Urinary incontinence (UI) is the involuntary loss of urine from the bladder. The two main types of UI are stress urinary incontinence (SUI) and urge urinary incontinence (UUI).
The bladder fills throughout the day and stretches to allow for more room. A person will get an urge to go to the toilet when the bladder is half full, however we can generally hold on after this and go to the toilet when it is convenient. A healthy bladder can hold up to 600ml. UUI involves the sudden urge to urinate even when the bladder is not full, often followed by the involuntary loss of urine. UUI can also be associated with the need to pass urine frequently, even without the involuntary loss of urine.
SUI involves involuntary leakage of urine when a movement such as coughing, sneezing, laughing, running or heavy lifting increases intra-abdominal pressure. The increase in intra-abdominal pressure, coupled with dysfunction of the pelvic floor muscles leads SUI. Other factors that may contribute to SUI include obesity, chronic cough, diabetes and constipation.
UUI is generally more common as we age and can be seen in individuals with health conditions, such as stroke, Parkinson’s disease and multiple sclerosis, that impact on the brain’s ability to control the bladder through neural pathways. UUI can also result from a long history of poor bladder habits or constipation. Symptoms can be worsened by stress or certain fluids such as tea, coffee, carbonated drinks and alcohol.
SUI can affect women during pregnancy, childbirth or menopause, and may affect men following prostate surgery. Pregnancy and childbirth put strain on the pelvic floor muscles and they may become weak as a result. This weakness may lead to leakage as the pelvic floor muscles are unable to cope with extra pressure placed on the bladder. During menopause changes to hormone levels, in particular oestrogen, cause changes to the urethral lining leading to SUI.
UUI can be addressed by using strategies to control bladder function. This can involve reducing the strong urge sensation, increasing the storing capacity of the bladder or increasing the time between using the toilet. A bladder diary, bladder training program and pelvic floor muscle training are techniques a pelvic health physiotherapist may implement to help assist with improving bladder control.
SUI can be addressed by assessing the function of the pelvic floor muscles to ensure they are functioning optimally. An individual pelvic floor muscle training program can then be implemented to address any weakness or poor function.