Urinary Incontinence - Management Solutions

Urinary Incontinence - Management Solutions

Do you leak when you laugh, cough, sneeze, jump, squat, or exercise? Do you leak when you hear running water, put a key in the door, or get sudden urges to go? Do you frequently visit the bathroom or have a constant feeling of needing to go?

These are symptoms of urinary incontinence. Women’s Health Physiotherapy can help you. Millions of women, about 1 out of 3, suffer from urinary incontinence symptoms, so you are not alone and more importantly there is help that can get you to a better place or in many cases cured.


What is urinary incontinence?

Urinary incontinence is any accidental loss of urine. It can vary from a few drops of urine to a full emptying of the bladder. What are some of the common causes of urinary incontinence?

● Poor drinking habits: Different types and amounts of fluid can irritate the bladder and cause incontinence.

● Poor toilet habits: Going to the bathroom “just in case” trains the bladder to store smaller volumes than it should, which can cause incontinence.

● Conditions such as Parkinson’s disease, multiple sclerosis, stroke and diabetes can interfere with bladder sensations and emptying.

● Anatomical problems can block the urethra, for example: pressure from constipation, bladder stones or other growths.

● Some medications can affect bladder function, for example: diuretics make the bladder produce urine more quickly, increasing urgency.

● Weak pelvic floor muscles from constipation, chronic coughing, being overweight, pregnancy, vaginal birth delivery, high impact activities such as jumping, or heavy lifting.

● Menopause in women: The reduction in estrogen that occurs during menopause can result in thinning of the urethra. Urine may leak if the urethra does not close as well as it used to.

● Urinary tract infections sometimes cause urine to leak.

What other symptoms may occur with urinary incontinence?

● Urgency: Having an urgent desire to urinate

● Frequency: Urinating more often than usual (around 7-9 times is about normal)

● Nocturia: Waking more than once per night to urinate

● Nocturnal Enuresis: Leaking urine while asleep

What are the types of urinary incontinence?

The most common forms of urinary incontinence are as follows:

○ Stress incontinence: leaking urine when coughing, sneezing, laughing, lifting or doing exercise

○ Urge incontinence: feeling urgency to rush to the toilet, with some urine leaking

○ Incontinence associated with chronic retention: when the bladder is not able to empty properly, frequent small amounts of urine may leak

○ Functional incontinence: leaking urine because of not being able to get to the toilet.

The Foundation

Role of the Core/Pelvic Floor

● Core (Multifidus, TrA, Diaphragm, and PF) are small muscles that have a crucial role in stability of your back, hips, pelvis

● Pelvic floor acts as a sling to hold up our pelvic organs against gravity and increases intra abdominal pressure (pregnancy, cough/sneeze/laugh, aging)

● Controls stop and start of urine and faeces

● Improves sexual function

Pelvic Health Physical Therapy Assessment for Urinary Incontinence

Assessment with a women’s pelvic health physiotherapist may involve some or all of the following:

● A comprehensive history will be taken so we can understand your main concerns, what might be contributing to them and your goals for treatment

● You may be asked to complete some questionnaires and bladder and bowel diaries

● Your pelvic health therapist will do a thorough physical assessment of your muscles, including your pelvic floor muscles. The internal pelvic examination will evaluate the function of your pelvic floor muscles and your ability to contract and relax these muscles. Real time ultrasound assessment of your pelvic floor muscles can assist this process if required.

● Talk to your doctor about your urinary incontinence also. There are a variety of tests that they may do also. These may include a urine sample, ultrasound or urodynamic studies.

Management of Urinary Incontinence

Management of urinary incontinence can be through conservative treatment, medicines, or surgery. Initial treatment should be conservative; this is done with a women’s pelvic health physiotherapist who will have extra qualifications and specific interest in pelvic health. They are best equipped to assess, treat, and manage urinary incontinence.

Conservative management may involve lifestyle advice which is key when considering possible causes of urinary incontinence will give you information on changes you can make to help manage your incontinence. The discussion may include information about general exercise (what is helpful versus unhelpful), you can be educated about good bladder and bowel habits. You will also be advised how to sit on the toilet with correct posture.

Behaviour re-training and bladder retraining


People with urge incontinence need to learn urge suppression and control techniques to reduce the sensation of urgency. They may also need to avoid going to the loo, at certain intervals, to train the bladder to give correct signals of fullness. Your bladder diary will help to determine if bladder re-training is necessary.


Pelvic Floor Muscle Training – Your pelvic floor muscles are the muscles at the base of your pelvis. They attach from the pubic bone at the front to the tailbone at the back and from side to side. These are the muscles that help maintain continence and support your pelvic organs. To activate your pelvic floor muscles, squeeze and draw in as if stopping the flow of urine. You should feel closure around the anus and urethra. Women will feel this in the vagina also. You don’t need to tighten your buttocks or abdominal muscles. Once you have mastered this muscle activation with the guidance of your pelvic health physiotherapist, they will design you a pelvic floor muscle training program. The program will be reviewed and changed during subsequent treatment sessions. It takes time to alter the pelvic floor muscles and improve their function.

Other Physical Therapy Treatments

Depending on the type of urinary incontinence you are experiencing, your pelvic health physiotherapist may recommend that you use weights, support pessaries, electrical stimulation or biofeedback, in addition to your methods of management.

