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Physiotherapy interventions for urinary incontinence and pelvic floor rehabilitation

Urinary incontinence is defined as the involuntary leakage of urine. This leakage, minor or major, affects quality of life and sometimes prevents people from performing daily activities in fear of incontinence. Sports, hobbies, sexual intercourse, etc. many aspects of our lives can be touched by urinary incontinence when not treated. Research also shows a link between depression and urinary incontinence.

Still taboo for many people, urinary incontinence is often a subject that is not discussed with health care professionals. Companies selling special undergarments overflow with commercials in medias, trying to sell their products. Quick and easy fix for incontinence? No, only covering up the symptoms. However, pelvic floor physiotherapy has been proven effective in reducing urinary incontinence.. A much cheaper solution in the long term! pie.

What are the causes of urinary incontinence?

Attractive young girl running along the waterfront

Bladder and/or pelvic floor muscles malfunction are the usual causes for urinary incontinence. Indeed, to maintain a good continence function pressure that insures the urethra (the tube that goes from the bladder to the outside) remains in a closed position needs to be greater than the pressure inside the bladder. This means that any pressure malfunction can have a great impact on urine retention.

Decrease in intraurethral pressure

Pelvic floor muscles have several functions in the body. Running from the coccyx to the pubic bone, they help in sexual function, to increase stability, they support our organs, and help maintain urine, gasses and stools in. Pelvic floor contraction contributes to increase the message sent to the bladder to wait before emptying. So, any loss of muscle endurance, flexibility, tonus, and coordination can alter normal bladder function. 

Intravesical (bladder) pressure increase 

Several factors may contribute to an increase in the intravesical pressure including pregnancy, obesity and the effects of aging, certain diseases , and certain medications.

 

Types of urinary incontinence

There are several types of urinary incontinence. They are classified according to the underlying cause and symptom presentation. The following are the most frequently encountered .

Effort related urinary incontinence

This type of incontinence happens when the urethra closure pressure is smaller than the one in the bladder. Frequently, a decrease in pelvic floor muscles activation is responsible for that pressure loss, which causes involuntary urine losses when coughing, sneezing, and performing physical activity. Physiotherapy pelvic floor rehabilitation is efficient in reducing/eliminating this type of incontinence.

Urgency urinary incontinence

This type of urinary incontinence happens when the bladder contracts and creates an urgency for urination. Diabetes, pregnancy, stress, infections, poor urinary habits, and following a stroke are some examples of conditions that can influence muscle contraction and cause urgency incontinence. Rehabilitation takes into consideration the cause of muscle imbalances to be able to retrain them into working efficiently and properly.

Mixed urinary incontinence

Mixed urinary incontinence happens when signs and symptoms of stress incontinence and urgency incontinence are seen at the same time.

Functional urinary incontinence 

Functional urinary incontinence is due to the inability or the refusal to reach the toilet when the need to urinate comes. This type of incontinence can be caused by a lack of mobility or physical/architectural barriers preventing the toilets access, or by a state of consciousness alteration. When lack of mobility is the main issue, assessing physical function and giving tools to reach the commodities when needed is primordial in reducing this type of urinary incontinence.

Acute urinary incontinence 

This type of incontinence is generally caused by another medical condition affecting bladder function. For example, dehydration, urinary or vaginal  infections, and certain medications can affect bladder capacity to retain urine. Medical interventions are necessary to treat the underlying causes of incontinence.

Who is affected by urinary incontinence?

Although it is very little talked about, urinary incontinence affects many people on a daily basis. Both men and women can present urinary disorders, but there is a higher frequency in women.

In fact, urinary incontinence affects 2-6 out of 10 women depending on the age group with an increasing proportion with age (Hunskaar,2005; ICI,2009). Urinary incontinence is even more common than hypertension, diabetes and high cholesterol according to Cervigni M1 and  Gambacciani M2 (in 2015).

Some factors increase the likelihood of suffering from urinary incontinence. The main risk factor for urinary incontinence is actually decreased function of the pelvic floor muscles, but obesity, pregnancy, delivery, constipation and over consumption of irritant food and drinks (like caffeine) are risk factors for incontinence.

Note that aging is also a risk factor for urinary incontinence due to the changes it entails in the various structures involved in urinary continence such as the pelvic floor musculature.

belly tummy of a pregnant woman on a white background

belly tummy of a pregnant woman on a white background

 

Playing sports with load lifting, jumps and repeated impacts is also a risk factor for urinary incontinence.

 

How can pelvic floor rehabilitation help for urinary incontinence?

In fact, physiotherapy is an efficient first line treatment for urinary incontinence (ICI,2009;Hay Smith,2006;Dumoulin,2010).

Your physiotherapist will work with you to re-train the pelvic floor muscles by specifically targeting the impairments found in the assessment. he/she will give you home exercises to maximize efficiency and speed of the rehabilitation. He/she can also use manual techniques to stimulate or relax the muscles. In addition, devices can be used to better recruit the pelvic floor muscles and can show you in real time the degree of contraction static position or during an action, such as a movement or when coughing.

 

Your physiotherapist will also assess your posture, breathing dynamic, stability of your back and pelvis, and the function of your abdominal muscles and leg muscles as all these factors can influence your problems urinary incontinence. Following this assessment, he/she will be able to guide you with exercises, manual techniques and advices.

Finally , recommendations and strategies tailored to your condition you will also be given as needed to help you manage the urgent needs and to adopt positive lifestyle habits.

Our physiotherapist Esthel Pilon is specialized in perineal and pelvic rehabilitation and can answer your questions and help you !