Incontinence is classified as an unwanted/involuntary leakage of urine no matter how small the amount. Urinary incontinence as part of women’s health affects 1- 3 women in all stages of life; from those who have never been pregnant, through the child-bearing years and into menopause.
Leakage of urine with activities such as laughing, coughing, sneezing, fast walking, running or jumping. Treatment includes strengthening the pelvic floor muscles using exercise, biofeedback and muscle stimulation for very weak muscles.
Can’t get there on time to prevent a leak? It may be associated with increased urinary frequency and leaking large amounts of urine. Treatment includes assessing the ability of the pelvic floor muscle to contract and relax correctly and bladder training.
A prolapse is a bulging of the pelvic organs into the vagina, bulging of the vaginal and rectal walls and descent of the rectum. It can occur as a result of childbirth or chronic constipation. A strong pelvic floor helps to provide a hammock-like support for these tissues and improve quality of life by decreasing the awareness of the prolapsed tissue.
This can include staining or incontinence of faeces or wind and can be very distressing. Weakness of the pelvic floor is the main cause although damage to the sphincter during surgery or childbirth can be present. Chronic constipation can also be a contributory factor. Poor defecation mechanics can play a part as the bowel may not be emptying completely. Treatment of the pelvic floor muscle is a very important part of therapy and dietary issues often need to be addressed. Advice is also given on correct bowel habits.
There are many reasons for constipation but poor bowel movements can be a major cause in chronic constipation. If there is poor muscle co-ordination between the abdominal and pelvic floor muscles, this can cause a difficulty in emptying the bowels. Diet and hydration are also very important. Treatment consists of biofeedback therapy to train the muscles to work properly.
A contributory factor to pelvic pain is over-active pelvic floor muscles. This means these muscles never relax fully and there’s a constant high level of tension in the muscles (like a “knot” in your shoulder). This over activity can contribute to conditions such as vulvodynia, pain during sexual intercourse, pain with bladder or bowel emptying, prudendal neuralgia and post pelvic trauma. Physiotherapy focuses on down training and releasing these muscles using techniques such as manual therapy, diaphragmatic breathing techniques and education. Actively contracting your pelvic floor muscles as per the often advertised strengthening programmes can be detrimental to this problem. It does require the intervention of a specialist Physiotherapist.
How a Physiotherapist Can Help
A detailed history can help us make a diagnosis. An assessment will be made on your ability to correctly perform a pelvic floor contraction. Your may need some assistance with this, a biofeedback unit or muscle stimulation. You may also be asked to fill out a fluid balance chart or give information on your dietary habits.
You will be given a home exercise programme with advice on bladder/bowel retraining and diet where necessary. Reviews will be carried out to monitor your progress. Muscles take time to become strong so you will need to persevere with your programme.