WOMEN'S HEALTH

URINARY INCONTINENCE & POP

TYPES OF URINARY INCONTINENCE
Stress Urinary Incontinence (SUI) refers to leakage of urine from the bladder occurring with physical activity or exertion. It may happen with coughing, sneezing, laughing, heavy lifting, jumping or exercising.

Urge Urinary Incontinence (UUI) refers to a sudden strong urge to urinate associated with small or large amount of urine loss and increased frequency of urination.

DOES PREGNANCY AND CHILDBIRTH CAUSE URINARY INCONTINENCE?

SUI and/or UUI may develop during pregnancy or post-partum. During pregnancy, the growing uterus and baby place increased pressure on the bladder and the pelvic floor muscles. The decreased bladder volume and strain on the pelvic floor muscles cause incontinence. During childbirth, the birth canal (vagina) with its associated nerves and pelvic floor muscles can be excessively stretched – especially if stage 2 of the delivery (the pushing phase) is either very fast (less than 10 mins) or prolonged (more than 30 mins). A stage 2 labour that is of approximately 20-30 mins duration has been statistically shown to reduce the incidence of nerve and pelvic floor muscle damage. Although pregnancy and childbirth can cause UI, it can be effectively treated with physiotherapy management.

WHAT ARE THE RISK FACTORS ASSOCIATED WITH URINARY INCONTINENCE?

Common causes of UI are:

Multiparous (multiple pregnancies)
Obesity
Gynaecological or urogenital system surgery
Chronic illness e.g. Parkinson’s, Diabetes etc.
Certain medications
Smoking
Chronic straining due to constipation
Chronic cough or chronic respiratory disease
Post-menopausal women due to hormonal change

WHAT IS THE ROLE OF THE PELVIC FLOOR MUSCLES?

The pelvic floor consists of three layers of muscles that function to support the pelvic organs; assist in urinary and faecal continence; aid in sexual performance; and stabilise the pelvic girdle.If three muscles and their associated ligaments or nerves become over stretched, they are unable to create sufficient tension to ‘hold up’ the pelvic organs (bladder, uterus and rectum) or ‘close off’ the urethra (outlet of the bladder); vaginal passage; and rectum. This may result in pelvic floor dysfunction, urinary or faecal incontinence, decreased sexual sensation during intercourse or the possibility of a pelvic organ prolapse. (Figure 2.1)

Figure 2.1

WHAT IS PELVIC ORGAN PROLAPSE(POP)?

POP Occurs when there is inadequate support of the bladder, uterus or rectum by the pelvic floor muscles and associated ligaments; or when there is excessive pressure on the pelvic organs. Either or both of these factors can cause sagging and a downward bulge of any or all of the pelvic organs into the vagina. Childbirth is often the cause of a prolapse, affecting 50% of porous (child bearing) women.

Symptoms of a POP may include:

Heaviness in the vagina
Sensations of something “coming down”or a Lump bulging out of the vagina
Pain or decreased sensation with intercourse
Recurrent urinary tract infections
Difficulty emptying your bowel
A slow urine stream during voiding

CAN PHYSIOTHERAPY HELP URINARY INCONTINENCE AND PELVIC ORGAN PROLAPSE?

Medical research confirms that pelvic floor muscle training is the most effective treatment option in address both urinary incontinence and pelvic organ prolapse.

At Morthan Cure, our Women’s Health Physiotherapist will carry out a full assessment of your pelvic floor muscle strength and function using real time ultrasound imaging in addition to an internal examination. If indicated, a pelvic floor muscle rehabilitation program will be prescribed, which may include pelvic floor muscle exercises, intravaginal electrical stimulation, bladder training and abdominal core stabilisation exercises. In addition, any other factors that are contributing to increased pressure on the pelvic floor will be addressed during a comprehensive assessment.