Urinary incontinence is not always due to having a weak pelvic floor.
Instead, in many cases, it is linked to an inability to relax the pelvic floor muscle. Overactivity of this muscle has led to it becoming fatigued, irritable and tight, with a resulting loss of control over bladder function.
It is a common problem, affecting both men and women, and can take different forms (footnote 1).
So what can be done? Physiotherapy for urinary incontinence should work not only on improved control of the pelvic floor muscle, but also needs to focus on other movements linked to the pelvis – the way we sit and stand.
Most people don’t appreciate the fact that the pelvic floor also plays an important role in contributing to proper control of posture and movements of the pelvis – it is a primary muscle group contributing to our ‘core control’.
Research has shown that sitting and standing with a normal lumbar curve with the pelvis upright encourages automatic contraction of all the deep core muscles, including the pelvic floor muscle. Sitting slumped or standing with a sway back reduces activity in the pelvic floor. (See articles on Core stability and Sitting properly).
It is important to work on this. Incontinence develops when the pelvic floor muscle (footnote 2) becomes inefficient, overactive or weak due to excessive downward pressure on the muscle as a result of a sustained increase in intra abdominal pressure.
This can occur for a range of reasons: pregnancy, vaginal birth, chronic cough, chronic constipation and straining, high impact sports, repeated heavy lifting, upper chest breathing, abdominal crunches, excessive abdominal bracing and poor posture.
Doing it the right way
When contracting their pelvic floor, many people do it incorrectly by flattening then tightening their abdominal muscles. They need to learn to relax the pelvic floor muscle as well as contract it while breathing properly without tightening and contracting the upper abdomen.
Your therapist can show you the right way and prescribe the best exercises for you.
To help with urinary incontinence there are also many things you can do as part of your daily activities.
To keep the pelvic floor muscle in good shape
- Sit upright with a lumbar curve. Don’t cross your legs. (see article on Sitting properly)
- Stand with your weight on both feet, only slightly apart and your pelvis aligned over your ankles. Stop the habit of clenching your buttocks
- Drink 2000ml of fluid daily, preferably water. Drink more if it is hot or you are exercising. Eat plenty of fibre
- Only urinate when you need to; break the habit of urinating ‘just in case’. Urinate 4-6 times a day only (300-350mls each time). Encourage the kids to urinate when they need to, not when it suits you!
- Contract and lift your pelvic floor muscle prior to lifting. Do not lift more than your pelvic floor muscle can handle
Using the toilet
- Sit; don’t hover over the toilet as the pelvic floor muscle can’t fully relax in this position
- Keep your lumbar curve in neutral, by sitting upright and lean slightly forward at your hips to allow the pelvic floor muscle to relax
- While urinating or defecating do not brace or bear down on the pelvic floor muscle. Relax your abdominal muscles while breathing into your abdomen
- After passing urine or faeces, contract and lift the pelvic floor muscle, then fully relax it.
- Aim to maintain the natural lumbar curve
- Ensure you breathe into your abdomen and avoid bracing with the upper abdominals, as this will increase the intra abdominal pressure. Always relax the pelvic floor muscle fully after actively contracting it
- Avoid high impact and explosive exercise (running, jumping) until your pelvic floor muscle is working effectively. For some this may mean avoiding this type of exercise all together. Abdominal crunches and ‘sit ups’ are not recommended
- Walking, swimming and supervised appropriate floor exercises such as our Key Moves™ exercise classes are recommended. Don’t avoid all exercise. Laugh lots and have great sex!
There are 2 types of urinary incontinence which may be present, in isolation or in combination:
Stress incontinence occurs where there is leakage of urine with a sudden increase in intra abdominal pressure e.g. when you cough, laugh, jump, sneeze, lift run or perform a sudden exertion.
Urge incontinence occurs when one feels the urge to urinate, even when there is only a few mls. of urine in the bladder. Thus, one releases small amounts of urine regularly.
The first type is a matter of physical control, the second is more mental, linked to habits and responses to cues.
The pelvic floor muscle is a multi layered muscle that sits like a hammock at the base of the pelvis. It is slung between the sit bones (ischial tuberosities), the tail bone (coccyx) and the pubic bone in front. It specifically supports the bladder, the uterus and the bowel. It contains the muscle sphincters around the openings for the urethra (tube from the bladder), vagina and the anus and is therefore largely responsible for maintaining continence.