Recovering your pelvic floor through physiotherapy

Many people are surprised when their doctor refers them to a physiotherapist for treatment of their urinary incontinence. They are more used to hearing that physios treat knees and ankles rather than bladders and bowels. But Continence and Women’s Health Physiotherapists spend their working days helping women, men and children re-gain control of not only their bladder and bowel, but also help with prolapse management, pelvic pain and sexual dysfunction.

Urinary incontinence is a silent problem, despite over one in three Australian women and 13% of men being affected. More research tells us that 65% of women and 30% of men sitting in a GP waiting room, report some type of urinary incontinence, yet only 30% of these people will get help from some type of health professional. So there is stigma or shame attached to urinary incontinence which acts as a barrier to people seeking help.

The most common types of urinary incontinence are stress incontinence, which is commonly associated with pregnancy, childbirth and also following prostate surgery for men, and urge incontinence, which can be a more age-related condition. Stress incontinence is when you leak urine with increased internal pressure such as with cough and sneeze or higher impact sport, whereas urge incontinence is associated with leakage of urine with the urge to go, often triggered by putting a key in the door or hearing running water. Urge incontinence can also be associated with debilitating symptoms of frequency, urgency and nocturia (when you get up frequently at night).

So what will happen if you head off tomorrow to get help from the Continence physio? Education, education, education! The physio will primarily educate you about good bladder and bowel habits – yes constipation will make your urinary control worse! You will learn where the pelvic floor muscles are situated, how they work to help with bladder control and be asked to do pelvic floor exercises as a matter of habit over your lifetime. Interestingly, you will be taught the importance of relaxing your pelvic floor muscles as well as tightening them, to ensure effective activation of the muscles.

The most important concept to stay dry with cough, sneeze and bending over though, is to pre-contract your pelvic floor muscles prior to the increase in pressure – a type of learned response to give support to the bladder and prevent urine escaping. This sounds hard, but in fact being dry is a very powerful reward and learning this skill, which is called ‘the knack’ is not as hard as it sounds. We all learnt to cover our mouths with cough and sneeze as a five year old, and this is something we can also learn with practise.

If you are suffering with urge incontinence, then mastering urinary control with what we call the urge control strategies helps to retrain the bladder to behave and reduces the terrible anxiety associated with bladder urgency and leakage. Some of these strategies include curling your toes, squeezing your buttocks or crossing your legs; using distraction such as counting backwards can also help with bladder control and doing pelvic floor exercises to help switch the urge off. You will be asked to do a bladder diary to practise storing 350-500 mls in your bladder- yes this is the normal capacity of the bladder but through bad habits such as going ‘just in case’ to the toilet regularly, can cause many of this problems to occur.

So the big message from this article is – seek help from a Continence and Women’s Health physiotherapist if you have any issues with your most private areas. We physios are well versed in helping you feel comfortable when divulging these details to us- in fact many of us started in managing pelvic floor dysfunction when we had our own children and started to experience pelvic floor, urinary and faecal problems. If you have any questions please send them in so I can address them here in this forum because if you are struggling so are many others. You are not alone!

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