Tag Archives: Pelvic health

Leakage of urine, Pelvic Health, Pelvic health physiotherapy

Incontinence: What To Do When You Can’t Control Your Bladder

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What is urinary incontinence?

Urinary incontinence is when person leaks urine by accident due to loss of control of the bladder muscles. The severity of incontinence may vary from occasional incidents, like leaking while coughing or laughing, to more severe like having sudden strong urges where you are unable to make it to the toilet in time.

How does the bladder function normally?

These organs make up our body’s urinary system, which is how our body creates and removes urine from the body

Normally, the brain and the bladder work in close partnership to control urination. First, urine gets stored in the bladder until it receives the signal from brain to empty it. The bladder is one of the pelvic organs, meaning that the pelvic floor muscles provide support to it and hold it in the proper position. Usually, the bladder muscle stays in the relaxed position while it holds urine. At the same time, the urethra, which is the tube that carries urine out of the body is closed by a sphincter (controlled by the bladder muscle), so that urine doesn’t leak. Once you receive the signal from the brain, the bladder muscle contracts, opening up the sphincter and lets the urine out of the urethra.

What are the different types of urinary incontinence?

  1. Stress Incontinence

Stress incontinence is where the leaking occurs with several activities of daily routine like coughing, sneezing, running, laughing, jumping, exercising or lifting heavy. These activities exert lots of pressure on the bladder due to weak pelvic floor muscles, results in urine leakage. As expected, the chances of leaking increase the fuller the bladder is. This is one of the most common types of incontinence, especially in elderly women. However, unlike some people believe, urinary incontinence is not a normal sign of aging. Instead, it is a problem which should and can be properly treated.

Risk factors for stress incontinence:

Postpartum women are at a high risk due to damage to tissues or nerves that may occur during delivery. Women with vaginal and forceps delivery are also at higher risk than with c-section
or vacuum delivery. Additionally, men after prostate surgery can develop this. For example, the removal of the prostate gland in cancer patients may weaken the sphincter muscles which lies below the prostate gland.

Othe contributing factors include:

  • Chronic illness with high frequency of coughing
  • Smoking which can cause frequent coughing
  • Obesity: Excess body weight puts more pressure on pelvic organs and can lead to stress incontinence
  • History of pelvic organ prolapses: Depending on the level of prolapse, mild bladder prolapse can cause occasional incontinence.

2) Urge incontinence

It is a type of incontinence that causes the sudden urge to void the bladder and results in involuntary leakage of urine. In other words, you may leak the urine before you reach the bathroom.

Urge incontinence is most commonly associated with an overactive bladder. The muscles in the bladder squeeze more frequently than normal. As a result, you feel like you have to use the bathroom frequently even though the bladder is not actually full.

Risk factors for urge incontinence:

  • Diabetes: Uncontrolled blood sugar levels can lead to increased chance of urinary tract infection and frequent urges to urinate. People with uncontrolled sugar levels may have damaged the nerve controlling the bladder, leading to urge incontinence.
  • Hysterectomy: Damage to the nerve around the bladder during this procedure can lead to incontinence
  • Spinal cord damage due to direct trauma or injury
  • Stroke
  • Prostate problems like prostate cancer or an enlarged prostate

How can incontinence be treated?

Incontinence can be treated through consultation with a specialist. It is important to gain the proper education and understand the condition of incontinence. A pelvic health physiotherapist can help you understand the basic function of the urinary system. With this understanding, they can teach you different techniques to control the leakage, frequency, and urgency of it.

For example, some of these techniques may include:

  • Toileting positioning education regarding proper liquid intake and its importance
  • Breathing exercises
  • Double voiding methods
  • Keeping a log of urinary leakage (bladder diary)
  • Pelvic floor strengthening exercises
  • Electrical stimulators
  • Internal manual techniques

How do I get help?

Our physiotherapy clinic PhysioNow has 9 locations to serve you across the GTA, from Burlington to Etobicoke

At PhysioNow, our pelvic floor physiotherapists can guide you in your recovery from incontinence and other pelvic-related conditions.  With locations across the GTA including Burlington, Oakville, Mississauga, and Etobicoke, we will have a location suited to you. Book with PhysioNow today for your first assessment and treatment.

