Incontinence is a term used to describe any involuntary or accidental loss of urine from the bladder (urinary incontinence) or bowel motion, faeces or wind from the bowel (faecal incontinence.) Incontinence is a varying condition which ranges in severity from leaking a small amount of urine, all the way through to a total loss of control of the bladder and/or bowel. The important thing to note with incontinence is that it is very treatable and at times also curable. Incontinence is a common and widespread condition with over 4.8 million Australians and 1 in 3 women experiencing bladder or bowel control problems across their lifespan.
The Pelvic Floor
The pelvic floor is a group of muscles which originates from the tailbone at the back and stretches like a hammock to the pubic bone at the front. The pelvic floor acts as a support to the bladder, bowel and uterus (in females.) The urethra (urine passage), vagina and rectum all pass through the muscles of the pelvic floor which allows the pelvic floor to control the opening of the bladder and bowel and therefore maintain continence. When there is dysfunction or weakness in the muscles of the pelvic floor, proper contraction of these muscles does not occur in a timely fashion, resulting in the urethra and rectum being uncontrolled and ultimately resulting in incontinence of the bladder or bowel.
Urinary incontinence is a very common condition commonly associated with pregnancy, childbirth, menopause and several unrelated conditions such as asthma, diabetes and arthritis. Urinary incontinence can range from small leakage of a few drops of urine, right through to total loss of control of the full volume of the bladder. There are two distinctive types of urinary incontinence, of which we will go into greater depth below; stress incontinence and urge incontinence. Urinary incontinence is multi causational and varies dependent on each individual. Urinary incontinence can however be treated, improved in most cases and in a number of instances, it can also be cured.
Faecal incontinence or poor bowel control is the condition of difficulty in controlling the bowels and the release of faeces or wind. Like urinary incontinence there is a large scope or span to faecal incontinence ranging from the unintentional passing of wind and staining of the underwear, right through to the total loss of the contents of the bowel.
Faecal incontinence is less common than urinary incontinence (1 in 20 Australians experience faecal incontinence in their life) and is also more complex and more multifaceted in nature than urinary incontinence. Commonly individuals who experience faecal incontinence also experience urinary incontinence. The most common causes of faecal incontinence are:
- weak pelvic floor muscles due to pregnancy and childbirth, older age, surgery or radiation therapy
- Severe diarrhoea
Stress incontinence is the leaking of urine during activities which increase the intra-abdominal pressure (pressure inside the abdomen) and push down on the bladder. Stress incontinence is a result of pelvic floor muscles that are unable to contract with force or speed great enough to counteract the pressure within the abdominal cavity and on the bladder. This imbalance results in the pelvic floor “failing” and leaking of urine occurs as a result. Stress incontinence is most common in high impact activities or activities which increase the intra-abdominal pressure such as laughing, sneezing, jumping, lifting and running. Stress incontinence at times can be closely linked to pregnancy, with the weight of the growing foetus placing stress and strain on the pelvic floor muscles for 9 months, leaving them stretched and weakened. This then results in the pelvic floor being unable to contract properly resulting in urinary incontinence during moments of high intra-abdominal pressure. During the later years of life, females have a drop in the hormone oestrogen which helps to maintain the thickness of the urethra lining. With this reduced oestrogen production the urethra lining thins and can lead to the urethra not properly sealing after the passing of urine resulting in urinary incontinence. Women are not the only ones who experience stress incontinence, after prostate surgery a number of men develop stress incontinence for the 6-12 months post-surgical intervention.
The second most common type of incontinence is referred to as urge incontinence (sometimes referred to as an overactive bladder or an unstable bladder.) In a normally functioning bladder, the muscle of the bladder (also known as the detrusor muscle) remains in a relaxed state as the bladder slowly fills with urine. The bladder stretches as it fills and when it is approx. 50% full, the nerves of the bladder let the brain know that the bladder needs to be emptied soon.
