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Urinary Incontinence

Urinary Incontinence

There are three main types of urinary incontinence:

Stress Urinary Incontinence – Occurs when urine leaks during activity where there is increased abdominal pressure or impact such as coughing, sneezing, laughing, jumping, running, lifting, etc.
Urge Urinary Incontinence – Is when a strong urge to empty the bladder is accompanied by leaking.
Mixed Urinary Incontinence – Is a mixture of stress and urge incontinence.
Urinary Incontinence often occurs when the pelvic floor muscles are not working effectively. This may be due to weakness, decreased coordination, decreased muscle awareness, increased pelvic floor muscle tension or difficulty relaxing the pelvic floor.

In Stress Incontinence, the pelvic floor muscles normally contract automatically to support the pelvic organs (including the bladder) and prevent leakage when you increase the pressure in your abdomen by coughing, laughing, sneezing, lifting, jumping or running. If your pelvic floor muscles are too tight or too weak, they may not be able to contract effectively to prevent this leakage. Another issue could be that your pelvic floor muscles no longer contract automatically.

In Urge Incontinence, the pelvic floor muscles are responsible for controlling when you release urine. When your pelvic floor contracts, it causes the bladder (a muscle) to relax and continue to fill. When your pelvic floor is too tight or too weak, it cannot effectively inhibit the bladder muscle, causing urge that you cannot delay.

Treatments for incontinence may include education on bladder function and urge, education on the effects of diet and activities, bladder training, pelvic floor muscle training, stretches, and the release of tight pelvic floor muscles.

Recommendations for Stress Incontinence

The Canadian Urological Society Guidelines on Incontinence states that pelvic floor muscle training (one component of Pelvic Floor Physiotherapy) should be first-line therapy for stress incontinence.

Recommendations for Urge Incontinence

The Canadian Urological Society Guidelines on Incontinence recommends that conservative treatments such as Pelvic Floor Physiotherapy should be initiated before considering medication or surgery for Urge Incontinence. They note that Pelvic Floor Muscle Training (one component of Pelvic Floor Physiotherapy) is effective for Urge Incontinence.

Urinary Urgency / Frequency / OAB (Overactive Bladder)

Urinary urgency and / or frequency is often called Overactive Bladder. It occurs when there is a frequent, strong urge to urinate that interferes with daily life. Often these urges are out of proportion with how much urine is actually in the bladder.

The pelvic floor muscles are responsible for controlling when you release urine. When your pelvic floor contracts, it causes the bladder (a muscle) to relax and continue to fill. When your pelvic floor is too tight or too weak, it cannot effectively inhibit the bladder muscle, causing urge that you cannot delay.

Other things that can contribute to urinary urge are diet, drinking habits, toileting habits, stress and anxiety. It is commonly thought that drinking less will help decrease urge. This can in fact have the opposite effect as this will concentrate urine, irritating the bladder.

Pelvic floor physiotherapy can help to decrease tension in your pelvic floor, or strengthen your pelvic floor, depending on your needs. Your pelvic floor physiotherapist will also teach you how to use your pelvic floor, as well as other techniques to first decrease the intensity of your urge, and then how to actually delay urge. She may make recommendations on fluid intake.

Pelvic floor physiotherapy is an effective treatment for overactive bladder (OAB) and urge. Your pelvic floor physiotherapist will assess all factors contributing to your condition including your pelvic floor tension and strength, diet, drinking habits, toileting habits, stress and anxiety. Pelvic floor physiotherapy may include education on bladder function and urge, education on the effects of diet and activities, bladder training, pelvic floor muscle training (kegels), stretches, and the release of tight pelvic floor muscles.

Vulvodynia

Vulvodynia essentially means pain in the vulva.  It is diagnosed where other medical conditions or infections have been ruled out.  It often occurs when your pelvic floor muscles and surrounding tissues have become very tight.  It is usually accompanied by increased sensitivity in the surrounding nerves and nervous system as a whole.

Pelvic Organ Prolapse

Pelvic organ prolapse is when one or more of the pelvic organs (the bladder, uterus, or rectum) encroach on the vaginal space.  Symptoms of a prolapse may include pressure or discomfort in the perineal area, a feeling of something “coming down”, or noticing something protruding from the vagina.

Pelvic organ prolapse affects approximately 50% of women who have had children, and also occurs in a significant number of women who have never been pregnant.  Pelvic organ prolapse is often due to weak or ineffective pelvic floor muscles that are unable to support the downward pressure of the pelvic organs.  Pregnancy, childbirth, chronic constipation and hormonal changes all contribute to pelvic organ prolapse.

A pelvic floor physiotherapist will help you to release trigger points and address tension that may be resulting in pain or discomfort.  She will also help you address the prolapse itself by creating an exercise program tailored to your specific needs.  One-on-one physiotherapy has been shown to be an effective treatment for pelvic organ prolapse.

