Continence, Incontinence & How Physiotherapy Can Help!
Have you ever felt a slight leakage of urine, or have felt unable to ‘hold it in’ before reaching a toilet?
The word ‘incontinence’ is usually associated with a negative stigma with many women, and men, embarrassed or ashamed to talk about it.
Statistics show that 70% of people with urinary incontinence do not seek advice or treatment for their problem (Millard, 1998). Below are some facts on continence and incontinence, and what you should do if you’re experiencing symptoms.
What is Continence and Incontinence?
The term ‘Continence’ refers to having control of your bladder and bowel.
The term ‘Incontinence’ refers to “accidental or involuntary loss of urine from the bladder, or faeces or wind from the bowel” (Continence Foundation of Australia).
Incontinence can vary in degree of severity, from a very small leak, to complete loss of bladder or bowel control.
How Many People are Affected by Incontinence?
The incidence of incontinence is widespread, with 4.8 million Australians experiencing bladder or bowel control problems, according to the Continence Foundation of Australia.
Up to 13% of Australian men and 37% of Australian women (i.e. one in three) experience urinary incontinence.
Different Types of Incontinence
There are many different types of incontinence, with the most common ones listed below:
- Urinary incontinence
- Stress incontinence
- Urge incontinence
Urinary Incontinence
Urinary incontinence refers to “accidental or involuntary loss of urine from the bladder” (Continence Foundation of Australia). It is commonly associated with, but not limited to:
- Pregnancy
- Childbirth
- Menopause
- Obesity
- Chronic conditions (including asthma, diabetes, and arthritis)
- Prostate surgery
- Pelvic girdle pain (Lee & Lee, 2004)
Causes & Symptoms:
Urinary incontinence is usually caused by weak pelvic floor muscles (PFMs), and symptoms can include:
- Occasional leakage with increased abdominal pressure (e.g. when laughing, coughing or exercising)
- Wetting yourself (complete inability to control your bladder)
- Constant need to urgently or frequently visit the toilet
With appropriate advice and management, urinary incontinence can be cured in many cases.
Although it is more prevalent in the elderly population, with 77% of nursing home residents in Australia affected by incontinence (Steel & Fonda, 1995), over a three-month period, an Australian study found 50% of women between 45-59 years of age experienced some degree of mild, moderate or severe urinary incontinence (Millard, 1998).
However, it can still affect people at younger ages, particularly men with prostate conditions, and women post-natally. Particularly for postnatal women.
Persistent incontinence two-three months after childbirth is common, but NOT normal.
Stress Incontinence
Stress Incontinence refers to the leakage of urine during activities that increase abdominal pressure, and push down on the bladder.
These activities may include:
- Coughing
- Sneezing
- Laughing
- Walking
- Lifting
- Playing sport, or exercising
Common causes:
It is commonly associated with other conditions such as diabetes, chronic coughing (related to asthma, smoking or bronchitis), constipation and obesity. Both men and women can be affected.
For women, it is usually related to pregnancy and/or childbirth, due to the stretching and weakening of PFMs; and to menopause, due to lower amounts of the female hormone, oestrogen.
For men, it usually follows prostate surgery, and can take six to 12 months to resolve. Seeking professional help is advised.
Urge Incontinence
Urge Incontinence refers to the sudden and strong need to urinate, potentially causing some leakage. The muscle surrounding the bladder can become overactive, causing the bladder to contract and leak urine before you can reach a toilet.
Factors that can contribute to urge incontinence include:
- Ageing
- Increased stress
- Caffeine or alcohol
- Related health conditions (including Parkinson’s Disease and Multiple Sclerosis)
- Constipation
- Enlarged prostate gland (males)
- Long history of poor bladder habits
- Unknown cause
Symptoms of urge incontinence may include:
- Need to frequently pass urine
- Waking several times at night to go to the toilet (Nocturia)
Urge Incontinence is strongly associated with prostate disease, and has an increasing prevalence with age – 30% for those aged between 70-84 years, and 50% for those 85 years and over (Australian Institute of Health and Welfare, 2006).
Management and Treatment of Incontinence
With appropriate advice and support, incontinence can be managed, and cured in some cases!
Pelvic Floor & Kegel Exercises
Pelvic Floor Exercises, or Kegel Exercises, are recommended for appropriate management of incontinence. The pelvic floor muscles form a sling or support inside the pelvis, and have the following functions:
- Internal support to pelvic floor organs
- Providing stability to the surrounding pelvic bones
- Preventing incontinence and prolapsed
- Sexual function
It is important to increase the strength and endurance of pelvic floor muscles, to enable control over the bladder and bowel. The ability to release and relax the pelvic floor is just as important, to avoid overactivity.
Muscle Strengthening
Gluteal muscle strengthening exercises are also recommended, because they help PFMs to work at optimal length, and help support the pelvis and sacrum (Continence Foundation of Australia).
Studies have shown that 84% of women with stress urinary incontinence are cured with PFM training after five physiotherapy sessions (Neumann PB et al., 2005).
When to seek professional help:
Seeking professional help from a physiotherapist, or a Continence Physiotherapist, is highly recommended for correct education and exercises to reduce incontinence.
Research shows up to 50% of women who attempt Kegel Exercises from a handout get the technique wrong, which can worsen the problem (Bump et al., 1991).
Potential implications may include long-term problems such as further weakening of PFMs, continued incontinence, prolapsed or pelvic instability (Continence Foundation of Australia).
For more detailed instructions on how to strengthen your pelvic floor, take a look at our kegel exercises blog.
Have a confidential conversation with a Back In Motion physiotherapist
If you have any questions or concerns, or just want to find out more, feel free to contact a Back In Motion Physiotherapy practice close to you for a confidential conversation about your health convern. Take a look at the practice locations across Australia where specialist physiotherapists with post graduate qualifications in continence physiotherapy are employed.
Nicole Tang - Physiotherapist, Back In Motion Aspendale Gardens
Nicole completed an undergraduate science degree and a Doctor of Physiotherapy degree at the University of Melbourne. This course gave her experience working in both hospital and private practice environments, including overseas clinical experience in the U.S.A.
Nicole's clinical interest areas include Musculoskeletal Physiotherapy, Clinical Exercise and Women’s Health. She is a certified APPI (Australian Physiotherapy and Clinical Exercise Institute) Pilates instructor, and has experience in instructing Clinical Exercise classes, for specific injuries, improving fitness and pre- and post-natally.
Most recently, Nicole ruptured her Achilles tendon whilst playing netball, subsequently requiring surgical repair. This has increased her affinity and empathy with people with serious injuries, and those who have undergone surgery!