Leak Less, Laugh More – Urinary Incontinence

by | Aug 25, 2021 | Incontinence, Pelvic Floor

1 in 3 women over the age of 45 experience some form of urinary incontinence. There is a great misconception that leakage is a natural part of the ageing process and there is nothing that can be done about it. However, no-one should have to tolerate any form of urinary incontinence and there is actually lots we can do about it!

Urinary incontinence is the accidental or involuntary loss of urine, and can range from tiny leaks to a complete emptying of the bladder.

Risk factors for incontinence can include, pregnancy, pelvic floor trauma after vaginal birth, menopause, hysterectomy, obesity, hormonal changes such as menopause, urinary tract infections, chronic cough, constipation or high impact sport such as gymnastics, trampoline, cross-fit and hurdling to name a few.

Types of urinary incontinence vary, however there are two the main types:

  • Stress Urinary incontinence:

Small amounts of leakage occur during increased intra abdominal pressure, such as sneezing, coughing, laughing, skipping, jumping or running. Basically when the pelvic floor structure has a sudden increase in load of which it cannot take.

  • Urge incontinence:

This occurs when the detrusor (bladder) muscle contracts unexpectedly, causing a strong sense of urgency and can be accompanied by involuntary loss of urine. Sometimes urgency does not always lead to incontinence, but the sensation of needing to go can lead to small amounts of urine to pass when on the toilet. This can develop into frequency and urgency, also known as overactive bladder. Which means the detrusor muscle is contracting when it shouldn’t be, giving you the over whelming sensation of urge to urinate when it doesn’t need to.

What is the pelvic floor?

The pelvic floor is essentially a hammock of muscle, ligaments and fascia from the front of the pelvis to the back, and side to side. Functionally the pelvic floor supports the bladder neck and anus to help them stay closed. They actively squeeze when you cough/ sneeze/ lift to help avoid leaks from bladder or bowel.

Pelvic floor physiotherapy exercises are now regarded as the first stage of treatment for stress urinary incontinence. For many women, a regular and sustained pelvic floor strengthening program can improve or even entirely overcome the symptoms of stress incontinence. A pelvic floor muscle strengthening program can take 3 to 6 months to change the muscle contraction and its strength.

How do we find out if your pelvic floor is weak?

It is impossible to determine the strength of the pelvic floor without an internal examination using a device called a Peritron. This, along with a physical assessment will help to determine what muscles are either weak/long or overactice/short and will help direct treatment.

How can physiotherapy help?

Often women find it difficult to contract their pelvic floor muscles, 50% of women will be doing a pelvic floor contraction incorrectly when using a verbal instruction. An internal pelvic floor biofeedback assessment is usually needed to help retrain the pelvic floor muscles and ensure the correct contraction is happening. Your women’s health Physio will be able to assist in correct activation, then direct you to the appropriate treatment technique.

There is a growing amount of evidence to show that pelvic floor exercise devices can help to achieve faster and more effective results for the pelvic floor. Bio feedback devices, vaginal weight and balls, or even electrical stimulation for very weak muscles can help stimulate the muscle’s strength and bulk.

Treatment guidelines suggest that any women seeking professional help for stress urinary incontinence, try a regular and a sustained program of pelvic floor physiotherapy exercises before resorting to more invasive options such as surgery.

Studies by Moreno et al. (2004) and Dumounin (2014), showed that pelvic floor physiotherapy exercises are an effective and low cost treatment for stress urinary incontinence. Furthermore in the most recent guidelines from the American College of Physicians (2014) stated that pelvic floor strengthening exercises have a high quality evidence base for stress urinary incontinence.

Practical tips for managing incontinence

Although a physiotherapy assessment and management plan is the most effective treatment, there are other practical ways in which you can help your incontinence.

