What is Urinary Incontinence?

Urinary incontinence is the involuntary or accidental leaking of urine and can range from a small occasional leak to a complete loss of bladder control. Urinary leakage is a very common condition, with approximately 1 in 10 Australian men suffering from urinary incontinence at some point in their life. Unfortunately only 30% of people with urinary leakage report seeking help from a health professional.

There are 2 main types of urinary incontinence:

• Stress incontinence is the leaking of urine during activities that increase pressure on the bladder, such as coughing, sneezing or exercising.
• Urge incontinence, which is the leaking of urine due to a sudden, strong and unexpected urge to urinate, which consequently results in not making it to the toilet in time.

What Causes Urinary Incontinence?

Stress incontinence occurs in situations where the pressure in the bladder becomes greater than the “closing down” pressure produced by the pelvic floor muscles. This increase in bladder pressure could be caused by coughing, sneezing, or the effort exerted during exercise. These activities cause increased abdominal pressure, which is then transmitted to the bladder. If the pelvic floor muscles are not strong enough to keep the bladder and urethra closed, small amounts of urine leak out.

Urge incontinence occurs due to premature contraction of the bladder’s muscular wall called the ‘detrusor’. In regular bladder function the bladder should stretch gradually as it fills, giving a light urge to urinate which progressively strengthens over time. In people with urinary urgency or urge incontinence, the bladder wall suddenly contracts without warning before it is full, and often doesn’t allow people enough time to make it to the toilet.

How is Urinary Incontinence Diagnosed?

Usually, a clinical diagnosis can be made based on your history and the information you provide. A physical examination looking at the strength and function of your pelvic floor muscles will also be completed. Occasionally other tests may be required to assist with diagnosis, ranging from bladder diaries to urodynamic studies, however, these are only utilised if necessary depending on your presentation.

What Treatments Are Available For Urinary Incontinence?

Physiotherapy is often considered the first line of treatment for urinary incontinence. Your physiotherapist will form a management plan with you, which often involves:

• Identifying your pelvic floor muscle function using real-time ultrasound
• Individualised exercise program for pelvic floor muscle strengthening and endurance
• Strategies to re-train optimal bladder and bowel habits for improvement of symptoms
• Short and long term strategies for incontinence management, including continence aids
• Exercise and lifestyle advice for general health

What Results Can You Expect?

A large proportion of people with urinary incontinence can be treated, managed, and in many cases completely cured with physiotherapy. However, it is important to seek help from your health professionals as soon as possible, as symptoms may gradually worsen if left untreated.

Will You Need Surgery?

A small number of people will have symptoms that do not completely resolve with physiotherapy alone and may need to consult with a doctor or specialist to discuss surgical options. For more information, please consult your physiotherapist with a special interest in men’s health physiotherapy.