Physiotherapy is one of the best and most effective treatments for urinary incontinence. Not only is it a low-risk solution, but a good physiotherapist can help you retrain your bladder and strengthen your pelvic floor muscles to help resolve the problem.
Depending on the different types of urinary incontinence, there are many different exercises and ways in which physiotherapy is beneficial. Cape Town physiotherapist Corina Avni specialises in pelvic function and says, “Leaking isn’t just a symptom of a weak pelvic floor, it could also be a sign of muscles that are too tight as a result of knots in the pelvic floor, endometriosis or even constipation. This is why a full assessment is vital.”
1. Stress incontinence: This refers to the involuntary need to urinate when there is increased intra-abdominal pressure – such as coughing, jumping or running. According to Corina this is because the pelvic floor muscles are not being used properly to keep the bladder closed when it is subjected to pressure.
2. Urge incontinence: Also known as an overactive bladder, this is characterised by an overwhelming need to urinate and the involuntary passing of urine because of this. Sometimes this can be triggered by something as small as hearing running water or seeing the toilet.
3. Mixed incontinence: This is a combination of both forms.
A physiotherapist should be able to diagnose the type of incontinence following a short examination which includes obtaining details about your bladder control, your health history including any surgeries or pregnancies, your diet and your current lifestyle.
The ultimate goal of physiotherapy is to help you regain control of your bladder, and is primarily focused on the pelvic floor muscles and how to tighten or relax them so that they function properly to keep you dry.
Exercises and treatments
Corina says that one of the methods she uses is behavioural modification, which involves re-learning how to go to the toilet and learning how to effectively empty the bladder. Simple as it sounds, she says some incontinence issues stem from bad toilet-going habits such as pre-emptive urination (going to the toilet when you don’t actually need to), as well as straining excessively when on the toilet. Both put unnecessary pressure on the bladder and weaken it over time.
Pelvic Floor Exercises are probably the most well known forms of exercise for pelvic dysfunction. This involves a conscious tightening of the muscle around the anus, vagina and front passage to "lift it up" and inwards without clenching the buttocks. These can either be done in a slow-squeeze and hold or a fast squeeze with no hold. Both are most commonly known as kegel exercises and are designed to strengthen the pelvic floor.
Neuromuscular stimulation is another method used which activates nerves and their associated muscles. In the case of incontinence, an internal probe with light electrical currents is applied to the pelvic floor to stimulate the nerves and cause muscle contractions with the aim of teaching the correct action and use of the pelvic floor muscles or calming of overactive nerve responses.
Weighted vaginal cones are plastic, cone-shaped devices which the physiotherapist inserts into the vagina to help exercise the pelvic floor muscles. Weights can be added to them or removed and they work by gradually stretching the vaginal opening as the cone drops lower. This stimulates the pelvic floor to contract and tighten up to try and hold the cone in place. Corina says it’s the sensation of falling out which triggers a contraction to keep it in.
Bladder retraining literally means retraining the bladder how to work. Although bladder training can take at least six weeks before it has a noticeable effect, many people find it a successful endeavour.
These are the tips Corina offers on bladder retraining:
- Don’t pee "just in case": Try to wait a little longer when you feel the need to urinate, which will stretch the bladder and encourage it to hold bigger volumes.
- Keep calm: When the urge to go appears, try to sit down and hold a pelvic floor contraction hard enough to prevent leaking for as long as you are able, allowing the "desperate urge" to pass, and buying you a few more minutes.
- Keep hydrated: Don’t restrict your fluid intake as this will only result in stronger urine which will only irritate the bladder. If you wake to go to the loo during the night, however, limit your liquid intake two hours before bed.
- Limit caffeine and alcohol: Some bladders react negatively to caffeine and alcohol and limiting your intake of these substances may reduce your need to urinate.