Urinary incontinence — the loss of bladder control — is a common and often embarrassing problem. The severity ranges from occasionally leaking urine when you cough, sneeze, run or jump (entitled stress incontinence) to having an urge to urinate that is so sudden and strong you don’t get to the toilet in time (urge incontinence).

Although it occurs more often as people age and in women who have given birth, urinary incontinence isn’t an inevitable consequence of aging or of having had kids.

Ir urinary incontinence affects your daily activities, seeing a Pelvic Floor Physiotherapist can certainly help. Fortunately, for most people, simple lifestyle and behavioural changes, bladder training as well as specific pelvic floor strengthening and relaxation exercises can lessen symptoms and even may stop urinary incontinence altogether.

Read on to learn about the types of urinary incontinence and how you can effectively retrain your bladder and pelvic floor to ease these unwelcome and discerning symptoms.

There are four main types of incontinence:

1) Stress incontinence. This occurs when urine leaks when you exert pressure on your bladder by coughing, sneezing, laughing, jumping, exercising or lifting something heavy.

2) Urge incontinence. This occurs when you have a sudden and intense urge to urinate followed by an involuntary loss of urine. It may also cause you to feel the urge to urinate more frequently.

3) Overflow incontinence. This occurs if you experience frequent or constant dribbling of urine due to a bladder that doesn’t empty completely.

4) Mixed incontinence. This occurs if you experience more than one type of urinary incontinence. For example, you can suffer from both stress and urge incontinence at the same time.

For the sake of this article we will focus strategies for stress and urge incontinence.

The “Knack Reflex”

Most of us have heard of the “kegel” exercise, but maybe not the “knack” reflex. A kegel is a contraction of the muscles of the pelvic floor that when performed properly helps to keep the pelvic floor strong. Whereas the “Knack” reflex is a well timed contraction of the pelvic floor muscles just before an increase in intra-abdominal pressure such as a cough, sneeze or laugh. The proper timing of the pelvic floor contraction is a reflexive reaction. However, if there is any pelvic floor dysfunction or imbalance, this reflexive contraction has likely become slow, “lazy” or non-existent.

If you are curious if your “knack” reflex is working optimally, go ahead and test yourself! Place your hand over your vaginal and/or rectal opening. You can do this in any position and above clothes if that makes you more comfortable. Perform a couple strong coughs. Do you feel a pushing down or bulging into your hand? Or do you feel everything stay still or even your muscle contract under your hands? If you feel a pushing down or bulging and you are dealing with bladder issues it may be worthwhile working on your pelvic floor control and “knack” reflex. A pelvic floor physiotherapist can fully assess you and determine the best approach for re-training your pelvic floor based on your symptoms.

Bladder Training

A lot of us unintentionally teach our bladder poor habits that may gradually result in increased incontinence or increased urinary urgency/frequency. For example, if you have a habit of urinating before your bladder is full, “just in case”, your bladder learns to signal the need to go when less volume of urine is present. Fortunately, old bladders can learn new tricks. Bladder training is a program of urinating on schedule, enabling you to gradually increase the amount of urine you can comfortably hold.

1) Keep track. For a day or two, keep track of the times you urinate or leak urine during the day, how much fluid you are taking in and how long your urinations are (count in “mississippis”).

2) Calculate. On average, how many hours do you wait between urinations during the day?

3) Choose an interval. Based on your typical interval between urinations, select a starting interval for training that is 15-30 minutes longer. If your typical interval is one hour, make your starting interval one hour and 15 minutes.

4) Hold back. When you start training, empty your bladder first thing in the morning and not again until the interval you’ve set. If the urge hits first, remind yourself that your bladder isn’t really full, and use techniques to delay going. Try gently contracting and relaxing your pelvic floor 10x, sit down and perform 10 deep breaths, distract yourself with another activity.

5) Slowly increase your interval. Once you are comfortable with your set interval, increase it by 15-30 minutes. Over several weeks or months, you may find you are able to wait much longer and that you experience far fewer feelings of urgency or episodes of urge incontinence

Lauren Sutherland MscPT, BHK
Registered Pelvic Health Physiotherapist
Core Connection Mobil
Physiotherapy

Core Connection Mobile Physiotherapy
Victoria BC
Admin@coreconnectionphysio.com 
250-999-0568

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