By Angela Hewitt, Women’s Health Physiotherapist

Incontinence is the involuntary or accidental loss of urine from the bladder, or faeces/wind from the bowel.  According to the Continence Foundation of Australia: 1 in 3 Australian women experience urinary incontinence, and 1 in 20 experience faecal incontinence.  Prevalence increases with age and unfortunately none of us are getting any younger!  But it is important to note that incontinence is not a normal part of ageing nor is it a normal part of being a mum.   Only one third of people with incontinence seek help, but there is no need to suffer in silence – there is a lot that can be done!

There are several reasons why a person may leak; the two most common types of urinary incontinence are stress urinary incontinence (SUI) and urge urinary incontinence (UUI).

Stress Urinary Incontinence

Stress incontinence occurs when there is an increase in pressure in the abdomen such as coughing, sneezing, laughing, lifting, or exercising.  Pregnancy and childbirth are two big risk factors for developing SUI, as they stretch and weaken the pelvic floor muscles and the connective tissue supporting the bladder and urethra.  It is also more common in breastfeeding and post-menopausal women, when oestrogen levels are lower.  Oestrogen helps to maintain the thickness of the urethral lining, so when it drops the urethra cannot seal as well and urine leaks out.

There are surgical options to address SUI but the good news is, SUI is very responsive to conservative treatment.  Studies show that pelvic floor muscle training can improve or cure stress incontinence in 72% of women.  One particular manoeuvre taught by pelvic floor physios is “the knack”.  It involves consciously contracting the pelvic floor muscles before any increase in intrabdominal pressure.  Studies have found that within a very short period of using “the knack”, leaking on cough can be reduced by 73-98%.  This has nothing to do with strengthening, but more to do with timing and co-ordination of the muscles.

It is critical that the PFM contraction is performed correctly.  It is thought that around one third of women who think they are contracting correctly are in fact using a “bearing down” strategy instead of a “squeeze and lift” strategy, despite good instruction.  In fact, for some women strengthening is not the answer.  Some women have an overactive pelvic floor, meaning it is working too hard all day and when the time comes to sneeze/cough/laugh, the muscles are too tired to work effectively.  The best way to know for sure is to have an assessment with a pelvic floor physio.

Urge Urinary Incontinence

Urge incontinence is a completely different condition.  In this case, leaking occurs with a sudden desire to pass urine.  Often the woman is rushing to the bathroom but cannot quite make it in time.  It may occur together with frequency (passing urine more than 7 times/day) and nocturia (passing urine one or more times overnight).  When grouped together, these symptoms are called overactive bladder.  There are many other health conditions that can cause bladder changes such as pregnancy, diabetes, heart conditions, infection, neurological conditions, and some medications, so it is always a good idea to see your GP to rule these out.

In overactive bladder, the nerves in the bladder wall are a bit too sensitive.  They tell the brain that the bladder is full when really it isn’t.  The muscle around the bladder starts to contract or spasm involuntarily which creates a sudden sense of urgency to get to the bathroom.  Over time, this becomes a learned habit, and the bladder tries to empty frequently with small volumes.  It becomes very frustrating for the woman whose life is now ruled by her bladder!

Conservative management for urge incontinence can involve completing a bladder diary to determine the holding capacity and urge patterns, identifying any triggers (eg. running water), learning bladder calming strategies, retraining the bladder to fill and empty at normal intervals, identifying bladder irritants such as caffeine, alcohol and fizzy drinks, optimising fluid intake and bowel habits and sometimes using electrical stimulation to the nervous system to calm down the bladder.

These strategies are effective for many women, but for more stubborn cases your doctor can prescribe effective medications for overactive bladder.

Finally, some women have “Mixed urinary incontinence” which is a combination of SUI and UUI.  These women often need to work on both their bladder behaviour and their pelvic floor muscle strength/timing.

Simple steps you can take to prevent or reduce bladder problems:

• Remain active and maintain a healthy weight
• Drink 1.5L – 2.0L of fluid/day, mostly water. Drink more if you are breastfeeding, or sweating a lot while exercising/working
• Avoid bladder irritants such as caffeine, fizzy drinks, alcohol, artificial sweetener, citrus if you find they make you urgent
• Avoid emptying your bladder “just in case”. The bladder should fill to 350-500ml and empty 5-7 times/day if you are drinking 2L/day.
• Don’t hover over the toilet seat. Sit down, relax your pelvic floor muscles, and take your time to fully empty your bladder.
• Avoid constipation and straining – this can irritate the bladder and weaken the pelvic floor. Eat plenty of fruit and vegetables to achieve a regular bowel motion that is formed but soft and easy to pass.
• Maintain strong pelvic floor muscles – an assessment with a pelvic floor physio is a good idea to ensure you’re on track.
• Don’t be embarrassed to ask for help!