Incontinence describes any accidental or involuntary loss of urine from the bladder (urinary incontinence) or feces from the bowel (fecal or bowel incontinence).
Incontinence is quite common, with over 3.3 million Canadians suffering from some form of bladder or bowel control. It can range in severity from ‘just a small leak’ or an occasional leak when you laugh or sneeze to complete loss of bladder or bowel control. People who suffer from incontinence can experience the constant need to use the toilet or never feeling that they’ve fully emptied their bladder.
There are many different types of incontinence and many reasons why people are afflicted by this condition. Some of the most common types are:
Stress Urinary Incontinence (SUI): Small amounts of leakage caused by pressure increases in the abdomen that push down on the bladder. Can occur in both men and women and is commonly caused by coughing, sneezing, laughing, walking, lifting or playing a sport. Diabetes, chronic coughing, constipation and obesity can contribute to SUI.
Stress Incontinence in Women: Commonly caused by the stretching and weakening of the pelvic floor during pregnancy or childbirth, leading to internal organs pushing down on the bladder. Can also be caused by weakening of the urethra during menopause because of changing hormonal levels.
Stress Incontinence in Men: A common condition after prostate surgery that can take six to 12 months to resolve.
Urge Incontinence: A strong and sudden need to urinate, often during the night time hours. The causes of urge incontinence are not fully understood but it does tend to be more common in more mature people, worsens during stressful times, and may be related to constipation, an enlarged prostate gland or a history of bladder habits.
Fecal Incontinence: Leakage of the bowels caused by long-term straining, medications, lifestyle (heavy lifting leading to weak pelvic floor muscles), weak back passage muscles, diabetes, bowel disease (such as Coelicac disease or Crohn’s disease), nerve disorders (resulting from multiple sclerosis or Parkinson’s), severe diarrhea or constipation.
Pelvic organ prolapse is a very common condition, and can affect about half of women who have had children by vaginal delivery. It occurs when one or more of the organs in the pelvis (bladder, uterus, rectum, or small or large bowel) drops down due to weakened or stretched pelvic floor muscles.
The weakening of pelvic floor muscles and other supportive structures in the pelvis that cause prolapse can also cause incontinence.
If you answer ‘yes’ to any of the following questions, you may have a bladder or bowel control problem:
Kegel exercises are a term used for strengthening of the pelvic floor muscles, and like other exercises, it is important that they are done correctly in order to strengthen the pelvic floor. Kegels are often helpful for incontinence, when combined with other lifestyle changes like weight loss and improved fitness.
The pelvic floor muscles work closely with other muscles of the core (lower abdominals, oblique abdominals and deep back muscles) and with breathing can act like a piston: it is a pressure system that needs to be controlled – not just simple strengthening of the pelvic floor muscles themselves.
If is often beneficial for a physiotherapist who specializes in pelvic health to do a complete assessment of your pelvic floor, including an internal exam to confirm proper contraction of the pelvic floor muscles and determine your strength, endurance and control. Starting a progressive strengthening program for the pelvic floor and core with proper breathing can improve and often fix urinary incontinence.