Incontinence is a common condition which refers to an inability to effectively control the nerves and muscles which help the bladder hold or release urine. In other words, incontinence is the involuntary loss of urine.

The two main types of incontinence are stress and urge incontinence. Stress incontinence refers to urine leaking in association with physical exertion, whereas urge incontinence refers to an abrupt and urgent desire to urinate, resulting in leakage and the voiding of urine. Mixed incontinence refers to a combination of these two. In women, inconsistency is typically related to pelvic floor dysfunction, often arising during pregnancy or after childbirth, or during menopause.

**Urge Incontinence**

Sudden intense urge to urinate (generally followed by an involuntary leakage) is called Urge Incontinence. Many people suffering from this type of incontinence also tend to urinate often, including throughout the night. This can happen no matter how much urine is actually in your bladder and it can happen without any warning as a result of the sphincter muscle not functioning as it should.
Other terms used to describe this are bladder spasms, irritable bladder, spasmodic bladder, or detrusor instability. Unlike stress Incontinence which happens due to a physical activity (e.g. coughing), urge Incontinence generally occurs due to things like the sound of running water, turning the key when you arrive home, or after a single sip of water.
**Causes and Contributing Factors of Urge Incontinence**
Bladder infection, bladder inflammation, bladder cancer, bladder stones, neurological disorders like multiple sclerosis (MS) or trauma including a stroke, and diabetes can cause urge incontinence. Urge Incontinence can also occur due to childbirth from damage to the nerves that control the bladder.

Mixed Incontinence

Mixed Incontinence is the combination of both Stress and Urge Incontinence. This is common among older women, but can happen at any age.

**Incontinence In Pregnancy and After Childbirth**

During pregnancy, muscles of the pelvic floor and the bladder sphincter (the valve at the bottom of the bladder that controls urine flow) are put under stress due to the additional pressure on the bladder from the baby.
In addition to weight, pregnancy and birth can cause the bladder and urethra to move. Childbirth can injure the bladder and the pelvic floor muscles especially with assisted delivery (e.g. forceps) and episiotomies. It is recommended that all postpartum people see a pelvic physiotherapist.

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Treatment of Incontinence

Kegel Exercises

The most common exercise to treat incontinence is kegel exercises. This involves strengthening of the pelvic floor muscles by contracting for 5 to 10 seconds and then resting. The exercise is performed by mimicking the act of stopping your urine from flowing. Depending on the reason for the incontinence, some women have trouble performing a proper kegel (for example, due to lack of sensation). A Pelvic Floor Physiotherapists can help assist you with evaluating your technique and guiding you through the breathing, positioning, and contraction. For more exercises to stop stress incontinence click here.

Pelvic Floor Physiotherapy

A Pelvic Floor Physiotherapist specializes in diagnosing and treating pelvic floor dysfunctions that cause incontinence and other issues such as painful intercourse. They can help determine the root cause for your incontinence and guide you through proper exercise techniques that treat your dysfunction. Pelvic Floor Physiotherapy is a holistic approach including treatment of the 3 important functions: pelvic organ support, bladder and bowel control, and sexual function.

Depending on the patient's comfort level, Physiotherapists can perform an internal or external examination to look at the pelvic muscles and function. One purpose of internal pelvic work is to help loosen any tight muscles that might be causing the weakness. Another purpose is to assess the degree of prolapse (which can put pressure on the bladder). External work involves teaching diaphragm breathing to target the deep core muscles, proper kegel technique, and more. A virtual pelvic floor health expert can help with external techniques and training like those found on Wellby. For a full assessment (including internal examination), an in-person clinic is advised.

Bladder Training

Bladder training is the process of spacing out the times in which you urinate. For example, set a goal of going to the bathroom a maximum of one time per hour and then overtime, stretch this out to 90 minutes. The goal is to eventually achieve a duration of 3 to 4 hours in between urination. For those with Urge incontinence, you would avoid going to the bathroom after that initial urge or bladder spasm and instead wait 15 minutes. A week or two later, increase the wait time to 30 minutes. Pelvic Floor exercises focused on strengthening the urethra can be effective, but there are also some medications that can help – speak to your doctor about bladder muscle relaxers.

Lifestyle Changes

Avoiding certain foods or activities that cause bladder irritation can be an effective remedy for incontinence. Avoiding alcohol, caffeine, foods with artificial sweeteners, as well as acidic or spicy ingredients can help. Avoid smoking (especially since smoking can cause coughing). Losing weight (if you are overweight) can help reduce pressure on the bladder and can also reduce the risk of type two diabetes which can help reduce risk of incontinence. Constipation can put pressure on the bladder as well, so eating foods high in fiber can help reduce bladder stress.

When to see a Pelvic Floor Health Practioner

Involuntary leakage is common, but it’s not okay. It also gets worse with age. If you are leaking urine before going to the bathroom, urinating more than one time every two hours, waking up in the night to go to the bathroom, or unable to fully empty your bladder then you should speak to a Pelvic Floor Health practitioner today.