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Taking Control: How Physiotherapy Can Treat Urinary Incontinence

Urinary incontinence can be quite an embarrassment, even potentially leading to anxiety and discouraging someone from going outside. Research shows that up to one-third of women will encounter urinary incontinence at some point in their lives. Surprisingly, even in young female elite athletes who have never undergone pregnancy, the incidence ranges from 28 to 52%. This is particularly observed among gymnasts, ballerinas, basketball players, tennis players, and track athletes.

For those of you who have successfully navigated the challenges of sports and childbirth without experiencing leaks, the onset of menopause and how it declines oestrogen levels can become a new challenge. Simply put, regardless of childbirth or lifestyle, urinary incontinence can affect anyone throughout the lifespan.

Let’s get into the different types of urinary incontinence!

  1. Stress urinary incontinence (SUI) is characterised by the involuntary loss of urine during strain, effort, or exertion. It is the most common type and is often associated with weakened pelvic floor muscles or damage to the connective tissue supporting the bladder. It’s important to note that there is a group of women with increased tone or overactive pelvic floor muscles who may also experience leakage, emphasising the importance of a pelvic floor examination to identify contributing factors. Usually, women with SUI may notice leaks during activities such as coughing, sneezing, jumping, or running, where the support structures struggle to actually support the urethra.

HOW CAN PHYSIOTHERAPY HELP MY SUI SYMPTOMS?

 

Research backs that physiotherapy serves as the first-line treatment for SUI. Treatment typically involves:

  • Conducting a comprehensive history and assessment to identify contributing factors.
  • Providing education and a personalised pelvic floor muscle training program.
  • Offering guidance on resuming activities or incorporating exercises as pelvic floor support improves.
  • In certain cases, consider a pessary as a supplementary measure.

 

What are my treatment options?

  • Do nothing
  • Medical management
    • Surgery: Pubovaginal sling, colposuspension, retropubic mid-urethral sling, transobturator mid-urethral sling
    • Urethral bulking agents: Urethral bulking involves an injection into the wall of the urethra usually of water-based gels or silicone substance, to help strengthen the muscle around it. Urethral bulking is not a first-line treatment for SUI.
    • Vaginal Estrogen: helps with vascularisation of the tissues around the urethra
    • Medication
  • Non-medical management
    • Lifestyle management: Addressing the modifiable risk factors (i.e avoid causes of constipation, maintaining weight within a healthy range) have shown to reduce the severity of SUI.
    • Pelvic floor muscle training:
      • The National Institute for Health and Care Excellence (NICE) guideline 2019 suggests that a trial of supervised pelvic floor muscle training (PFMT) of at least three and up to six months duration should be the first line of treatment for women with SUI. Evidence showed that PFMT is just as effective as surgery for around half of women with SUI. Up to 75% of women show an improvement in symptoms of leakage after PMFT.
    • Group exercise class led by a women’s health physiotherapist. It is shown that the success rate of pelvic floor muscle training varies between 60-75% under the supervision of a physiotherapist, whereas home training is less effective at 9-17% (Fitz et al, 2017).
    • Intravaginal devices (Contiform, tampon, pessaries): Intravaginal devices are intended to provide some support to the bladder neck and possibly some compression to the urethral to correct SUI (Bo et al 2017 ICS/IUGA).
  • Urge Urinary Incontinence (UUI) is the sudden, uncontrollable desire to urinate that leads to a leak. This may be triggered by stimuli like running water or inserting a key into the door upon arriving home. It’s important to note that urgency may or may not be accompanied by urinary incontinence.
  • Overactive Bladder (OAB) is frequently used interchangeably with UUI.

Women experiencing OAB typically report the following symptoms:

  • Difficulty in deferring the urge to pass urine, with or without leaking.
  • Frequent visits to the toilet.
  • Fear of urinary leakage, even in cases where it has never occurred.
  • Nocturia, or the need to use the toilet more than once during the night.

WHAT CAUSES OAB?

Up to 40% of adult females may experience OAB. Numerous factors can cause it, including pelvic floor weakness or overactivity, chronic constipation, pelvic organ prolapse, low oestrogen levels, bladder irritants (caffeine, artificial sweeteners, or carbonated drinks), and imbalances in fluid intake.

HOW CAN PHYSIOTHERAPY HELP MY OVERACTIVE BLADDER SYMPTOMS?

Since we already know that physiotherapy is the first-line treatment for urinary incontinence, best to make that visit now! Your physiotherapist may ask you to complete a bladder diary to provide detailed information about your bladder habits (Yes, you may need to measure your urine for 48 hours). Once we have taken a detailed history and performed our assessments, we may use some or all of the following strategies:

  • Bladder education
  • Bladder training
  • Bladder retraining and calming
  • Bladder drills
  • Pelvic floor muscle exercises
  • Transcutaneous Electrical Nerve Stimulation (TENS)
  • Teach you how to respond when urgency strikes
  • Breathing education
  • Musculoskeletal treatment to address other contributing factors to urgency
  • Medication advice from your doctor on calming the bladder
  • Mixed Urinary Incontinence (MUI) combines elements of Stress Urinary Incontinence and Urge Urinary Incontinence. Whether you’re dealing with a little or a lot of urinary incontinence, be it SUI, UUI, or MUI, conservative physiotherapy management, guided by a wellness health physiotherapist, can treat your incontinence.

If you are suffering from urinary incontinence, please call or WhatsApp us at 9780 7274, or email us at help@embracephysio.sg and let’s discuss a treatment that works for you.

Feel free to look through our website, where you can learn about other women’s health conditions we treat. This is a safe space where we can discuss how we can help you with physiotherapy.

Note: While I am a physiotherapist, I am not your personal physiotherapist. The contents of this website are for informational purposes only and are not intended to serve as personal medical advice.

References:

  1. Bo K, Frawley HC, Haylen BT, Abramov Y, Almeida FG, Berghmans B, Bortolini M, Dumoulin C, Gomes M, McClurg D, Meijlink J, Shelly E, Trabuco E, Walker C, Wells A. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. Neurourol Urodyn. 2017 Feb;36(2):221-244.
  2. Fitz F, Sartori M, Girão MJ, Castro R. Pelvic floor muscle training for overactive bladder symptoms – A prospective study. Rev Assoc Med Bras (1992). 2017 Dec;63(12):1032-1038.
  3. Todhunter-Brown A, Hazelton C, Campbell P, Elders A, Hagen S, McClurg D. Conservative interventions for treating urinary incontinence in women: an Overview of Cochrane systematic reviews. Cochrane Database of Systematic Reviews 2022, Issue 9.
  4. NICE Guidance – Urinary incontinence and pelvic organ prolapse in women: management: © NICE (2019) Urinary incontinence and pelvic organ prolapse in women: management. BJU Int. 2019 May;123(5):777-803
  5. Nygaard IE, Thompson FL, Svengalis SL, Albright JP. Urinary incontinence in elite nulliparous athletes. Obstet Gynecol. 1994;84(2):183-187.
  6. Thyssen HH, Clevin L, Olesen S, Lose G. Urinary incontinence in elite female athletes and dancers. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(1):15-17.
  7. https://www.embracephysio.sg/what-is-a-pelvic-floor-exam/
  8. https://www.embracephysio.sg/wp-content/uploads/2021/10/Bladder-Diary-FINAL.pdf
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4980849/

 

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