  1. Fluid intake. Most women wil reduce their intake in an effort to avoid toileting, however this can actually place more stress on the bladder leading to worsening urge incontinence. Try instead, to sip small amounts regularly. Urologists recommend 80-100mls/hour.
  2. Try reducing caffeine and acidic drinks. Caffeine is a diuretic and can cause dehydration if not balanced with water and acidic drinks may irritate the bladder.
  3. Schedule your toilet breaks. Keep a bladder diary and work out how often you go and try to schedule these at routine intervals during your day.

If you are experiencing urinary incontinence or other pelvic floor dysfunctions please contact our certified Women’s Health Physiotherapist, Jessica Findlay for an appointment today.

References

  1. Nonsurgical Management of Urinary Incontinence in Women: A Clinical Practice Guideline From the American College of Physicians. (2014). Annals of Internal Medicine, 161(6). doi:10.7326/p14-9034
  2. Dumoulin, C., Hay-Smith, J., Habée-Séguin, G. M., & Mercier, J. (2014). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women: A short version Cochrane systematic review with meta-analysis. Neurourology and Urodynamics, 34(4), 300-308. doi:10.1002/nau.22700
  3. Moreno et al. (2004) Clinical and Experimental Obstetrics and Gynecology [01 Jan 2004, 31(3):194-196]

Ankle dorsiflexion knee to wall measure for squat

How to Treat and Manage Stiff Ankles

If your ankle mobility isn’t up to par, the next steps depend on the source of the restriction. Generally, if the limitation is felt at the front of the ankle, it may be due to joint-related issues.

  • Banded Ankle Mobilizations: This technique involves using a resistance band tied to a stable surface while performing ankle flexing exercises on a step. Check out this quick helpful video for guidance.

Conversely, if the tightness is located in the back of your ankle around the Achilles tendon region, consider:

  • Contract/Relax Stretches: A simple exercise like the bent-knee calf raise can effectively relieve restrictions in this region.

Lastly, for an immediate solution, consider using a wedge or support under your heels during a squat. Two papers from The Journal of Strength and Conditioning Research have shown that wedges can enhance squat depth without negatively impacting biomechanics. While some may see this as a “cheat,” the science supports it. If you struggle to achieve that 12 cm in the knee-to-wall test and find it challenging to squat low, use that wedge!

Hip Range of Motion

How Much Flexibility Do I Need and How Do I Test It?

For effective squatting, studies have determined that achieving 125 degrees of hip flexion is necessary—this is 35 degrees beyond a right angle. To test your hip mobility, you can use an inclinometer available on your iPhone. Simply follow these steps:

  1. Lie down on your back with your legs extended.
  2. Place the inclinometer length-ways on your thigh,
  3. Gently lift your knee towards your chest to measure the maximum angle, without moving the opposite leg.

     

    measuring hip flexion

    How to Treat and Manage Stiff Hips

    The hip joint is mostly passive during a squat, so if you’re experiencing limitations, it’s most likely due to an issue with the hip joint itself. There is up to 20% of the population that may be limited by the shape of their hip joint and the way it developed during childhood and adolescence. If that is the case, it makes if very difficult to improve the range of motion. Things like acetabular retroversion or a lower femoral head/neck offset ratio cannot be changed.

    For the rest of the population, here are some effective strategies for improving hip mobility:

    • Banded Hip Mobilisations: These exercises can help increase the range of motion in your hips by stretching and mobilizing the joint. Look for a demonstration in this video.
    • Inner Range Hip Flexor Strengthening: Strengthening your hip flexors can counteract tightness and enhance your ability to squat lower.
    • Like with ankle mobility, adding a heel wedge can help. By elevating your heels, you may experience a reduction in trunk forward bend, minimizing the hip flexion required and facilitating a more comfortable squat position.

    Conclusion

    Mastering a deep squat requires more than just strength; it hinges on sufficient ankle and hip range of motion. The studies from 2015 and 2022 have made it clear: flexibility in these joints is paramount for optimal performance.

    By regularly assessing your mobility and implementing these targeted exercises and techniques, you can improve your squat depth, enhance your overall strength training, and reduce the risk of injury. Remember, every body is unique, so listen to yours and adjust your approach accordingly. Happy squatting!