontinence is when you need to empty your bladder and cannot control the flow, again, as the name suggests, giving you the urge/urgency to get to the bathroom as quickly as possible. A very common time to experience this is on arrival home and key in the door knowing the loo is just the other side. This can point to an underactive pelvic floor but usually on the endurance side of things which is the length of time you can engage your pelvic floor before it fatigues/tires. This is not so common in young females but not ruled out totally and hence why individual assessment is always required. Reduced pelvic floor endurance is common after vaginal birth and urgency will continue to progress if not treated and therefore is quite common in later life. As we get older and less active our pelvic floor is doing less and so will become under active, particularly if you’re rushing to the loo, as it is a postural muscle too so works double hard with a full bladder upon movement.
The pelvic floor and vulval/vaginal tissue is also largely affected by hormones (oestrogen/estradiol) and so urinary incontinence may worsen during and after the menopause when oestrogen production changes from the ovaries to the adrenals and is less abundant making changes to the urethra (where the urine comes out). Neurological disorders will also play a role in urinary incontinence depending on the presentation of the disease.
Because of the range in presentation of urinary incontinence it is really important that each person is individually assessed to know exactly why the leaking is happening and to plan a tailored rehab program around the presentation. And physiotherapy can help with this.
In a physiotherapy session we will do a full check of how your body is moving and breathing and an internal assessment of the pelvic floor to see how it performs. We will look at your lifestyle to make changes where we can in order to move toward your goals of a leak free life. You'll always have homework to do which will include exercises specific to you and your needs.
Leaking is common but not normal and as much as it’s getting a lot of air time I still feel it is lived with more than it needs to and people are spending far too much money on pads so we will try to put them out of business with decent physiotherapy. If you are worried about coming to physiotherapy with your leaking then be sure to know that this is the safest place to share all your concerns on this topic and could be the beginning of the end of your leaking!
DON’T JUST LIVE WITH IT!
Book in for a Pelvic Health Initial Consultation & Treatment with Sarah