In most individuals at 50% full the pelvic floor remains contracted and the detrusor muscle remains relaxed until the individual finds a convenient time to go to the toilet. In an overactive bladder (such as with urge incontinence) the bladder can often feel a lot fuller than it actually is, which can result in the detrusor muscle contracting too early to empty the bladder. This can lead to a very sudden feeling of needing to go to the toilet and being unable to hold on and also can often result in a small amount of urine leakage prior to getting to the toilet.
Often individuals with urge incontinence will also need to frequently pass urine and can wake several times each night to do so (frequent urination at night time is referred to as nocturia.) The cause of urge incontinence is not wholly understood however there appears to be a trend that symptoms worsen as we age. Symptoms also appear to be worsened at times of high stress ad with the ingestion of diuretics such as tea, coffee, fizzy drinks and alcohol.
The Role of Physiotherapy in Incontinence
Physiotherapists play a vital role in diagnosing, assessing, managing and treating both urinary and faecal incontinence. Through taking a thorough and extensive history, your Physiotherapist can advise you on small life changes which can positively impact your incontinence symptoms. Your Physiotherapist can also provide you with instruction and discussion on the importance of the pelvic floor and exercises to strengthen the pelvic floor which can result in the reduction of stress and urge urinary incontinence.
Here at Lifeline Physiotherapy we have had several years in advising and treating patients with Pelvic Floor Dysfunction. Providing you with the most recent evidence and making small, manageable changes to your everyday life can at times make a large difference in incontinence. Please contact us on 9306 9266 or go online to our website http://www.lifelinephysiotherapy.com.au/ to book your appointment or pop into our practice to discuss your continence concerns.
- Post-Operative Care
- So, you have just had surgery and are unsure what is to be done next. It is definitely the right time for you to call us and seek information. Surgery is just the first step and we will follow through by ensuring you regain normal function.Our physiotherapists are trained in giving you the right treatment for you to achieve full recovery post-surgery.
- Corporate Health
- Sitting is the new smoking. Sitting for more than a couple of hours a day can affect your posture, mood, lifestyle and health.We at lifeline Physiotherapy will give you a thorough insight of how to setup your desk i.e.: ergonomic setup. We can recommend either a stand-up desk or other options for your employer to assist you with.
- Gym Rehabilitation Programs
- Exercises are commonly used to address nerve, joint, muscle or ligament issues and we are experts at this. We have the right knowledge to assist with the biomechanics of your body and give you appropriate exercises for injury prevention.
- Motor Vehicle Accidents
- Whiplash Associated Disorders commonly take place following a motor vehicle crash. This occurs due to the sudden forces of acceleration and deceleration being placed on the spine.Lifeline Physiotherapy understand the repercussions following such an injury and encourages you to come see us to protect further symptoms. We are well aware of the management and treatment required and will go the extra mile to assist you with recovery.
- Dry Needling
- Often you will find that massage doesn't cut it and minutes later you are tight or stiff again. Dry needling is a good option to release tight trigger points, increase blood flow into the area promoting healing.Dry needling can be used to increase muscle length and function, ease pain and reduce swelling
- Pilates incorporates low impact exercises for all ages and levels of fitness. It is used to strengthen the core and stabilize the spine. These exercises are gentle and focus on spinal articulation, breathing and stability.
- Sports Physiotherapy
- Our physiotherapists have extensive knowledge on injuries that can arise while playing sport. Our practice principal has been involved in many sporting clubs such as Ingelwood uniter and Balcatta Soccer Club. Athletes and those who love to be active put extreme demand and stress on their bodies, in particular their muscles and joints and sports physiotherapy can help deal with pain, improve performance and function and prevent future damage and injuries.Sports physiotherapy may include a customised gym rehabilitation program, hands-on treatment, taping and exercise and stretch prescription.
- Geriatric Care
- At Lifeline physiotherapy, we provide specialized treatments for seniors as we understand what a toll it can take on you with joint replacements, or having to deal with osteoporosis or osteoarthritis.The aim for geriatric care it to address your needs whether it be improving your sleep or mobility to reducing your pain and discomfort. We understand ailments you can have as you age and are passionate about helping you with them.