Urinary incontinence is a common condition affecting 1 in 3 women after childbirth. There are several different types of incontinence as well as several different causes behind them. Let’s look into them in a bit more depth.
The most common type of leakage is stress incontinence (SI). Stress incontinence is leakage of urine with effort or exertion such as coughing, sneezing, bending forward, lifting, standing up from a chair, jogging, laughing, jumping on a trampoline and/or vomiting.
SI occurs when either the pelvic floor muscles and connective tissue are too weak and stretched; there is too much load or weight on the muscles (from a congested bowel, adhesions or abdominal obesity) or when the urethra loses its closure tone due to ageing changes or trauma.
Treatment for stress incontinence often involves:
- Weight loss
- Toning of the deep abdominal muscles and pelvic floor
- Decongesting the bowel and small intestine with supplementation, dietary changes and visceral manipulation
- Addressing any abdominal adhesions and reducing their impact with visceral manipulation
Overactive bladder syndrome is a collection of symptoms, including:
- Frequent urination (more than 6 times per day)
- Nocturia (getting up to the toilet more than once at night)
- Getting a desperate urge to rush to the toilet to urinate with or without leakage
Causes of an overactive bladder can include:
- Abdominal/pelvic adhesions
- Chronic constipation
- Pelvic floor weakness
- Age-related changes
- Altered microbial environment inside the bladder
Symptoms of overactive bladder syndrome can point to a more serious problem occurring in the body. It is therefore wise to have further investigations done first before proceeding with treating the bladder itself.
Investigations may include:
- Urinalysis (urine test)
- Pelvic ultrasound (to rule out malignancy and to check if you can empty your bladder properly)
- Completion of a bladder diary (to check for more serious conditions like diabetes or other systemic diseases)
- Urodynamics (a test performed by urologists or gynaecologists)
- Cystoscopy (looking into the bladder with a camera)
If the investigations confirm overactive bladder syndrome, the treatment for it includes:
- Alteration of bladder habits (fluid intake, caffeine and carbonated beverage reduction)
- Bladder retraining (training the bladder to gradually increase its capacity)
- Regulating bowel function
- Visceral manipulation to restore mobility and movement to the bladder
- Pelvic floor exercises
- Antimuscarinic medication (prescribed by the GP or specialist, which calms the bladder down)
If these measures fail, a specialist referral is often necessary. Treatment options may then progress to being more invasive and can include Botox injection into the bladder, nerve stimulation at the lower spine or bladder augmentation surgery.
Overflow incontinence is the least common type of leakage. It occurs when the bladder cannot empty completely and due to being chronically overfull, will leak small amounts regularly throughout the day.
Symptoms of overflow incontinence often include:
- Frequent and urgent urination
- Regular, small volume leaks throughout the day
The cause of overflow incontinence can be:
- Obstructed bladder outlet (narrowed urethra, stone)
- Weak bladder muscle
- Medications that cause retention
- Nerve conduction problems (eg diabetes or degenerative nerve conditions)
- Masses within the pelvis
Treatment varies according to the cause behind the issue, but can include:
- Education regarding how to urinate most effectively
- Using running water or a cold compress over the abdomen
- Using vibration over the lower abdomen
- Adjustment of medications, which may be causing the problem
- Clean, intermittent, self-catheterization
- Permanent catheterization
This type is also fairly rare and is most often found in elderly or disabled people. It simply is the inability to get to the toilet in time due to poor mobility, lack of dexterity causing issues removing clothes, not reading body signals about when one needs to toilet or not recognizing the toilet.
It is caused by:
- Poor mobility
- Lack of dexterity
- Poor eyesight
- Poor signage of where toilets are
It can be improved by appropriate toilet signage, better access to toilet facilities, wearing clothes that are easier to don off and on and giving reminders regarding regular toileting for those who lack the signal.
If you are experiencing problems with bladder leakage – book in today to have a consult with our continence physiotherapist!