General Exercise Advice – Maintaining your general fitness will help improve overall muscle tone in your body, including your pelvic floor. Daily physical activity will also keep your bowel emptying at regular intervals. Your women’s pelvic health physiotherapist will help you establish an exercise program, taking into account your individual goals and preferred exercise. Attending Foundation Pilates classes is a fantastic option to help you on this journey. You learn a lot about strengthening from the inside out, with the exercises specifically designed for your body. These classes, in addition to your home exercises, build a great foundation for you to return to your chosen sport or activity. Medical and Surgical Management – You can also talk to your doctor about urinary incontinence. There are a variety of tests they may recommend, including analysis of a urine sample, an ultrasound or urodynamic study. Your doctor will advise you if medications or surgery are appropriate. Medications help with some forms of urinary incontinence. Injectable agents or surgery may be considered if conservative measures have failed or if the incontinence is severe.


Your women’s health physiotherapist will be able to determine if your pelvic floor muscles need to be strengthened, relaxed, or both with a pelvic floor examination.

Some people think their pelvic floor muscles are weak and stretched, while the opposite may be the case. For some people the pelvic floor muscles are too active and they will need to be taught to relax these muscles. You will learn how to exercise your pelvic floor muscles according to what is needed for you.

Kegels are commonly prescribed to women when they say they have a pelvic floor dysfunction. Most women do not know how to perform a pelvic floor muscle contraction correctly. They may be using other muscles or bearing down. Kegels may do you a disservice and increase your symptoms. Your women’s health physiotherapist will guide you on whether or not you should start performing pelvic floor muscle contractions or if they need to be relaxed.

No. In fact, we encourage you to continue exercising as it has many physical and mental benefits. We may ask you to take a short break from some of the activities that are causing you to leak or may modify an exercise so you can still participate in the activities you enjoy. For instance, if doing double unders while skipping causes you to leak, we may suggest you do single jumps if it does not cause you to leak. Other forms of exercise include Foundation Pilates (we offer reformer pilates at Body Logic Health), swimming, indoor or outdoor cycling, water aerobics, walking, and low impact resistance exercises

This is not required, and is sometimes not necessary, however your pelvic floor physical therapist will be able to tell you what is best for your current situation. A pelvic floor assessment will be beneficial for your treatment by showing if your pelvic floor muscles are tight, weak, or both. This will be helpful to get baseline information for your progression and put the best management plan in place.

Your women’s health physiotherapist will first ask for your consent to perform the examination. An external examination will be performed looking at your skin, assessing sensation, mobility, and manually checking your strength. The internal assessment will be guided by you. No instrumentation will be used. This is performed using one digit.

Yes. Taking a proactive approach is the best way to prevent urinary incontinence. Even if you are feeling fine during your pregnancy and especially postpartum, the best thing you can do for your body is to see a women’s health physiotherapist to assess your core and pelvic floor. This applies to those that have never had children and are experiencing these symptoms.

You should call your clinician if you are experiencing any urinary leakage, even if it is occasional. This is extremely common in women, however it is not normal and should be addressed. You should also schedule an appointment if you have urinary incontinence that has not improved with other treatment options, if you have a surgery scheduled, or after surgery. If surgery is required, a collaborative approach with your surgeon and women’s pelvic health physiotherapist is recommended to ensure a successful outcome.

These are common, but not normal and should be addressed. Waiting to see if your symptoms resolve on their own is taking a reactive approach. We recommend making an appointment with your women’s health hpysiotherapist for a full assessment to improve your symptoms and determine if a referral is needed.

Foundation Pilates is a method of exercising that targets your deep postural muscles, training them to work better to control your lumbar spine and pelvic joints. This is treating “the cause” rather than just treating the symptoms. Foundation Reformer Pilates offers individually prescribed exercises in a 1.2.1 environment, after a full assessment, by the instructor, we have two who are experienced with pelvic health recovery.

Once per week is the minimum you should do Reformer Pilates initially. Foundation Pilates is a “skill” more than “fitness”, just like learning a new tennis shot, or golf swing. If you have a lesson once per week, you will learn to play tennis. If you have a lesson twice a week, you will learn to play faster. When your body is learning something new, it is important to regularly attend your classes, or perform your exercises. This is how your neural pathway learns most effectively.

We encourage you to maintain an exercise routine, however some exercises may be worsening your urinary incontinence, which could lead to other complications, such as pelvic organ prolapse. Your Women’s Health Physical Therapist will be able to guide you to find an exercise that is safe for you to do.

This depends on a few factors: compliance with the protocol your women’s health physiotherapist provides you, complications with pregnancy/delivery, and illness or injuries can cause a recurrence of UI. The best way to prevent this from returning is to maintain a healthy and active lifestyle and follow up with your provider and physical therapist if you have any concerns.
Conditions that pelvic health physical therapists treat include:
• Stress urinary incontinence
• Urge urinary incontinence and urinary urgency
• Urinary frequency and nocturia
• Pelvic organ prolapse
• Post-gynecological surgery management
• Pre- and post-natal care, including pregnancy-related pelvic girdle pain, abdominal separation and mastitis
• Pelvic pain including vaginismus, dyspareunia and chronic pelvic pain.

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