A physiotherapist can help you to fix problems with incontinence. And it’s simpler than you think.

When you laugh, or sneeze, do you wet your pants? What about when you are rushing to go to the toilet – do you always make it?
If you’re squirming with embarrassment about telling someone you can’t “hold on”, here’s something that may make you less reluctant to talk about it.
Incontinence is one of the most common health conditions affecting Australians, according to the Australian Physiotherapy Association. In fact, an incredible six million Australians will experience it during their lifetime, it says.
While pregnancy and giving birth are the most common causes of incontinence in women, for men it often occurs as a result of prostate surgery and associated radiation therapy.
Other causes can include stroke/other neurological conditions, diabetes or endocrine diseases, menopause, pelvic surgery and general ageing.

You can fix or reduce the problem

Now, here’s something even more surprising: there is no need for you to give up on being able to “hold on” and think that wearing protection is the only answer.
Yes, all those ads for incontinence pads may try to normalise bladder leakage but there’s really nothing normal about it, says Cape Byron Medical Centre physiotherapist Danni Turner.
“We have a funny level of acceptance about incontinence,” she says. “Many mothers especially think that, after having a baby, it’s okay to wet yourself. That’s a misconception. The majority of the time incontinence is very treatable with an assessment with a specialised physiotherapist trained in pelvic health management and a basic exercise routine.”
APA pelvic health physiotherapist Dr Irmina Nahon, Assistant Professor in Physiotherapy and Clinical Education Coordinator at the University of Canberra, agrees with Danni that help for incontinence is available, and sufferers need not be resigned to it.
“Incontinence has a significant effect on quality of life, and has both psychological and financial impacts,” she says. “It does not have to be endured as a result of ageing or child birth, which many people assume and therefore don’t talk about openly or seek treatment for.”
With World Continence Week starting on June 18, APA is reassuring all Australians that treatment for incontinence is available.

Your amazing pelvic floor muscles

First up, what is it exactly that your pelvic floor muscles do?
When you contract them, the internal organs lift and the sphincters tighten the openings of the vagina, anus and urethra.
The muscles of the pelvic floor also work with the abdominal and back muscles to stabilise and support the spine.
When your pelvic floor muscles are not working properly you may experience fecal or urinary incontinence. You may also pass wind more easily.
Says Danni: “After my first baby, pelvic floor health became a lot greater interest of mine.
“I’d gone through childbirth and experienced challenges with continence.
“Thankfully GPs are now referring women to me from early in their pregnancy instead of late so we can work to make their make pelvic floor strong before they give birth and prevent problems.”
With age naturally the pelvic floor becomes deconditioned and lacks tone so older women and men can also benefit from pelvic floor training, says Danni.

And one, two, three

To assess a female patient’s pelvic floor strength, Danni uses a high-tech device called a NeuroTrac that gives an electronic reading of how well the floor is contracting, whether the exercises the patient is doing are correct, and how fatigable the muscles are.
“That allows me to design an at-home exercise program,” she says. “It is linked up to a little probe that goes into the vagina. It is really non-invasive. The patient can put it in themselves and, while we do the assessment, they can remain fully clothed.”
The first assessment usually lasts 45 minutes and includes taking a full history.
Follow up can be anywhere from two to three weeks, or longer.
Danni says: “Anyone can start retraining their pelvic floor at any age.
“First of all, they need a really good awareness of how to turn on pelvic floor. A lot of people are not really sure if they are doing it right.”
That’s where a trained physiotherapist helps.
Verbal cues may be helpful in isolating and working those hammock-like pelvic floor muscles.
“You might imagine sucking a piece of spaghetti up your vagina, or lifting a hammock up towards your belly button” says Danni. “There are six or seven cues I use and we use the NeuroTrac to see which suits the patient best.”
Exercises focus on both fast and slow twitch muscle fibres.
“Fast are the ones you use when you sneeze or cough to hold urine in and slow are the ones that are there all the time to hold your organs in.”
Typically exercises involve lifting the pelvic floor and holding it for a certain amount of seconds, then relaxing. The muscles are worked until they are totally fatigued, twice a day.
Danni adds that having a stronger pelvic floor can increase the enjoyment of sexual intercourse for both parties.

Tricky cases

Sometimes a too tight pelvic floor can make urination or sex painful.
If Danni finds this is the case, training can involve relaxation and visualisation more than exercise.
Some patients may also have a reasonably strong pelvic floor but a weak bladder.
“There are three kinds of incontinence – stress incontinence, frequency incontinence and urgency continence and some of these can include a psychological element where the brain triggers that full feeling and you have to go to the loo,” she says.
“You might need to start holding off for two minutes when you first feel that you want to go.
“Often you will forget about it for a while, as the brain will switch off.
“An overactive bladder can also be caused by too much stimulant, for example, coffee.”
Danni says she asks patients to fill out a bladder diary about how often and when they are going, and pee into a measuring jug.
She adds that for cases of pelvic floor and bladder weakness, it is still important to drink plenty of water to maintain health.
“A lot of people stop drinking enough fluids.”
It’s also worth noting that exercise, even when pregnant, can help keep the whole body in good condition.
“Some things are better than others, though.
“Running or ball sports are stressful on the pelvic floor but cycling, walking, swimming, light resistance exercise, yoga and Pilates are, for the most part, safe.”

Book a  session with Danni here

By Cape Byron Medical Centre