Urinary Incontinence is described as the involuntary loss of urine, which is objectively demonstrable, social and a hygienic problem (International Incontinence Society, ICS).
Urinary incontinence is common in females and has become more prevalent with ageing. A negative impact of urinary incontinence on quality of life and the symptoms thereof pose a stigma in society. People are often reluctant to seek help due to the embarrassing nature of the condition and the social stigma attached to the symptoms (Bardsley 2016).
Women often see urinary incontinence as a part of ageing and a so-called “normal” process. Still, many do not seek help unless their symptoms worsen and their quality of life, including social interactions, participation in society, mental health, sexual function, and physical function is negatively affected (Titman et al. 2019).
Classifications of incontinence
There are three classifications of urinary incontinence (Ghaderi and Oskouei 2014):
- Stress urinary incontinence (SUI) is described as the voluntary leakage of urine on effort or exertion activities such as sneezing or coughing (Ghaderi and Oskouei 2014). It is predominantly due to raised intra-abdominal pressure which puts an increased stress on the pelvic floor muscles.
- Urge urinary incontinence (UUI) is described as an involuntary leakage accompanied by or preceded by a powerful desire to void which cannot or is difficult to defer or withhold (Bardsley 2016). UUI is also associated with overactive bladder syndrome (OAB) which is described as an early or abnormal contraction of the bladder muscles during filling which then creates the sensation of needing to urinate. (Ghaderi and Oskouei 2014), (Bardsely 2016).
- Mixed urinary incontinence (MUI) is a combination of UUI and SUI and is described as the complaint of involuntary leakage associated with urgency and exertion, effort, sneezing or coughing (Ghaderi and Oskouei 2014).
Risk factors for SUI
• Smoking history
• Elderly population
• Neurological conditions such as strokes, prudendal (Latin, meaning external genitals) nerve damage
• Recurrent urinary tract infections
• High or frequent fluid intake especially of alcohol or caffeine to name a few
Physiotherapy and management of incontinence
Physiotherapists have a significant role to play in the assessment and management of the pelvic floor muscles (PFM) which ultimately contribute to the overall control of the bladder and urethral sphincter closure (Titman et al 2019). Pelvic floor muscle strengthening remains the first line of treatment for individuals with SUI (Bø 2020) and thus physiotherapists have the expertise to assess and treat PFM dysfunction which can lead to SUI.
Pelvic floor muscle strengthening:
The aim of PFM strengthening is to strengthen the levator ani muscles (pelvic floor) which allow for contraction and closure of the urethra and support of the pelvic organs, specifically the uterus, bowel, and bladder. The control and endurance of the pelvic floor muscles together with the core muscle activation of the abdominal muscles help to maintain contraction and closure which will ultimately prevent leakage of urine (Ghadheri and Oskouei 2014). Physiotherapy is aimed at activating and retraining the various pelvic floor muscles needed for contraction and for endurance in sustaining the contraction which is essential for managing the symptoms of SUI (Titman et al 2019).
Your physiotherapist will first assess the pelvic floor muscle function before moving on to PFM strengthening and exercises. Thereafter, they have the expertise to demonstrate and educate patients to correctly identify and activate the pelvic floor muscles with cues and supervision to learn the correct techniques before integrating this into other forms of functional exercises and daily activities, such as lifting, pushing, or pulling a load (Titman et al 2019).
Group exercises such as Pilates are found to be beneficial in improving self-satisfaction and management of SUI symptoms (Titman et al 2019). Titman et al (2019) also found that regular contact with healthcare providers and other patients diagnosed with SUI in a group setting can provide emotional support and empower participants to manage their symptoms with regular exercise.
Should you suffer from symptoms of SUI or any other type of incontinence, please feel free to contact a physiotherapist at your nearest Lamberti Physiotherapy branch for a comprehensive assessment, treatment, and exercise programme.
This article was submitted by Lamberti Physiotherapy Sandton.
- Bardsley A 2016 An overview of urinary incontinence. British Journal of Nursing 25 (18): In press http://www.magonlinelibrary.com/toc/bjon/current.
- Bø K 2020 Physiotherapy management of urinary incontinence in females. Australian Physiotherapy Association: Journal of Physiotherapy 66:147-154.
- Ghadheri F, Oskouei AE 2014 Physiotherapy for Women with Stress Urinary Incontinence: A Review Article. Journal of Physiotherapy Science 26: 1493–1499.
- International Continence Society (ICS) website: https://www.ics.org. Last accessed 14/03/2023.
- Titman SC, Radley SC, Gray TG 2019 Self-management in women with stress incontinence: strategies, outcomes and integration into clinical care. Research and Reports in Urology 111-121 [in press]:DOI: 10.2147/RRU.S177826.