To say that accidental urine leakage is unpleasant is an understatement. Incontinence can leave you with lingering anxiety and lower self-esteem. It can also cause social withdrawal, especially when left untreated for a long time.

Treatment options depend on the type of incontinence and the underlying cause. Women’s physiotherapy for continence can help you treat, manage, and reduce symptoms, and even completely cure the condition.

What is Incontinence?

Accidental urine leakage, also known as incontinence, is a condition where an individual is unable to control their bladder or bowel movements resulting in involuntary leakage of urine or faeces. It can be caused by a variety of factors such as muscle weakness, nerve damage, certain medical conditions, or medication side effects.

Both men and women can suffer from incontinence, but the condition is more prevalent for women. Female incontinence affects up to 38% of Australian women. Pelvic floor trauma with childbirth, menopause, hysterectomy, obesity, and cognitive impairment are the most common reasons for female incontinence.

The pelvic floor (PF) consists of passive and active components that support the bladder, reproductive organs, and rectum. In women, proper functioning of the soft tissue components, including the urethra, vagina, and rectum, is ensured by the appropriate coordination of their opening and closing movements. Ligaments, fascia, and muscles surrounding the pelvic floor play a role in posture, labour, and continence.

Types of Incontinence

Incontinence is categorised based on the expressed symptoms:

• Stress incontinence: When your bladder leaks urine under pressure, for example, during sneezing, laughing, or coughing.
• Urge incontinence: When the urine leaks as you feel a sudden uncontrollable urge to pee.
• Mixed incontinence: A combination of urge and stress incontinence, it can show up even during standing up.
• Overflow incontinence/Post void leakage: When you can only release a small amount of the bladder or bowel, and a small amount leaks involuntarily afterwards.

There are several treatment options for incontinence, and the best option depends on the type of incontinence and the underlying cause. Physiotherapy can help by strengthening the pelvic floor muscles and is usually the first-line treatment before undertaking a more invasive procedure.

How Can a Physiotherapist Help with Incontinence?

A women’s health physiotherapist can help with incontinence by assessing your individual condition and determining the underlying cause.

They can then design an individualised exercise program to target specific muscles, such as the pelvic floor muscles, which help to control the bladder and bowel. These exercises, known as pelvic floor muscle exercises, can help to strengthen the muscles and improve their function, which can help to reduce or eliminate incontinence symptoms.

In addition to exercises, the physiotherapist can:

• Teach you how to properly perform each exercise
• Provide feedback to improve your technique
• Educate you on bladder and bowel habits
• Advise daily strategies to manage incontinence

In certain situations, physiotherapy for incontinence may also provide relief from associated conditions, such as pelvic pain, back pain, or sexual dysfunction. In such cases, physiotherapy can be an important part of a multidisciplinary treatment approach.

Diagnostic Evaluation for Urinary Incontinence

To evaluate a patient with complaints of urinary incontinence, the healthcare professional will undertake some or all of the following steps:

1. Ask you about your medical history: You will be guided to provide information about your symptoms, past medical conditions, and any medications you take.
2. Perform a physical exam: The healthcare professional will perform a pelvic examination to look for any physical abnormalities that may be contributing to the incontinence.
3. Do a urinalysis test: A urine sample will be analysed to discover signs of infection or other abnormalities.
4. Recommend you keep a bladder diary: You will be asked to record the frequency and volume of urination, as well as any accidents or leakage for several days.
5. Urodynamic testing: This test measures the pressure and flow of urine to determine the function of the bladder and urethra.
6. Imaging: Depending on the results of the above tests, you may need to take an ultrasound or MRI to further evaluate the bladder and surrounding structures.

Common treatments for incontinence include medications, electrical stimulation, nerve stimulation, sacral nerve modulation, surgery, bladder retraining, and injectable treatment.

Treating Urinary Incontinence with Physiotherapy

Physical therapy for incontinence typically involves exercises and techniques to strengthen the muscles of the pelvic floor and improve their function. Some common types of physical therapy used for incontinence include:

Pelvic Floor Muscle Exercises (Kegel exercises)

These exercises involve repeatedly contracting and relaxing the muscles that control the bladder and bowel area.

Biofeedback

This technique uses electronic devices to help the patient learn to contract and relax the pelvic floor muscles correctly by gaining greater control of wilful manipulation.

Neuromuscular Electrical Stimulation (NMES)

This technique uses electrical impulses to stimulate the pelvic floor muscles and help them contract. NMES increases muscular strength and range of motion and counterbalances the effects of disuse.

Manual Therapy

Manual techniques include hands-on techniques for soft tissue mobilisation, joint mobilisation, and manipulation to improve the function of the pelvic floor muscles.

Myofascial Release

This technique involves the use of soft tissue manipulation to release tension and improve flexibility in the muscles of the pelvic floor. The focus is to work on the fascia — the tough membrane wrap that connects and supports the muscles.

Specific types of physical therapy used may vary depending on the individual case, the healthcare professional’s expertise, and the availability of the devices required to perform the treatment.

Overcoming Incontinence with Pelvic Floor Muscle Exercises

Pelvic floor muscle exercises are often placed among the most effective treatments for stress and urge incontinence in women. These exercises involve repeatedly contracting and relaxing the muscles that control the bladder and bowel and can help to strengthen the muscles and improve their function.

For stress incontinence, pelvic floor muscle exercises are usually most effective when combined with weight loss, smoking cessation, and avoiding cough and sneezing.

Some examples of pelvic floor muscle exercises include:

• Slow contractions: Tighten the pelvic floor muscles as much as possible and hold for a count of 10, then relax for a count of 10. Repeat 10 times.
• Quick flicks: Tighten and release the pelvic floor muscles quickly and repeatedly, as if trying to stop the flow of urine. Repeat 20 times.
• Sustained contractions: Tighten the pelvic floor muscles as much as possible and hold for a count of 10, then relax for a count of 10. Repeat 10 times.
• Gradual release: Tighten the pelvic floor muscles as much as possible and hold for a count of 10, then slowly release the muscles over a count of 10. Repeat 0 times.

While the above are examples of pelvic floor exercises, it is important to have the pelvic floor assessed so exercises can be prescribed to manage the specific muscular dysfunction causing the incontinence.

These exercises should be done regularly, ideally daily. It is important to consult with a physiotherapist to ensure that you are performing the exercises correctly, as well as to monitor your progress.

How to Do Kegels for Urinary Incontinence?

To do Kegel exercises, it’s important to identify the correct muscles. To do this, try to interrupt the flow of urine when using the toilet. The muscle you use to do this is the pelvic muscle you should contract during the exercise.

Once you have identified the correct muscle, you can do the exercises in any position, whether sitting, standing, or lying down.

The basic steps for Kegel exercises include:

• Tightening or contracting the pelvic floor muscles for 5 seconds
• Relaxing the muscles for 5 seconds,
• Do this process for 10-15 repetitions.

You can extend the duration of contraction as your PF muscles grow stronger. Kegel exercises may take several weeks or months to have an effect, and it’s best to check with a physiotherapist to ensure that you’re doing the exercises correctly.