by Jocelyn McEachern MScPT FCAMPT
updated Feb 4, 2022
What is Urinary incontinence?
Simply put, incontinence is the involuntary loss of bladder control. It is often uncontrollable and almost always negatively impacts your life. Many people assume that incontinence is a normal process of aging. While your risk of experiencing some form of incontinence does increase as you get older, poor bladder control should not be accepted as part of the normal aging process. There are many treatment options that can help!
What are the different types of urinary incontinence?
Increased pressure on your bladder causes you to leak urine when your pelvic floor muscles aren’t strong enough to support the pelvic organs. Examples include urine leaks with coughing, sneezing, laughing, heavy lifting and exercising. Women after childbirth and men after prostate surgery are more at risk for stress incontinence.
Urge incontinence is sometimes also called overactive bladder (OAB), is leakage followed by the sudden, strong, uncontrollable urge to urinate. This may cause increased frequency to pee throughout the day (>8 times) as well as through the night. This is often triggered by certain environmental factors such as the sound of running water, certain medications or beverages including alcohol or caffeine, after an infection or in women who are postmenopausal when estrogen levels are lower.
This is the frequent dribbling of urine when the bladder isn’t able to fully empty. Overflow incontinence is more common in men with an enlarged prostate gland, and people with chronic diseases such as multiple sclerosis, diabetes or people who have suffered a stroke.
This occurs when a physical or cognitive impairment prevents you from making it to the bathroom in time. For example, severe arthritis can impair the ability to get up from a chair, or unbutton your pants fast enough.
The presence of more than one type of incontinence, most often a combination of stress incontinence and urge incontinence.
What causes incontinence?
Bladder Irritants: spicy, sugary or acidic foods, citrus fruits, carbonated beverages, alcohol, caffeine and herbal teas, artificial sweeteners and chocolate can all stimulate your bladder to increase the flow of urine.
Urinary Tract Infections: A symptom of a UTI is a strong urge to urinate as a result of the bladder being irritated, and can sometimes lead to incontinence.
Medications: Diuretics and antidepressants increase urine production which will increase urinary frequency and can lead to urge incontinence.
Pregnancy/Childbirth: During pregnancy, the uterus and weight of the baby places extra pressure on the bladder and pelvic muscles. In childbirth, there can be injuries to the vaginal walls which can affect the strength of the muscles as well as lead to pelvic organ prolapse, which can affect the position of the bladder and be associated with incontinence.
Being Overweight: Excess weight puts more pressure on the bladder which can cause stress incontinence.
Smoking: Smokers tend to have more urinary incontinence than non-smokers, perhaps because smokers are more likely to have a chronic cough leading to increased pressure on the bladder causing stress incontinence.
Constipation: Hard, impacted stool will occupy more space in the pelvic region and can cause the nerve that controls both the rectum and bladder to become overactive and increase urinary frequency and/or incontinence.
Age: Age can cause the pelvic muscles to get weaker and less flexible, preventing the muscles from allowing the bladder to hold as much and decreasing control over the release of urine.
Menopause: Decreased estrogen production due to menopause impacts the health of the bladder and urethra tissues.
Enlarged Prostate: An enlarged prostate can prevent full bladder emptying, which can lead to overflow incontinence.
Prostate Cancer: Both stress and urge incontinence are side effects of untreated prostate cancer, and is even more common following prostate cancer surgery. If possible, it is recommended to do pelvic physiotherapy prior to treatment to improve long-term outcomes.
How do you fix incontinence?
See a pelvic health physiotherapist
Pelvic physiotherapy provides education and strategies around delaying urge incontinence, and strengthens and improves coordination of the pelvic floor muscles for stress incontinence. Click here to learn how pelvic physiotherapy works. A well designed treatment plan that begins with a pelvic exam to identify muscle weakness and other contributing factors will be a powerful tool to resolve urinary incontinence.
- Delay strategies: when you get the urge to void, try to delay for 10 more minutes by taking some deep breaths or distracting yourself. The goal is to spread your voids out to every 2.5-3.5 hours.
- Double voiding: this can help to ensure full bladder emptying, after you go, stand up and reposition yourself and try again, sometimes leaning forward and pushing on your bladder can help more urine come out.
- Scheduled voids: plan to void every 2-4 hours to avoid leakage or strong, sudden, uncontrollable urge.
- Fluid and diet management: avoiding alcohol, caffeine and acidic foods, weight loss and increasing physical activity can all help decrease incontinence.
- Anticholinergics: may calm the muscles for overactive bladder/urge incontinence. Examples include oxybutynin (Ditropan XL), tolterodine (Detrol), darifenacin (Enablex), fesoterodine (Toviaz), solifenacin (Vesicare) and trospium chloride.
- Mirabegron (Myrbetriq): for urge incontinence, relaxes the bladder muscles so the bladder can hold more urine.
- Topical estrogen: to bring more elasticity and blood flow to the urethra and vaginal tissues.
- Alpha blockers: in men with urge or overflow incontinence, these medications can relax the muscles in the bladder neck and prostate to allow for easier/more complete emptying. Examples include tamsulosin (Flomax), alfuzosin (Uroxatral), silodosin (Rapaflo), and doxazosin (Cardura).
- to assist with strengthening and coordinating the pelvic floor muscles for stress incontinence.
A pessary is a silicone ring inserted into the vagina which applies pressure to support the urethra and decrease leakage. Pessaries are also used to treat pelvic organ prolapse.
Wearing a pad can be an effective method of collective urine leakage but does not address the root of the problem. We encourage pad use as needed while you treat the cause of the incontinence, rather than defaulting to wearing pads as a long term solution.
While urinary incontinence is a common pelvic floor dysfunction, it is often very treatable and not something that you have to accept as a normal aging process and have it negatively impact your life. Our expert pelvic floor physical therapists at Cornerstone can help to identify the type and causes of your incontinence to guide you through treatments that will be effective in getting you back to living your life! Our locations offering pelvic floor physiotherapy are located in Toronto, North York and Burlington. Contact us today to learn more.
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