Bladder leakage, or urinary incontinence, is a relatively common affliction for both women and men of all ages. Stress incontinence is the leakage provoked by pressure or activity – think coughing, sneezing, jumping, running and skipping.
This is one of the primary complaints that bring our clients into the clinic, and it’s especially common in a couple of key demographics:
Female athletes, particularly gymnasts, dancers, runners, and in jumping sports
Pregnant and postpartum women
Men post prostatectomy (surgery to remove the prostate gland due to cancer).
What causes stress incontinence?
Stress incontinence can occur due to a variety of factors. Often people blame pelvic floor weakness, which can be the case. But it’s usually more complicated than this, involving a variety of factors including:
Pelvic floor dysfunction, such as weakness, tightness, low endurance, &/or poor co-ordination
Anatomical changes, such as with injury (e.g. childbirth) or surgery (e.g. prostatectomy)
Hormonal impacts, around menstrual cycles, pregnancy, postpartum and perimenopause
Maladaptive movement patterns, especially around intra-abdominal pressure management.
What can be done about stress incontinence?
The solution depends on the cause of the problem, which is why it’s important to have a thorough assessment by a women’s health/pelvic floor physiotherapist. This will direct treatment direction best. Typically this will include pelvic floor muscle training (not always just strengthening!); techniques for optimising pressure management (including breath/core control and timing); and reducing lifestyle risk factors like constipation/straining, overweight (particularly excess weight around the abdominal region as this puts more pressure on the pelvic floor), and chronic heavy lifting. For women, there is also the option to try and insertable medical device called a continence pessary that creates a splinting support of the base of the bladder to prevent leaking.
How successful is pelvic floor muscle training in curing stress incontinence?
About eighty-five percent of women can either cure or greatly improve their incontinence with pelvic floor exercises. But there’s a couple of caveats to this:
The exercises need to be tailored to you, i.e. based on an assessment (to ensure correct technique and adequate dosage)
You need to be supervised or followed up regularly, usually requiring around 5 sessions across 3-6 months.
How is pelvic floor function assessed?
Pelvic floor physiotherapists have several ways to assess what your pelvic floor is up to, which can be tricky for you to know because the muscles aren’t easy to see or feel. The most thorough assessment can usually be done with an internal vaginal/rectal assessment, checking each of the individual muscles within the pelvic floor specifically. Our other option is using biofeedback, such as non-invasive real-time ultrasound, to get an image of the pelvic floor to watch it move and correct technique.
What if I have both stress AND urge incontinence, or “mixed incontinence”?
It’s quite common to experience a combination of both stress incontinence and leakage associated with urgency (i.e. not making it to the toilet in time), and one can certainly influence the other. Sometimes we need to do a combination of treatments, depending on which one seems to be the bigger bother for you. For more information on urge incontinence, or overactive bladder, you’ll find our blog on this topic helpful.
What are my options if I don’t see results with pelvic floor physiotherapy?
If you and your physio agree that despite your best efforts - including adequate technique, time and dosage of your rehabilitation exercises - your stress incontinence persists, it may be appropriate to seek a specialist’s opinion on surgical options available to you.
Surgery can be an appropriate option for the right candidate, but we feel really strongly that everyone should pursue conservative (i.e. non-surgical) options first (for both stress incontinence and prolapse). This is the case for a couple of reasons:
All surgery carries risk, including infection, chronic pain and other complications (in this instance, difficulty emptying the bladder), and ineffectiveness for resolving your problem.
If there are ongoing risks factors (such as chronic constipation/straining, ongoing heavy lifting, and ongoing poor awareness/strength in the pelvic floor) this can reduce the longevity of the surgery’s success.
In summary: although common, you do not have to put up with bladder leakage that interferes with your daily activity or exercise. There is LOTS that can be done, and we would love to empower you to achieve your activity and exercise goals – whether that’s getting through a dance class, going for a run, or jumping on the trampoline with the kids. Book an appointment online for any of our clinics or via telehealth to get started. We can’t wait to work with you!