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Incontinence and physiotherapy

That little bit of urine that escapes when you sneeze or cough is just a side effect of having babies or ageing, right? Not at all. An expert explains the link between incontinence and physiotherapy in women.

Stress incontinence – an involuntary emission of urine when pressure in the abdomen increases suddenly – is a fairly common condition in South African women. And in almost all cases, it’s treatable and even completely fixable with physiotherapy. But first, your medical practitioner has to know about it.

‘South Africans are generally quite conservative, and particularly in the case of older women, incontinence isn’t something they like to talk about,’ says physiotherapist Carren Hughes, who works out of Mediclinic Sandton. ‘But leaking urine isn’t a normal part of ageing. It’s not something that everyone should just expect to happen and have to live with.’

Carren says younger South African women are more inclined to be honest about incontinence. This is the group whose incontinence may have been triggered by a heavy pregnancy or difficult delivery, or by a vaginal delivery. Hoewever, Carren adds, ‘Even women who’ve delivered via C-section can experience incontinence, as the pregnancy puts pressure on the bladder and urethra. If after your six-week checkup you’re still peeing a bit when you cough or sneeze, you need to see a physio.’

What causes incontinence?

There are three different types of incontinence, says Carren: stress incontinence, an overactive bladder, and mixed incontinence.

She sees stress incontinence most often. ‘It’s usually caused when the pelvic floor muscles don’t do their job properly.’ The pelvic floor muscles are like a hammock that supports the bladder and uterus, and also wrap around the urethra, rectum and vagina.

‘Women who’ve given birth often experience stress incontinence. However, it also affects women who have exercised very little throughout their lives and whose muscles, as a result, are weaker than they should be, including their pelvic floor muscles,’ Carren explains.

On the other side of the scale are professional triathletes, ballerinas and gymnasts whose pelvic floor muscles are so tight that they can’t contract enough to properly close the urethra when necessary.

Stress incontinence can also be caused by many years of chronic constipation, says Carren, with the constant bearing-down pressure having strained the ligaments that hold onto the bladder.

An overactive bladder can also cause incontinence, says Carren. This may manifest as a sudden strong urge to wee even when your bladder isn’t full or your bladder may not empty completely when you go to the toilet, and end up leaking. This is usually a neural (brain-bladder) issue, and needs to be managed by a urologist. ‘We as physiotherapists often work together with a urologist in cases like these, to advise on lifestyle and habit changes as well as bladder retraining,’ says Carren.

It’s common for women to experience mixed incontinence, which is a combination of stress incontinence and an overactive bladder. This may, for instance, be triggered by hormone fluctuations as a woman enters menopause, and be aggravated by weak pelvic floor muscles.

How does physiotherapy help incontinence?

‘Your physio will assess the strength and coordination of your pelvic floor muscle contraction and function, and perhaps test the strength of the muscle contraction by electromyography, which measures the electrical activity of muscles during rest and contraction,’ Carren explains. ‘Our treatment includes neuromuscular stimulation to stimulate very weak muscle contraction.’

A strengthening programme may be drawn up for the patient, and the physiotherapist will teach her how to do pelvic floor exercises correctly. If the muscles are too tight, the physio will work to release pelvic floor muscle spasm.

Bladder retraining is another technique. ‘Bladder retraining aims at resetting the brain-bladder communication by changing the volume, type and frequency of fluid intake, as well as the timing and frequency of going to the toilet,’ says Carren.

‘Correct posture on the toilet, plus relaxation and breathing techniques, can help with chronic constipation to prevent incontinence.’

In the interest of our patients, in accordance with SA law and our commitment to expertise, Mediclinic cannot subscribe to the practice of online diagnosis. Please consult a medical professional for specific medical advice. If you have any major concerns, please see your doctor for an assessment. If you have any cause for concern, your GP will be able to direct you to the appropriate specialists.