Incontinence is a type of pelvic floor dysfunction that can affect anybody, but is more common in women and older people. Women’s Health Physio at Six Physio Chelsea, Kayleigh Robinson, gives us the low down.
Incontinence refers to the involuntary loss of urine (urinary or bladder incontinence) or stool (faecal or bowel incontinence). Urinary incontinence is more common, and both have various causes and can affect people differently.
The most common forms of urinary incontinence are urgency and stress incontinence. Urgency or urge incontinence is where people have a sudden urge to urinate and struggle to control their bladder. This can lead to people rushing to get to the toilet or leaking before they can make it there. Stress incontinence is where pressure on the bladder causes it to leak, such as when you laugh, sneeze, cough or jump.
It is also possible to suffer from complete insensible incontinence, where people leak urine without being able to feel it, but this is much more unusual. Bowel incontinence is also less common and mostly presents as urgency incontinence.
In some cases incontinence can be caused by weakness of the pelvic floor, where the muscles are not able to adequately support the pelvic organs, leading to leakage. Conversely, it can also be caused by having a higher tone pelvic floor, where the muscles have difficulty relaxing. This means that when more pressure is exerted on the pelvic organs, such as during a sneeze or cough, the pelvic floor is already at full capacity and breakthrough leaking occurs.
Urinary incontinence affects one in three women, and up to ten percent of men. Bowel incontinence affects one in 10 people at some point in their lives. These stats indicate that incontinence is common, and that it can happen to anybody, but there are certain factors that make you more susceptible to continence issues.
Age is a risk factor and people are more likely to develop incontinence as they get older. Pregnancy and childbirth can also precede incontinence, as the weight of carrying a baby can lead to pelvic floor weakness. Menopause is a leading cause of incontinence, which is often due to the reduction in hormones causing a loss of muscle tone. This occurs throughout the entire muscular system, including the pelvic floor, and means the muscles aren’t as big or strong as they were previously and are therefore less efficient.
However, incontinence can also affect younger people and even teenagers, as this tends to be a sporty population. High impact athletes such as gymnasts, track and field athletes and weightlifters are likely to experience incontinence due to increased risk of a higher tone pelvic floor.
Various health circumstances can lead to incontinence as a secondary symptom. Being overweight or obese can increase your likelihood of developing incontinence, as there is more weight and load going through the pelvic floor, therefore requiring higher levels of strength endurance.
People with chronic lung conditions are also often at higher risk of incontinence, especially those who suffer chronic coughing as a symptom. Similarly, those suffering with constipation or gastrointestinal diseases such as Chron’s or colitis may also be at increased risk as these all put more strain and pressure on the pelvic floor, which can lead to muscle weakness and leakage.
Lifestyle factors can have an impact as well. Those with a high intake of caffeine or alcohol may experience incontinence due to increased irritation of the bladder.
There are lots of causes, so you’ll be pleased to hear that incontinence is treatable. If you are experiencing incontinence, it’s nothing to be embarrassed about, and you should get help as quickly as possible.
A Pelvic Health Physiotherapist will be able to examine you and find the root cause of your incontinence. If you have a higher tone pelvic floor, the treatment will be focused around encouraging relaxation. They will demonstrate useful breathing exercises and wide leg poses to help you relax.
If your incontinence is related to pelvic floor weakness, your physiotherapist will show you strengthening techniques that will be individualised to you. This may include pelvic floor exercises including long holds, short holds and multiple repetitions a day. Sometimes people find it hard to tell if they are performing these exercises correctly, which is why we use ultrasound and digital internal assessment to look inside the body and see the pelvic floor muscles at work.
There are lots of other specialist treatments, including electrical stimulation to cause contraction of the pelvic floor, bio-feedback, and abdominal release exercises.
At Six Physio, we’re all about the cure. Incontinence can absolutely be cured, but it doesn’t mean that it won’t reoccur in the future. It takes a long time and strict adherence to a rehab plan to get better.
Often when we have patients come into clinic for continence issues, they may not notice any change in symptoms for up to 12 weeks. We would usually try to see incontinence patients at least once a week because we know how frustrating and demotivating it can be when the improvements are hard to see.
These weekly sessions include monitoring and training the pelvic floor, but can also incorporate exercise-based physiotherapy in the gym, such as bridges, squats and deadlifts. These types of strengthening exercises are useful as they all help increase the amount of load that the pelvic floor can accommodate.
Treatment for incontinence is not just limited to physiotherapy. We highly recommend people with continence problems to explore Pilates, as it teaches you how to use your core properly. The pelvic floor, deep abdominal muscles, diaphragm and deep back muscles all work together a unit. If you have a problem in one area, it’s possible you may have issues elsewhere, which is why the guidance and expertise of a trained Pelvic Health Physiotherapist can make a world of difference.
