“Stress incontinence is a type of incontinence that occurs when women cough, sneeze, or undertake physical activities such as running and jumping; and it is these physical forces that push down on the bladder and force urine out”
1 in 3 Australian women suffer from incontinence and this figure rises once women have had their first baby. But not all women with stress incontinence have had children. They might have a family history of stretchy connective tissue, be overweight, have a chronic cough, constipation or have had surgery. Stress incontinence is also actually quite common with women playing sport or exercising, due to the forces of the abdominals on the pelvic floor. According to PhD physiotherapy student Trish Neumann from UniSA’s School of Health Sciences, stress incontinence during physical exertion is the most common reason for urinary incontinence, affecting about one in three women of all ages.
While women are the main sufferers, incontinence can also be a problem for men, especially after prostate surgery. Studies show 1 in 10 men will also suffer from incontinence in their life.
Pelvic Floor Physiotherapy is effective in treating stress incontinence in about 80 per cent of cases, according to the first national study undertaken in clinical practice by researchers at the University of South Australia. This compares to surgery with success rates around 50 – 60%.
For a long time stress incontinence was treated by surgical procedures without going through physiotherapy as a first option, but the outcomes of surgery have not always been positive with success rates as low as 50 to 60 per cent recorded in a recent study and with the potential of complications. This led to recommendations that physiotherapy be tried first, which carries no risks, and keep the surgery option open to people who fail pelvic floor muscle training. “To find out how effective physiotherapy could be in curing stress incontinence, researchers conducted the most comprehensive study ever undertaken in Australia in this field involving a trial of 274 women with stress incontinence. After an initial assessment, the women, aged from 23 to 77 years, undertook pelvic floor muscle training taught by specialist continence physiotherapists in 35 centres across all Australian states,” Neumann said.
“About one-third of women who are given a brochure about pelvic floor exercises, get the basic action wrong and don’t do well on their own with pelvic floor muscle training. They need expert guidance to achieve the correct technique, not from a general physiotherapist, but a specially trained continence physiotherapist”
The women in the study had an average of five treatments over several months, as well as a home program that was monitored.
Of the women who took part in the study, the majority were either cured or significantly improved and were happy with the outcome. After one year about 80 per cent of the study participants who responded to a questionnaire indicated that they were still very happy with the outcome of treatment.
In all, only 15 of the women went on to have surgery. “Age is not a factor in the success of the treatment but maintaining a strong pelvic floor once the muscles have been strengthened with regular exercise built into their daily lives is the key to long-term success. Exercise takes very little time and can be done at times that suit participants, and as part of their everyday activities.”
Being able to understand how to contract the pelvic floor muscles the right way is essential for a successful outcome. At South Perth Physiotherapy we use real time ultrasound imaging to visualize the pelvic floor muscles in real time, giving us an immediate view of how your muscles are functioning and what we can do to help. We take a holistic view of your problems, as there may be other issues further up the chain that may also be contributing to pressure on the pelvic floor; such as other abdominal function, breathing patterns, lumbar and thoracic spine function and shoulder function during sport or activity.
If you are having any issues with your pelvic floor or continence – whether it is during or after childbirth, during sport or exercise or just with normal activities – make an appointment with me and let me help you take back control of your life. Don’t let fear or embarrassment hold you back – there really should be no need to just “put up with it”.
Miranda is a Senior Physiotherapist in Continence and Pelvic Rehabilitation. She has a B.App Sci (Physiotherapy), a B.App Arts (Psychology) and she has nearly completed her Masters of Physiotherapy (Continence and Pelvic Floor Rehabilitation). She currently holds the position of Clinical Specialist Physiotherapist in Continence and Pelvic Floor Rehabilitation at Swan Districts Hospital as well as practicing at South Perth Physiotherapy.
Miranda has dedicated her time to treating patients with pelvic pain using a holistic and integrated approach. She has a unique skill set which allows her to treat both the internal and external pelvic structures. This allows her to treat the pelvic unit as a whole and thus achieve more successful outcomes. She has expertise in managing both men and women with complex pelvic issues. These conditions include pain or inability to engage in sexual intercourse (including vaginismus and vulvodynia), bladder dysfunction (including urgency, frequency and pain), incontinence (urinary and faecal), surgical rehabilitation (gynaecological and prostate surgery), prolapse management, pre/post natal issues (including pelvic, pelvic floor and pelvic girdle pain) and chronic pelvic pain (including pelvic girdle, SIJ, coccyx and lower back pain).
Alewijnse, D., Mesters, I., Metsemakers, J. & Van Den Borne, B. 2003. Predictors of long-term adherence to pelvic floor muscle exercise therapy among women with urinary incontinence. Health Educ. Res., 18, 511-524.
Chiarelli, P. 2007. Chapter 8 – Lifestyle interventions for pelvic floor dysfunction. In: Kampen, K. B. B. M. V. (ed.) Evidence-Based Physical Therapy for the Pelvic Floor. Edinburgh: Churchill Livingstone.
Sapsford, R. 2004. Rehabilitation of pelvic floor muscles utilizing trunk stabilization. Manual Therapy, 9, 3-12.
Neumann PB, et al (2005) Physiotherapy for female stress urinary incontinence: a multicentre observational study. Australian and New Zealand Journal of Obstetrics and Gynaecology. Volume 45, Issue 3, pages 226–232