What is incontinence?
Incontinence is a term that describes any accidental loss of urine from the bladder (urinary incontinence) or bowel (faecal or bowel incontinence).
Common types of incontinence are:
- Stress urinary incontinence, which is bladder leakage with coughing, sneezing or during exercise and sport.
- Urge urinary incontinence is bladder leakage associated with a strong urge to empty the bladder “when you have to go, you have got to go!”
- Post prostatectomy incontinence which is bladder leakage following prostate
- Anal incontinence is difficulty controlling wind or stool and may be associated with a sudden urge to empty to the bowel or may occur without the person being aware until the next time they go to the toilet.
How common is it?
Bladder leakage affects 30% of women and 10% men, and although it is very common it is not normal. The symptoms of urinary incontinence may start with an occasional leakage of urine with coughing, sneezing or whilst trying to get to the toilet on time. If left untreated, leakage that initially occurs only occasionally may start happening every day.
Bowel leakage occurs in 3-10% of men and women but is often not talked about. Some people feel that they do not empty their bowels completely or may have soiling after using their bowels. This can occur with a looser bowel motion or may be associated with constipation.
Although incontinence is not a life-threatening condition it can affect a person’s quality of life and incontinence is often cited as one of the major reasons for older persons requiring nursing home care. It is, therefore, better to seek incontinence care, even when the symptoms may seem mild.
Bladder and bowel leakage can be a sign that the pelvic floor muscles are not functioning properly.
The myths about incontinence
✖ Incontinence is just a sign of old age
✖ You just have to live with incontinence
✖ I am too old to do anything about it
✖ Pelvic floor exercises won’t work for someone like me
✖ Light bladder leakage is normal
✖ Wearing a pad is the best solution
✖ Drinking less fluid will improve incontinence
✖ Surgery is the only successful treatment for incontinence
The facts about incontinence
✔ Incontinence occurs in people of all ages, and affects men women and children
✔ Age is no barrier to improvement
✔ The sooner you seek help the better
✔ Mild incontinence symptoms are an early warning sign to get help
✔ Incontinence can be greatly reduced or eliminated by seeing a pelvic health physiotherapist
✔ Pelvic floor exercises are recommended by the International Continence Society as first line treatment for incontinence before surgery
✔ An Australian study showed 83% of women with stress incontinence (leakage with cough, sneeze and exercise) significantly improved in 1-5 treatments with a continence physiotherapist
Risk factors for incontinence
Pregnancy, childbirth, menopause, older age, constipation, chronic coughing, being overweight, recurrent bladder infections, heavy lifting or high impact exercise, and pelvic surgery such as prostate and gynaecological surgery may increase your risk.
Assessment of incontinence
At Body Logic Physiotherapy our Pelvic Health physiotherapists have completed advanced postgraduate training in the treatment of incontinence.
Firstly, it is important to understand the factors that cause your incontinence symptoms and the impact that this has on your life. Our physiotherapists will take a thorough history, screen for factors that could be influencing your problem and establish your goals for treatment.
Following this we will conduct a comprehensive assessment of your condition including assessment of your ability to perform correct pelvic floor muscle contractions. Assessment of the pelvic floor muscles can be done fully clothed using real-time ultrasound. For a more comprehensive assessment of pelvic floor muscles a direct assessment can be performed via a vaginal or rectal assessment. This method is recommended for an accurate assessment of the strength of the pelvic floor muscles and the urinary and anal sphincters. The method of assessing your pelvic floor muscles is always your choice and will be thoroughly explained and based on your consent.
Following the assessment, we will explain to you in simple terms the factors that may be impacting on your problem and design a collaborative treatment plan to help you achieve your goals.
Treatment of incontinence and incontinence care
There is strong evidence that physiotherapy management should be first line therapy for incontinence before surgery is considered. Physiotherapy management includes pelvic floor and abdominal muscle training, bladder or bowel habit retraining. We can work with you to personalise a program that addresses lifestyle factors such as regular physical activity, sleep, diet and stress management.
Pelvic floor muscle training is an important part of any management program for the management of incontinence. Research has shown that pelvic floor exercises are difficult to perform correctly with up to one third of people performing exercises incorrectly and could be worsening incontinence symptoms.
We first teach you how to contract your pelvic floor correctly. Following this we will guide you in a progressive specific pelvic floor and abdominal exercise program. We will then integrate this into a generalised graduated exercise program based on your preference, starting with low impact exercise and building up as is necessary and aligned to your goals.
Incorporating your pelvic floor exercises into functional daily tasks is an essential as part of a self-management plan and is the key to controlling your symptoms in the long term. Research has shown that improvements can occur with 1-5 physiotherapy sessions.
Your physiotherapist is skilled in non-surgical management of incontinence and will identify additional factors that may need to be modified to optimise improvements and ensure they are maintained. We also work with your doctor if additional care is needed.
Children and adolescents – bladder and bowel problems
The journey through childhood and adolescence is a time of incredible learning, growth and development for both the mind and body. Problems with bladder and bowel control can greatly impact the life of a child and their caregivers, causing significant stress, anxiety, embarrassment and frustration.
Wee accidents or wetting in the daytime (daytime urinary incontinence), difficulties emptying the bladder, feeling of urgency or ‘busting’ a lot of the time, repeated urinary tract infections, and routinely delaying going to the toilet are common concerns raised by families. Bedwetting (enuresis) is also a problem for many children, and while often improving over time, in some cases this continues through primary school years and even in to adolescence.
Constipation is the most common bowel complaint, affecting approximately 10% of children. In the majority of cases, the constipation is functional, which means there is no underlying organic cause. Soiling issues (encopresis, or faecal incontinence) are often secondary to the constipation itself.
Children often present with both bladder and bowel concerns, which is rarely the result of poor behaviour or laziness. Our Pelvic Health Physiotherapists at Body Logic Physiotherapy have expertise in helping your child or adolescent with a thorough assessment to understand the underlying causes and issues that contribute to their toileting problems.
Age-appropriate education and practical advice for the child and parent form the basis of individualised management programs. Guidance on an appropriate toileting program, assessment and biofeedback using real time ultrasound, uroflowmetry, TENS and bedwetting programs are strategies that may be incorporated with consideration to your child’s needs. We also strive to collaborate with caregivers and other health providers to ensure your child is best supported in overcoming these challenges.
To learn more about incontinence and seek incontinence care, get in contact with us today.