Interstitial Cystitis / Painful Bladder Syndrome

Painful bladder syndrome, often referred to as Interstitial Cystitis, is pain or burning with a full or filling bladder, or with emptying the bladder. It may be accompanied by an increase in urinary frequency. It occurs in 2.7 to 6.5% of women. It is more commonly diagnosed in women than men, with 90% being women. Women with Painful Bladder Syndrome/Interstitial Cystitis may often also have endometriosis, dyspareunia (painful sex), vulvodynia (vulvar pain) or irritable bowel syndrome (IBS). There are many similarities in symptoms between Painful Bladder Syndrome/Interstitial Cystitis and Overactive Bladder (OAB).

In men, there is a significant overlap in symptoms between Painful Bladder Syndrome and Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CPPS). Because of this, many men are diagnosed with Chronic Prostatitis or Chronic Pelvic Pain Syndrome instead of Painful Bladder Syndrome/Interstitial Cystitis.

Symptoms of Painful Bladder Syndrome/Interstitial Cystitis are often exacerbated by diet. Coffee, tea, citrus, carbonated or alcoholic beverages, tomatoes, spicy foods, artificial sweeteners and wheat products are some of the more common irritants.

Painful bladder syndrome is often accompanied by tight pelvic floor muscles and surrounding tissues. In fact, 87% of patients with Painful Bladder Syndrome/Interstitial Cystitis have pelvic floor pain, tension or trigger points. Painful Bladder Syndrome/Interstitial Cystitis may or may not be accompanied by increased sensitivity in the surrounding nerves and nervous system as a whole.

The Canadian Urology Association recommends that patients with Painful Bladder Syndrome/Interstitial Cystitis participate in Pelvic Floor Physiotherapy, as it has been shown to provide moderate improvement to complete resolution in 71-83% of patients.

Bowel Incontinence

Bowel incontinence is the involuntary loss of stool. Bowel incontinence may be accompanied by either constipation or loose stools.  It is often related to ineffective pelvic floor muscles, which may be due to weakness, tightness, or decreased awareness of these muscles.

Pelvic floor therapy is an effective treatment option for bowel incontinence.

Vaginismus and Dyspareunia

Vaginissmus is the inability to insert anything (such as a penis) into the vagina.  It is usually accompanied by tight pelvic floor muscles that will tighten further with attempted penetration, or even the thought of penetration.  This may or may not be accompanied by pain.

Dyspareunia is pain with sex.  It is often accompanied by tight pelvic floor muscles and surrounding tissue.

Both vaginismus and dyspareunia are accompanied by increased sensitivity in the surrounding nerves and the nervous system as a whole.  A pelvic floor physiotherapist will provide treatment options to improve vaginismus and/or dyspareunia.

Pregnancy related Pelvic / Low Back / Hip Pain

This is the pain in the pelvis, hips or low back that occurs during or after pregnancy.  It is often accompanied by difficulty rolling in bed, as well as difficulty getting moving after being still (either sitting or lying) or getting dressed.  It is often due to increased or uneven mobility in the pelvic joints.  Though this is often referred to as “instability”, your pelvis is one of the most stable joints in your body.  Though it may feel like it, your pelvis will not “fall apart”.  Pregnancy related pelvic, low back and hip pain may be accompanied by pelvic floor dysfunction, either tension or weakness.

Persistent Pelvic Pain

Persistent pelvic pain is a broad term that refers to pain in the pelvic and genital region.  It often occurs when the pelvic floor muscles and surrounding tissues have become very tight.  It is often accompanied by increased sensitivity in the surrounding nerves and nervous system as a whole.

Pelvic floor therapy can provide effective treatment of persistent pelvic pain.

Chronic Prostatitis / CPPS (Chronic Pelvic Pain Syndrome

Chronic Prostatitis or Chronic Pelvic Pain Syndrome is a chronic pain condition in men.  While the suffix “itis” suggests inflammation or infection, Chronic Prostatitis/CPPS is diagnosed when infection has been ruled out.  Major contributing factors include tension in the pelvic floor muscles and surrounding tissues.  It is often accompanied by increased sensitivity in the surrounding nerves and nervous system as a whole.

Pelvic floor physiotherapy can be an effective treatment for men suffering from chronic prostatitis or chronic pelvic pain syndrome.

Post-Prostatectomy Incontinence

Urinary incontinence is common in men who have had surgery or radiation for prostate cancer.  The severity of incontinence varies between men.  It is often related to decreased effectiveness of the pelvic floor muscles due to weakness, tension, or decreased awareness of the muscles.

Irritable Bowel Syndrome (IBS)

Irritable Bowl Syndrome (IBS) is a common disorder that affects the large intestine.  Common symptoms include: cramping, abdominal pain, bloating, gas, diarrhea and constipation.  It is often accompanied by increased sensitivity in the surrounding nerves and nervous system as a whole.

Pelvic floor therapy can provide relief from IBS.

Dysmenorrhea

Dysmenorrhea is the medical term for menstrual pain or cramps that occur before or during menstruation.  Dysmenorrhea is the most common menstrual disorder and affects as many as 90% of women of reproductive age.  It often occurs when the pelvic floor muscles and surrounding tissues have become very tight.  It may be accompanied by increased sensitivity in the surrounding nerves and nervous system as a whole.

Pelvic floor physiotherapy can provide relief from dysmenorrhea.

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