Stress and Urge Incontinence

The Pelvic floor
Back treatment The pelvic floor is a large sling (hammock) of muscles and other tissues stretching across the floor of the pelvis. All this forms the ‘undercarriage’ and the opening of your bladder, bowels and womb all pass through the pelvic floor.

Job of the Pelvic Floor
The pelvic floor supports all the pelvic organs and abdominal content especially during standing and when exerting yourself. The pelvic floor supports the bladder helping it to stay closed. It also helps control wind and when ‘holding on’ to your bowels. Finally the pelvic floor plays an importance in sexual function, helping increasing sexual satisfaction both for the female and the male during sexual intercourse.

Stress urinary incontinence
Stress urinary incontinence is a common condition that many women suffer from. It is especially common during and after pregnancy, post hysterectomy and during the menopause.

Stress incontinence occurs when the valve at the neck of the bladder and the pelvic floor muscles are not strong enough to hold the bladder tightly closed. As a result coughing, sneezing, laughing or exercise may cause the bladder to leak.

Urge Incontinence
This condition is often referred to as an overactive bladder and can occur at any age. Usually the bladder expands gently as it fills, sending the brain a message in good time too look for a toilet. When it is an appropriate time to empty the brain sends 2 signals; one to the muscles in the bladder wall to contract and the other to the bladder outlet valve to open and the bladder squeezes urine out. The bladder then relaxes for the process to start over again.

During urge incontinence the bladder does not work like this, instead it contracts uncontrollably, at the wrong time and giving very little, if any notice that you need to find a toilet, and can be as often as every half and hour. You may also find that you have to get up several times during the night to pass urine.

Fifty percent of women suffer from a genital prolapse. A genital prolapse is where one of the pelvic organs (bladder, bowel or womb) slips forward due to a weakness in the pelvic floor. When you have a prolapse it is often described as having a lump in your vagina and a dragging feeling which increases throughout the day, some patient’s report that they have difficultly opening their bowels. There are several causes of a prolapse and these include:

  • Childbirth
  • Hormone deficiency
  • Overweight
  • Constipation
  • Continuous/excessive Coughing
  • Heavy lifting
  • Hysterectomy

Stress, urge incontinence and prolapse can all be treated conservatively by a physiotherapist. Treatment would include an examination to assess the strength of the pelvic floor muscles, followed by the appropriate treatment, which will differ depending on the severity, but may include the use of pelvic floor exercises, biofeedback and electrical stimulation and education on how to manage the condition.

A probe is inserted in to the vagina which is connected to a specialist piece of equipment which senses the strength and durability of the pelvic floor muscle contraction. This can be used to treat both stress and urinary incontinence.

Electrical Stimulation
Electrical stimulation is used when indicated following examination. A small probe is inserted in to the vagina and the electrical stimulator is connected, then a small electrical current is sent to the pelvic floor muscles, this helps to stimulate the muscles and help with pelvic floor exercises.