It’s a really common complaint in a lot of women after giving birth that they may leak urine when they sneeze or laugh. A lot of women think this is a normal occurrence due to the changes in the body during pregnancy and birth. While it is a common occurrence, it definitely isn’t normal and shouldn’t be ignored. There are many things we can do to work on this, depending on the causes.
Lucky being a woman, isn’t it?
These don’t just happen due to pregnancy and birth either, sometimes habits like drinking lots of water or doing ‘just in case’ wee’s can cause this as well.
Let’s look at the different causes of urinary dysfunction; urinary incontinence refers to the uncontrolled leakage of urine. There are two main types of urinary dysfunction which can lead to urinary incontinence. The most common type people have heard of is stress urinary incontinence.
Stress urinary incontinence:
The uncontrolled leakage of urine during activities of increased load onto the body, most commonly tasks like sneezing, coughing or exercising. This relates to our ability to activate the pelvic floor correctly to close off the exit from the bladder, which should stop the leakage of urine with increased pressures. When the pelvic floor muscles activate, they cause a lifting and cinching of the bladder neck (exit from the bladder).
How to improve stress urinary incontinence:
Just like any other muscle, building up the natural tone but also strength and endurance of the pelvic floor muscles works to improve its function. Pelvic floor muscle strength/endurance can be improved by finding the point at which your pelvic floor muscles currently fatigue while attempting to hold a contraction and practicing regularly to improve it. If you’re unsure what the pelvic floor is, or how to contract your pelvic floor you can read more here.
Part of the issue often after giving birth can be the coordination. During pregnancy the pelvic floor muscles are stretched due to the extra weight of the fetus, and especially with a vaginal delivery an even further stretch and possibly tear can occur. This decreases their efficiency when being used, and messes up with their automatic contraction that would have previously occurred in activities like sneezing. So learning how to activate those muscles prior to sneezing can work to improve if not prevent leakage. Visiting a physiotherapist can be very beneficial in seeing if the activation and coordination is correct, as other issues can occur if we try and hold on too tight with our pelvic floor.
Urgency/ Overactive bladder.
Urgency refers to a strong urge to pass urine, often not correlated to the amount of urine in the bladder. This may or may not occur with urinary incontinence. If urgency occurs, its often referred to as overactive bladder, especially when accompanied with frequency (urinating >7 times a day) or nocturia (urinating >1-2 times overnight).
The main causes of this can vary as its not actually known. It is thought to related to the muscle of the bladder contracting without the bladder being appropriately full. It can also occur in someone who urinates quite often, meaning the bladder doesn’t stretch to accommodate urine as it should. So then when a small amount of urine goes into the bladder the signals to the brain of needing to urinate occur at a much smaller volume.
For most people with this condition alone, attempting to slowly increase the time between voids can help to slowly stretch the bladder and allow it to become accommodated to a more regular volume. This is known as bladder retraining. Doing this under the supervision of a clinician is highly recommended!
Sometimes, however, certain things can trigger this urgency. The sounds of running water, looking at a toilet or even walking through certain doors can all cause this strong urgency to urinate. We can have strong correlations to certain objects or acts that our brain contributes to urinating, and sometimes hearing or seeing these outside of the context of going to the bathroom can still cause the strong urge to urinate.
When attempting to make it to the toilet during an urgency episode, the pelvic floor muscles aim to hold in the urine. The rushing movements may result in some leakage. Sitting in place, attempting to relax and trialing the distraction techniques as listed below may allow the urge to decrease, and when a suitable time has passed since your last void, will you be able to make your way to the toilet.
Ways to delay urinating when urge occurs:
- Counting back from 100 in random numbers to distract the brain
- Contract your pelvic floor
- Scrunch your toes
- Place pressure over your perineum (using table corner).
All urinary symptoms will often be exacerbated by constipation. If the rectum is full of stool, the pelvic cavity is often more compressed than usual and can often cause any of the above urinary symptoms. If constipation occurs in conjunction with any urinary symptom, then working to improve the constipation is imperative as occasionally that alone can stop symptoms. You will be able to read more about the effects of constipation and how to improve it in an upcoming blog.
Another common thing that can result in urinary incontinence is the presence of an UTI. Having a screen done by a GP can rule this out an a contributing factor as any infection present will further irritate the bladder.
Arana Hills Physiotherapy are excited to start offering some women’s health treatment starting soon. Keep an eye on our socials. You can book online to see Rani here, or call us on 3351 5639.