General Category, Pelvic health physiotherapy, Physiotherapy, Pregnancy

Why You Should Do Pelvic Floor Muscle Training During Pregnancy

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Pelvic floor muscle training, when done in a structured way, helps to prevent certain complications during pregnancy and labour. These changes occur due to hormonal and anatomical changes. The complications that usually occur are incontinence, perineal tears, pelvic organ prolapse, less active pushing required during second stage of labour.

Why is pelvic muscle training important?

Pelvic Floor Muscles

Pelvic Floor Muscles

The pelvic floor is a set of muscles attached to the spine at the back and to the pubic bone at the front.  Importantly, these muscles are the key supporter for the uterus, bladder and bowel. Some activities of daily living help women maintain their pelvic floor strength to functional level. Unfortunately, pregnancy and childbirth lead to the potential injury and weakening of these muscles. As a result, pelvic floor dysfunction is common after childbirth. This includes urinary incontinence, pelvic organ prolapses, dyspareunia and perineal tears. Significantly, this reduces the quality of life in women and cause them to withdraw from fitness.

Structured pelvic floor training help to prevent or reduce these complications. First, it helps to elevate pelvic organs and the resting position of bladder to improve incontinence and prolapse.  Also, training during the antenatal phase reduces the active pushing required during the second stage of labour. Additionally, it improves incontinence by improving co-contraction of the pelvic floor muscles as the abdominal pressure increases. Overall, correct pelvic floor muscle contraction is the key factor to achieving the benefits of pelvic floor muscle training.

What happens to the pelvic floor during pregnancy and childbirth?

First, pregnancy usually leads to the decrease in levator ani strength (one of the major pelvic floor muscles) and anatomical changes occur such as downward movement of the bladder neck, increase in bladder neck mobility, downward movement of pelvic organs, and decrease in urethral resistance due to increased pressure from the growing uterus. As the gestational age increases, so too does the weight of the uterus leading to the pelvic floor being oppressed. As a result, there can be damage to the muscles and nerves.

Secondly, during pregnancy a large amount of progesterone is secreted to maintain pregnancy. Notably, progesterone is a smooth muscle relaxant. The pelvic floor has high amounts of smooth muscle, meaning progesterone may decrease pelvic floor support and urethra tension.  In conclusion, the mechanical and hormonal changes of pregnancy may have an irreversible effect on the pelvic floor. They need to be addressed at the right time through pelvic floor muscle training which is achieved through pelvic health physiotherapy.

Also, during labor, when there is vaginal surgical delivery (episiotomy), a large fetal head or a long second stage of labour, it will lead to damage in the pelvic floor muscles if they are too tight or the perineal area has less flexibility. Vaginal surgical delivery, large fetal head circumference and a prolonged expulsive stage are risk factors for a labour-associated pelvic floor injury.

Effect of pelvic floor muscle training during pregnancy and after childbirth

  1. Firstly, training during pregnancy helps to prevent developing urinary incontinence and can significantly improve the strength of pelvic floor muscles.
  2.  Secondly, exercises with a perineometer in the post-partum period are helpful in restoring the function and tone of the muscles. Importantly, this aids in preventing early cystocele and rectocele by limiting the movement downwards and improving the vaginal muscles for the retention of contraceptive diaphragm. The “Perineometer,” is an instrument that provides a visual guide to the patient during her exercises.

    Perineometer

    Perineometer for pelvic muscle training

  3. Next, training improves the neuromuscular activity of the pelvic floor in many motor tasks after a partial denervation of nerves in after the first pregnancy.
  4.  Furthermore, training helps to treat nonspecific low back pain and pelvic girdle pain during pregnancy as pelvic floor muscles provide stability to the spine.
  5. Additionally, training helps to shorten the second stage of labour and reduce perineal tears by improving the flexibility, strength and motor control. Overall, this may reduce the need of assisted delivery through forceps and episiotomy.
  6. Lastly, female sexual dysfunction after delivery can be treated by pelvic floor muscle training as it increases the flexibility of the pelvic floor to help the vagina feel looser and relax.

 

Considering all the positive effects of pelvic floor muscle training during and after pregnancy, it is highly recommended to see a trained pelvic floor physiotherapist. They will guide and train the pregnant women at the right time to prevent or treat any of the pelvic floor disorders.

If you are experiencing pelvic pain or are interested in pelvic floor muscle training, PhysioNow has experienced pelvic health physiotherapists that would love to assist you. Book with PhysioNow today for your first assessment and treatment!