Women’s Health: Stress and Urge Incontinence

It might not be particularly glamorous topic of conversation, but following pregnancy, it is not uncommon for women to develop stress or urge incontinence symptoms. Qualified physiotherapist, Anna Clayton, is here to give you the lowdown... 

If your friends get nervous when they laugh, cough, sneeze or attempt playing with their children on a trampoline, it could be because of the symptoms of these forms of incontinence, which are often related to childbirth. 

What Is The Difference Between Stress and Urge Incontinence?

Stress incontinence happens when urine leaks out at times when your bladder is under pressure; for example, when you cough or laugh as mentioned above.  Urge incontinence occurs when urine leaks as you feel a sudden, intense urge to pass urine, or soon afterwards.

Is This Normal?

Whilst it is not uncommon, particularly in the post pregnancy age group, it is not normal and can be improved with the right treatment.

Why Does This Happen?

Stress incontinence is usually the result of the weakening of / damage to the pelvic floor and urethral sphincter muscles that normally prevent urination.  Urge incontinence often results from the over-activity of the muscles that control the bladder. 

In some instances, the pelvic floor can be overactive and also lead to some additional pain around the pelvis as well as urge incontinence – this can be sorted by seeing a women’s health specialised physio. 

With images in the media of toned and slender women who have recently had babies, it is not an uncommon behaviour to consciously, or subconsciously draw the belly button in to engage the abdominal muscles thus achieving a flatter belly, particularly if everything is feeling a little less toned than it was pre-baby. 

Continual activation and engagement in these muscles can result in them becoming overactive leaving little slack in the system for when we want them to contract efficiently - to stop ourselves having a wee, or when the pressure in the trunk (intra abdominal cavity) increases when we sneeze or cough.

What You Can Do About It

An examination (yes, internal!) can distinguish whether your muscles are over active or need waking up around the pelvic floor area. 

If over-active:

This is when a women’s health physiotherapist can help you to learn how to differentiate between contracting muscles, relaxing them and then releasing tension completely.  Never before has the mildly irritating lyrics to Frozen been more apt With excessive muscle contraction, you really do want to allow your pelvic floor to ‘let it go, let it go...’.  These techniques may also be taught in antenatal/postnatal pilates classes to encourage your muscles to have a break between exercises.

If under-active:

An exercise that helps with preventing leakage is ‘The Knack’; here you are aiming to engage the pelvic floor muscles before coughing or sneezing, lifting or anything that generally increases your abdominal pressure.

Do this when you’re out for a walk and look to engage the pelvic floor about 50% the maximum you can tighten them and hold this gentler contraction throughout the movement/activity.  Obviously if you are going on a 3 mile walk, do this regularly through the walk, not for the entire duration!

If you are unsure you are engaging your pelvic floor muscles, a women’s health physio can examine you internally to check what is going on.  Otherwise, visual descriptions often help the sequence of muscle engagement, such as imagining the muscles work like an elevator can help, where you are drawing the pelvic floor upwards. Hold for 10 seconds as hard as you can, relax and then release – yes let it go..again.  Repeat 10 times and also add in some faster pulses of pelvic floor squeezes.  If you are less good at remembering to do them, incorporate them into the activities you do everyday = brushing your teeth, boiling the kettle, driving...little and often will see greater progress than once every 3 days!

Make sure to give it time for the muscles to wake up and remember their supportive role – at least 6 weeks and for more advice, seek out a women’s health physio. Happy laughing, sneezing & coughing and don’t forget to also let it go!

This blog was written by Anna Clayton: Anna works at Bury Physiotherapy Clinic as a Senior Musculoskeletal Physiotherapist and has recently completed a MSc in Advanced Physiotherapy.  She teaches regular Pilates classes including a Pink Pilates; specifically for breast cancer patients. At the clinic she offers patients acupuncture alongside other treatment techniques to help people back to normal day to day activities, sports and hobbies - she is all for functional movement! Anna enjoys keeping fit and active with regular running (the odd half or full marathon), occasional cycling and was a rower and heptathlete in her youth.