Get back to enjoying a laugh without discomfort.

If you’re suffering from the discomfort, pain or embarrassment associated with incontinence or pelvic floor dysfunction, you’re not alone. Pelvic floor dysfunction (PFD) affects as many as 4.8 million Australians and incontinence affects one in four Australians over the age of 15.

It’s not an issue that only affects women, though certainly it’s more common amongst women due to child bearing.

Regardless of your gender or age you shouldn’t have to live with the discomfort and embarrassment of incontinence or the limitations of compromised physical activity. PFD is preventable and treatable and no matter your age or stage in life you can take care of your pelvic floor.

Ask yourself

For some, the symptoms are obvious, but ask yourself these questions to determine if you are suffering from PDF or incontinence and can improve your condition:

-          Are you going to the toilet more than 6 times a day?

-          Are you going to the toilet more than once during the night?

-          Are you finding that your underwear is wet or dampened at times, especially after a cough, sneeze or laugh?

-          Are you passing less than 250mL of urine each time?

-          Are you having difficulty initiating the flow of urine?

-          Is passing urine irritating or painful?

If you answer yes to any of these questions, you may suffer from urinary incontinence. Understanding the mechanics of your pelvic floor can help to treat urinary incontinence.

How does it work?

The kidney streams urine into the bladder, where it stores urine, through tubes called ureters.  As it expands to almost full, the nerve endings in the wall of the bladder will send messages to your brain to let you know that you need to go to the toilet. The urethra is connected to the bladder and forms an outlet for the urine.

The pelvic floor muscles, which forms a sling in your pelvic basin, and the urethral sphincter, keeps the urethra closed until you find an appropriate time and place to pass urine. When you are ready to urinate, the pelvic floor muscles and urethral sphincter relaxes which allows the outlet to be opened. The bladder contracts and pumps urine out of the urethra until all urine has passed. The pelvic floor then contracts and closes the outlet of the urethra.

Hence, the pelvic floor muscles are responsible for the start and stop of urination. Problems occur when the strength of the pelvic floor muscles is weakened, which will impact on this function.

The many forms of incontinence

Incontinence takes on many different forms.

Stress Incontinence:
This occurs when there is exertion on the bladder including running, coughing, sneezing or lifting. The bladder is actually not pumping urine out, but the weakened pelvic floor muscles are unable to keep the outlet of the urethra closed under high pressure, causing leakage.

Urge Incontinence:
This occurs when the bladder takes over the role of starting and stopping urination instead of the pelvic floor muscles. The bladder is overactive and undergoes involuntary spasms which give you the urge and overwhelming need to go to the toilet – even if you just went.

Mixed incontinence:
This is a combination of Stress and Urge incontinence

Overflow incontinence:
When there is a blockage in the ureter this can prevent complete emptying of the bladder. Leakage eventually occurs because the bladder becomes over full. This is very common with men who have an enlarged prostate.

Treatments for Incontinence

The most influential and easiest period that you have in addressing incontinence and PFD, is when leakage begins.

Lifestyle Changes:

-          Reduce caffeine intake can reduce the amount of urine your body produces

-          Losing weight can help to reduce the pressure on the bladder and the pelvic floor muscles

Pelvic Floor Muscles Retraining:

-          Proper assessment from a physiotherapist is crucial to examine the control and strength of the pelvic floor. If pelvic floor muscles are not retrained correctly, it can lead to pelvic organ prolapse (when the pelvic organs drop down the pelvic diaphragm)

-          The strength of the pelvic floor muscles vary between individuals. It is vital that the dosage of your exercises is specific to your needs. Your physiotherapist can assist you with this.

-          For extremely weak pelvic floor muscles, electrical stimulation or biofeedback may be used by your physiotherapist.

Bladder training:

-          Bladder training begins with a diary of when and how much you urinate. With a physiotherapist, you can discuss techniques on how to increase the time between having the urge to urinate and when to actually urinate. These techniques are usually combined with pelvic floor exercises.

Clinical Exercise is a great way to strengthen your core stability which incorporates the pelvic floor. But, if you have PFD, be cautious about the intensity and type of routines. Only participate in Clinical Exercise under the supervision of a qualified physiotherapist who understands the specific challenges and considerations of weakened pelvic floor muscles.

Talk to your physiotherapist about exercises, diet and supplements that can provide essential relief from PFD and incontinence.

Kim Nguyen
Back In Motion Physiotherapist and Practice Director of Back In Motion Ascot Vale and Richmond