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Incontinence is a widespread condition that can range in severity from a small leak to a complete loss of bladder or bowel control.

According to the Continence Foundation of Australia, more than 4.8 million Australians have bladder or bowel control problems.

It is not normal and we can help – so let’s start talking about it!!

Continence and Pelvic Floor Physiotherapy is a proven way to regain control of your pelvic floor. We specialise in training the pelvic floor muscles correctly: the sooner you see us, the sooner you will be on your way to recovery!

What is the Pelvic Floor?

The pelvic floor is a set of muscles that spread across the bottom of the pelvic cavity like a hammock. The pelvic floor has three openings that run through it, the urethra, the vagina, and the rectum. The functions of the pelvic floor include:
• To support the pelvic organs, specifically the uterus, the bladder, and the rectum
• To help provide sphincter control for the bladder and bowel
• To withstand increases in pressure that occur in the abdomen such as coughing, sneezing,      laughing, straining, and lifting
• To enhance the sexual response

What is Stress Urinary Incontinence?

Stress urinary incontinence is the involuntary release of urine during laughter, coughing, lifting of objects or any movement that increases pressure on your bladder.

Urine is composed of water, electrolytes, and other waste material that has been filtered out of the blood in your kidneys. Urine is then transported via the ureters to your bladder, where it is stored. Once full, the muscles in the wall of your bladder contract forcing urine through the urethra and out of your body. Sphincter muscles and pelvic floor muscles keep the urethra closed to avoid leakage of urine. These muscles relax at the same time the bladder contracts in order to allow urine to exit your body.

What Causes Stress Urinary Incontinence?

It is caused by a lack of support to the bladder outlet, this is due to both pelvic floor and connective tissue weakness. These tissues act like a hammock to resist the downward pressure on the bladder during increased abdominal pressure e.g.- when coughing

There are several causes for stress urinary incontinence, these include:

-Hormonal changes During the week before your menstrual cycle, estrogen levels fall, causing symptoms of stress urinary incontinence to worsen. Additionally, as a woman goes through menopause, estrogen levels also fall causing the pelvic floor muscles to weaken. This results in less muscular pressure around the urethra, making stress urinary incontinence more likely.

-Pregnancy If you are pregnant, you may experience stress urinary incontinence due to hormonal changes and the enlarging size of the uterus.
During pregnancy, estrogen levels are lower, leading to less muscular strength in the sphincter and pelvic floor muscles. Additionally, as the fetus grows extra weight is placed on your bladder.
Childbirth Vaginal delivery can damage your pelvic floor muscles making urine leakage more likely. The supporting tissues of your bladder can also be damaged during vaginal delivery causing a cystocele, or prolapse of your bladder, symptoms of which include urinary incontinence. You may not know you have suffered damage to your pelvic floor until after you have gone through menopause, when the pelvic floor muscles are further weakened due to a fall in estrogen levels.

-Poor exercise choices: Some exercises will exacerbate a week pelvic floor, these include running, jumping or any high impact exercise. Other exercises which stress the pelvic floor include sit-ups and deep lunges.

-Hysterectomy and other surgery
The bladder and uterus are very close together and have common supporting ligaments and muscles. Surgery to, or removal of your uterus as in a hysterectomy, risks damage to the supporting structures of your bladder. If these supporting structures are damaged, a cystocele is likely to occur. Symptoms of a cystocele include urinary incontinence.

-Illnesses When you are ill and suffering from severe coughing, the pelvic floor muscles may fatigue and allow temporary stress incontinence due to an increase in abdominal pressure experienced while coughing.

-Obesity Obesity can increase the abdominal pressure on the bladder leading to urinary incontinence.

How is Stress Urinary Incontinence treated?

Treatments of stress urinary incontinence are tailored to suit your individual problem. The following should be considered:

Pelvic floor muscle strengthening Strengthening the supporting muscles of your bladder is very effective in helping stress urinary incontinence. Biofeedback, or the use of special computer equipment to measure muscle activity, can help improve muscle control. Electrical stimulation can also assist in strengthening the pelvic floor muscles.

• Deep abdominal or core strengthening
• Learning the knack – this is when you contract your pelvic floor and deep abdominal muscles      prior to coughing (or whatever triggers your incontinence)
• Lifestyle changes
• posture
• adjusting activities e.g.- avoid jumping until your symptoms improve
• Weight loss if necessary
• Vaginal splinting if necessary

Studies show 85% of women with Stress Incontinence are cured with Physiotherapy treatment

To prevent urinary incontinence, you should consider the following:

• Routine performance of pelvic floor muscle strengthening exercises
• Cessation of smoking
• Avoidance or correction of obesity, or chronic cough
• Increased daily intake of fiber and fluid to prevent constipation, a risk factor for urinary      incontinence
• Avoidance of bladder irritants such as alcohol and caffeine
• Staying physically active. Individuals who are physically active are less likely to develop urinary      incontinence
• Discussing the possibilities and risks of estrogen replacement therapy with your physician

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