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What is incontinence?

Incontinence is the accidental or involuntary passing of urine.  The NHS estimates that 3-6 million people have some degree of incontinence in the UK.  It is more common in females, with women 5 times more likely to suffer compared with men.  In fact, they predict that half the female population will experience incontinence at some time in their lifetime.  Unfortunately, only 1 in 5 women affected will seek help for their symptoms.  So, you are not alone in your symptoms and you are doing better than most in seeking help.

Let’s look first at a healthy bladder.  The bladder is a pelvic storage organ that holds the urine that is made in the kidneys. Once the bladder is half full, around 200-300mls, it will send a message to the brain that you will soon need to go to the toilet.  You will then have plenty of time to find a toilet.  When passing urine, the outlet muscles; the pelvic floor and sphincters, relax and the bladder contracts to release the urine. 

In stress urinary incontinence, there is leaking of urine when there is an increase of intra-abdominal pressure, such as when you sneeze, cough, laugh or jump.  This is often due to the pelvic floor not being strong or quick enough to withstand the extra pressure.  The pelvic floor can become weaker for a number of reasons. During pregnancy the weight of the baby can stretch the pelvic floor and this often worsens with the more babies you carry.  Your pelvic floor can become weakened or damaged in childbirth, especially if they need to use assistance (forceps, suction), you have a prolonged pushing phase, you have a severe perineal tear or if you deliver a large baby (over 4kg).  You can also suffer with incontinence if you have never been pregnant or had a baby.  In fact, any activity that regularly puts increased pressure on the pelvic floor can stretch and weaken them.  Having a persistent cough, constipation, being overweight or having a job that involves lots of heavy lifting.  Unfortunately, just aging weakens the pelvic floor!  During menopause there is a reduction in oestrogen which is needed for collagen health (collagen supports the muscles) and for thickening the urethral lining which acts as a seal after passing urine.  But don’t be disheartened, we can strengthen the pelvic floor with training!

In urge urinary incontinence, or sometimes called overactive bladder, the bladder contracts too early and you suddenly get the need to go to the toilet.  The cause here is often an overactive bladder muscle.  If you suffer from this type of incontinence, you may adopt some bad habits to try and manage your symptoms. Habits such as reducing your fluid intake, which can dehydrate and therefore irritate your bladder more, or going to the toilet ‘just in case’.  If you force yourself to go to the toilet before the bladder has filled you can make the bladder more sensitive or ‘twitchy’ which may in fact worsen the bladder muscle overactivity. Physiotherapy can help with bladder retraining or trying to break these bad habits and give you the confidence in your bladder again.

Don’t suffer in silence, let us help you with women’s health physiotherapy!

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