Incontinence Does Not Have to Be the New Normal

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5 Things You Need to Know About Incontinence…

According to the Physiotherapy Association of BC, Pelvic Floor Dysfunction, or PFD, refers to disorders found within the pelvic floor. Bladder and bowel dysfunction, sexual dysfunction, pelvic pain, pelvic organ prolapse (descent of the organs) and pelvic floor muscle dysfunction are all forms of PFD. Only 26% of Canadians experiencing incontinence have consulted a health care provider. Physiotherapy is the first choice and most non-invasive approach to treating pelvic health issues including incontinence.

Here are 5 things that I want you to know if you are dealing with incontinence: 

1.) You are not alone – it is common but not normal. 3.3 million Canadian have Urinary Incontinence. That is 1 in 4 women and 1 in 9 men are dealing with incontinence.

However, even though this issue is extremely common, only 1 in 12 of those individuals dealing with incontinence are known to health care workers. Many people may feel that it is simply a private issue.  As health care professionals we recognize that some people may feel uncomfortable discussing incontinence and as such respect each individual’s level of comfort in doing so.

It is important to remember that incontinence is not an inevitable part of aging nor is it an inevitable outcome of childbirth.  These are both common misconceptions that prevent or prolong the time an individual  takes to seek effective treatment from a specifically trained physiotherapist.The good news is that you can do something about it!

2.)  You can do something about urinary incontinence. Kegels form the basis of pelvic floor retraining (for all types of pelvic dysfunction). Best practice states that simple verbal or written instruction does not constitute adequate training for a Kegel exercise program so it is important to work with a professional to learn how to do them properly.

In it’s 2008 clinical guidelines on the conservative management of urinary incontinence, the Society of Obstetricians and Gynecologists of Canada recommends that “proper performance of Kegel exercises should be confirmed by digital vaginal examination or biofeedback”. As such you must confirm that you see a physiotherapist who has taken special postgraduate training in the pelvic floor.

3.) There are many different forms of incontinence: 

  • Stress incontinence is the loss of urine secondary to an increase in intra-abdominal pressure (coughing, sneezing, laughing, lifting, exercise or transitional movements) and is usually a small volume of urine.
  • Urge incontinence is urine loss associated with a strong, uncontrollable need to void.  It is the inability to delay voiding and can be a large or small amount of urine loss.
  • Mixed incontinence is urine loss associated with increases in intra-abdominal pressure (stress incontinence) AND with an intense urge to void (urge incontinence).  People often present with a combination of these.

The above 3 kinds of incontinence are readily treated by an individually tailored program prescribed by a physiotherapist who specializes in pelvic floor rehabilitation. Additionally, there exists overflow and functional incontinence.  Overflow incontinence is primarily treated medically to address the underlying condition and functional incontinence (eg trouble with dexterity that inhibits the ability to reach the toilet in time) could be helped with an assessment by an occupational therapist.

4.) Incontinence in men can be associated with treatment for prostate cancer. Current research shows that 1 in 7 men will be diagnosed with prostate cancer during his lifetime. Fortunately the progression of prostate cancer is usually very slow and if the cancer is detected early the chances of survival increase. Early detection  means that 98% will survive 5 years. However, incontinence can be a side effect of treatment. This can be a distressing outcome due to it’s impact on quality of life. Fortunately, again, for most men incontinence is a temporary side effect and can be assisted further in specific instruction in how to perform Kegels effectively, manage intra-abdominal pressure and how to move such that muscles work synchronously in a co-ordinated manner.

5.) There is an association between low back pain and urinary incontinence. As of 2010 low back pain is the number one cause of disability worldwide and it is growing every year.  Many studies show an association between low back pain and pelvic symptoms, particularly urinary incontinence.  In a 2008 study, urinary incontinence was noted in 78% of 200 women with low back pain.

Physiotherapists can help determine the cause of incontinence and assess which treatment is best for the individual, help strengthen pelvic muscles using exercises and biofeedback, establish healthy bladder habits, and assess diets to ensure it is not contributing to incontinence. Regardless of what has caused your incontinence or how long you have been experiencing this issue – physiotherapy can help.

Sarah, Physiotherapist at MM

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