What is urinary Incontinence?
Urinary incontinence is the involuntary loss of urine, regardless of how much is lost. These leaks can occur during physical exertion (eg. jumping jacks), sneezing, and even coughing. It affects women of all ages. Thus, whether it is a young trampoline athlete, a pregnant, or an aging woman, they can all experience episodes of incontinence, increased urinary frequency, and even urinary urgencies. If you have experienced these symptoms, you are not alone:
According to the International Consultation on Incontinence (2017), “Approximately 10% of all adult women report leakage at least weekly. Occasional leakage is much more common, affecting 25%-45% of all adult women.”
Urinary leakage, a taboo?
There are at least 3.3 million Canadians who have urinary incontinence and only 1 in 4 people have discussed it with their doctor. It makes you wonder why women don’t talk to a healthcare professional about it. This may be due to embarrassment, the thought that leaks are normal, as well as a lack of resources and knowledge transfer. This suggests that the prevalence could be even higher for the above reasons.
Are you thinking “I am too old for that, it will not be effective for me”?
Urinary incontinence is not a normal part of aging! Menopause changes that occur in women as they get older may contribute to incontinence, but that doesn’t mean you just have to live with it. Almost all cases of urinary incontinence can be treated and managed. Even if your problems have existed for a long time or your pregnancies date back several years, perineal rehabilitation will often be effective in improving your daily life.
| Rate of urinary incontinence according to sports | |
| Pilates | 26% (Bo, 2011) |
| Fitness | 27% (Bo, 2011) |
| Basketball | 42% (Jacome, 2011) |
| Cross Country | 46% (Poswiata, 2014) |
| Elite Dancing | 52% (Thyssen, 2002) |
| Jogging (Endurance) | 62% (Araujo, 2008) |
| Volleyball | 66% (Schettino, 2014) |
| Trampoline | 73-80% (Da Roza, 2015; Eliasson, 2002) |
On the other hand, urinary incontinence also affects athletic girls and women
In fact, high-impact sports increase the pressure exerted on the pelvic floor. If the muscles of the “CORE” (abdominal, lumbar, pelvic floor muscles and, the diaphragm) are unable to manage the increased intra-abdominal pressure and the pelvic floor is unable to compress the urethra, it can result in urinary incontinence.
So, what about pregnant women?
Urinary incontinence is very common during pregnancy and post-partum, but that doesn’t mean there is nothing you can do about it. Pelvic floor muscle training is the first line of treatment for women presenting with urinary incontinence post-partum. However, an assessment of the pelvic floor health during the pregnancy can prevent and reduce urinary incontinence in post-partum. The International Consultation on Incontinence (2017) recommends pelvic floor exercises in the prenatal period:
Continent women exercising as early as week 20 of pregnancy were less likely to experience urinary incontinence:
• 56% less at the end of pregnancy
• 50% less after childbirth
• 30% less than three to six months after childbirth
Are the Kegel exercises the key to success?
You have certainly heard of Kegel exercises, named after the American gynecologist who invented these exercises. They are often recommended after childbirth or suggested to treat urine leakage. While effective in strengthening the pelvic floor, they are not always easy to perform and should not be done consistently by everyone without an assessment of the overall condition. Indeed, some people having more stiffness of the pelvic floor will have to learn to relax their muscles in priority. Others will need to do coordination exercises and learn to contract the perineum in a specific context, before and during a cough, for example. Also, some push (strain) rather than contract their pelvic floor muscles, which can promote organ descent (prolapse). Others compensate by contracting their glutes and locking their breathing.
Actually, 1 in 2 women would not do their Kegel exercises properly, according to the College of physiotherapy in Québec (2019). Also, supervised pelvic floor strengthening is superior to unsupervised strengthening (ICI, 2017; Evidence Level 1).
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There is no magic formula, every woman is unique. Therefore, an analysis and an understanding of the whole problem are required. Pelvic Floor Physiotherapists are trained to advise and support the woman in her process, so do not hesitate to consult and try to “de-taboo” urinary leakage.
How to prevent these naughty leaks?
Pelvic floor rehabilitation can prevent, manage and treat urinary incontinence. It aims to normalize the strength, tone, flexibility, and coordination of the pelvic floor muscles. Without being limited to the perineum, a comprehensive approach considers the adjacent joint and muscle structures, such as the sacroiliac joint, the hips, the “CORE” (abdominal, lumbar/thoracic, pelvic floor muscles and, the diaphragm). The posture, the respiratory pattern, the management of intra-abdominal pressure, adhesions or scarring of the abdomen, and functional movements are elements assessed during a pelvic floor physiotherapy consultation.
If you have any questions, please call or email Kimberly!
Kimberly Lessard, MPT, Physiotherapist