You know my friend Anne spends every spare moment she’s not being a brilliant OT lecturer and author, searching for funny incontinence cards for my birthdays and as you can see from this year’s card, she has yet again excelled. This one pretty much takes the cake though because this is something that distresses so many of my patients – the lack of control that comes with increased intra-abdominal pressure such as with laughing and sneezing – it really isn’t a laughing matter for them. But there is plenty you can do to solve the problem.
All those activities involve an increase in intra-abdominal pressure (as well as bending, pushing the shopping trolley, blowing your nose, running etc) and when there is leakage it is called Stress Urinary Incontinence (SUI). The way to prevent any embarrassing leakage of urine with these activities is to learn the knack or habit of bracing- firstly engaging your deep abdominal muscle (Transversus Abdominis), then drawing in your vaginal muscles (Levator Ani muscles) and finally your anus (external anal sphincter). It is also important to strengthen these muscles individually by doing Pelvic Floor Muscle Training (PFMT) and specific Transversus Abdominis strengthening work. If you have a bad cough with the flu or a cold or are a runner and you are leaking, then another strategy is to use a super tampon as a splint to help prevent the leakage (not to soak up urine). If this doesn’t work then a device called a Contiform is a specific pessary to help with SUI.
But another very common type of leakage is called Urge Incontinence and it comes under the umbrella of the Overactive Bladder (OAB). It can be associated with urinary urgency, frequency and nocturia. The treatment strategies we use to help these conditions include:
- Bladder retraining – training the bladder to store bigger volumes of urine more in keeping with its normal capacity of 350-500 mls for every void (wee).
- Deferring the urge to go by using urge control strategies
- Following the good bladder habits (avoiding caffeinated drinks; drinking 2 litres of fluid including water, juice, milk and decaf tea and coffee; don’t go just in case; sitting properly to urinate, no hovering, no straining)
- Always sit properly for passing a bowel motion, never straining.
These are just a few of the strategies you can use to help treat the different types of urinary leakage. There is much more in my books, but also it is very important to seek individual help where possible from a Continence and Women’s Health Physiotherapist so she can ensure that you are contracting your pelvic floor muscles correctly.
I know you’ll all never think of multi-tasking the same way again……!