Having just had World Continence Awareness week (at the end of last month), I thought it was timely to ask our clinic’s women’s health physiotherapist expert, Kath Pryce-Jones to tell us about this important but often under-reported and under-treated problem.
For those that may not be sure, continence refers to the ability to control elimination of urine from the bladder. The inability or decreased ability to do this is known as urinary incontinence, and is a common and distressing problem that can have major impacts on a person’s day to day life and activities.
According to Kath, there are a number of reasons why someone may develop urinary incontinence, but from a physiotherapy point of view, the main cause that we are involved with is when someone has a weakened pelvic floor. The pelvic floor is the group of muscles that span the area between the legs, from the pubic bone to the tailbone, and side to side from there. The job of these muscles is to maintain normal bladder and bowel control, and also to keep important pelvic organs in place. When these muscles are weak, it can lead to problems such as bladder leakage, pelvic organ prolapse, and erectile dysfunction in men. So you can see how when these muscles are not working properly, they can have a real impact on someone’s quality of life – but also how it can be viewed as something embarrassing to talk about by some.
Things that can cause the pelvic floor to weaken include pregnancy and childbirth, aging, obesity, menopause/hormonal changes, heavy lifting or physical work, high impact sports, surgery to the pelvis, and some genetic factors, among others.
The good news though, Kath says, is that these muscles, like any other, can be strengthen and re-trained, and research shows that physiotherapy in the form of pelvic floor re-training can improve and resolve incontinence.
Working on the problem early on is easier, and can stop it from progressing and leading to further problems.
An exercise program for these muscles varies depending on a person’s pelvic floor strength, and it’s always recommended to see a professional in this area to get a programme that is right for you. However, an example of the type of exercise involved is one where you lie down or are in a seated position, check that your stomach and bottom muscles are relaxed, then activate the muscles, imagining that you are trying to stop the flow of urine, squeezing and lifting up around the ‘front passage’. You would aim to hold the squeeze for 3-10 seconds (start with a small amount) and repeat 5-10 times. These muscles might be weak initially and tire very quickly, but like anything, the more you do the exercise, the stronger you will get. It’s good to find a regular time during the day to remind you do to these, such as sitting at the traffic lights, or while brushing your teeth.
As with any muscle group, strengthening this area requires starting off slowly, building up more repetitions, and then doing the exercises under more challenging conditions.
A pelvic floor physio expert, including a physio like Kath, can help you locate these muscles, assess their current strength, and make sure you’re performing the exercises correctly, all in an understanding and supportive environment – so don’t be afraid to seek professional help if you are in this situation. Your physio can also help with related conditions such as pelvic pain or prolapse, including liasing with your GP or specialist if there are medical aspects to the problem that need assessment and treatment.