Understanding your bladder
What is incontinence?
Incontinence refers to the involuntary or accidental leakage of urine, no matter how small the volume. The most common type of incontinence is stress urinary incontinence which can happen with there is an increase in abdominal pressure such as coughing, sneezing, laughing, jumping, running etc. Urge incontinence occurs when a sudden intense urge to pass urine occurs and you leak on the way to the toilet. Some women with urge incontinence also complain of a frequency of voiding during the day or night.
Can incontinence be prevented?
One really effective way to manage or prevent incontinence is to ensure you have a strong pelvic floor. Things like managing constipation, avoiding repetitive heavy lifting, keeping your weight under control, and managing chronic respiratory conditions can also help to reduce the strain on your pelvic floor muscles. There are certain times when Women can be more susceptible to pelvic floor dysfunction and this is commonly seen post-pregnancy, around menopause or if you’re having any time of abdominal or pelvic surgery.
Isn’t incontinence just a normal part of ageing?
The simple answer is no. However, there are times where incontinence can be more prevalent; this is usually post-pregnancy, post-pelvic surgery and around menopause. The good news is there are things we can do to either prevent, cure or help manage your symptoms; regardless of how long you’ve had them for!
What should my normal bladder function be like?
- It is normal to go to the toilet anywhere between 5-7 times per day. More if you have a higher fluid intake. It’s also normal to have to get up once in the night time to void. Frequency symptoms can be quite subjective, and can come down to whether your frequency is bothersome to you.
- When you void, you should feel like your bladder is completely empty. You shouldn’t feel like you need to void again 5 minutes after going to the toilet. You should not have to push or brace to void.
- You shouldn’t feel like you have to rush to the toilet
- Having no urge or sensation to void your bladder is not normal
Can I train my bladder for optimal function?
Yes, the bladder can be trained! Reducing your fluid intake so that your frequency reduces is not the correct way to retrain your bladder. You should be drinking 6-8 cups of water per day. Caffeine, artificial sugar, carbonated drinks, and smoking can irritate the bladder, increasing frequency and urgency symptoms. Furthermore, voiding for convenience can create poor bladder habits by increasing the sensation to need to void despite there being only a small volume in the bladder; thus increasing frequency.
How do I contract my pelvic floor?
Follow these instructions to help strengthen your pelvic floor muscles:
- Firstly make sure you are in a comfortable position, either lying on your back or sitting in a chair with a backrest
- Contract your pelvic floor by imagining you are trying to seal off the flow of urine mid-stream or by thinking about closing around your anus, vagina, and urethra. The aim is to try and close and lift much like an elevator closes its doors and lifts up
- You shouldn’t feel excessive activation of your tummy muscles or buttock muscles, however, some lower abdominal contraction is normal
- To work on power, think about squeezing your pelvic floor as hard as possible, then letting go and relaxing completely
- Repeat this as many times as you can until you feel your pelvic floor fatigue. You can build on a number of repetitions working up to around 12-15 reps.
- To work on endurance think about contracting your pelvic floor and holding for as long as possible. Initially, you may only be able to hold for 5 seconds so count to 5, then take a rest. Repeat this 10-12 times.
- Work on building your holding time from anywhere between 10-20 seconds
- Just remember, do not hold your breath, do not bare down or brace and make sure your surrounding muscles are over activating
Where can I get help or more information?
Some physiotherapists are specifically trained in women’s health, in particular, the assessment and treatment of pelvic floor dysfunction and incontinence. Firstly a thorough subjective examination is conducted to gain an understanding of what is causing you the most concern regarding your bladder symptoms. Usually, a bladder diary is prescribed to look at your fluid intake versus your output. Your treatment will always consist of strengthening your pelvic floor; whether that be to improve power, strength or endurance will depend on what your symptoms are. Furthermore, bladder retraining can help to reduce the feelings of urgency and frequency.
Physiotherapist training in pelvic floor assessment can ensure that you are contracting your pelvic floor muscles correctly. This is very important because if you are not contracting the right muscles your symptoms will not improve. Hence it is always ideal to get a professional opinion. In some instances, your muscles can be quite weak and the need for additional assistance why the way of muscle stimulation can help to wake your muscles up again.
Do you have any quick, easy tips to help me manage my symptoms now?
Yes! Here are some easy to follow instructions:
- Every time you cough, sneeze or lift heavy objects remember to contract your pelvic floor
- Don’t rush to go to the toilet, settle your urge by focussing on your breathing and distracting your mind
- Just like any form of muscle strengthening, it’s going to take time, consistency and effort. Your hard work will pay off, just remember to persevere
- Set reminders or goals for yourself to do your pelvic floor exercises e.g at every traffic light or when you are lying in your bed of a night time
- This is not a temporary fix, this is a lifetime commitment to pelvic floor strength. Consistency is the key!