Cronulla clinic: (02) 9527 4099

What is incontinence?

Incontinence is defined as “the complaint of any involuntary leakage of urine”. It can range from ‘just a small leak’ to complete loss of bladder control.

Stress urinary incontinence: involuntary loss of urine on effort or physical exertion, or on sneezing or coughing.

Urge urinary incontinence: sudden and strong need to urinate. If you experience urge incontinence you will also have the need to frequently pass urine and may wake several times a night to do so.

Faecal incontinence: is the inability to control bowel movements, causing stool to leak unexpectedly from the rectum. It can range from an occasional leakage of stool while passing wind to complete loss of bowel control.

You are not alone!

In fact, over 4.8 million Australians have bladder or bowel control problems for a variety of reasons. Although incontinence has a considerable impact on a person’s quality of life, many people do not seek help. Embarrassment often prevents people from talking about their bladder and bowel problems. Some people restrict going out and have little social contact outside their home.

There is no need to become a recluse! The good news is that for most people, these problems can either be cured or at least better managed. You can lead a normal life without needing to plan your activities around the toilet.

What Can You Do?

Pelvic floor muscles

Having strong pelvic floor muscles gives us control over the bladder and bowel. Weakened pelvic floor muscles mean the internal organs are not fully supported and you may have difficulty controlling the release of urine, faeces (poo) or flatus (wind).

What are the pelvic floor muscles?

The pelvic floor muscles stretch like a muscular trampoline from the pubic bone to the tail bone (front to back) and from one sitting bone to the other sitting bone (side to side). These muscles are normally firm and thick.

The pelvic floor muscles have been likened to a trampoline. Just like a trampoline, the pelvic floor is able to move up and down.

Pelvic floor muscles provide support to the organs that lie on it. The sphincters give us conscious control over the bladder and bowel so that we can control the release of urine, faeces and flatus (wind) and allow us to delay emptying until it is convenient. When the pelvic floor muscles are contracted, the internal organs are lifted and the sphincters tighten the openings of the vagina, anus and urethra. Relaxing the pelvic floor allows passage of urine and faeces.

Although the pelvic floor is hidden from view, it can be consciously controlled and therefore trained.

The muscles of the pelvic floor work with the abdominal and back muscles to stabilise and support the spine.

What can make these muscles loose?

  • Pregnancy and childbirth for women
  • Straining on the toilet (associated with
    chronic constipation)
  • Chronic coughing
  • Heavy lifting
  • High impact exercise
  • Age
  • Obesity

How can I strengthen these muscles?

The first thing you need to do is find out which muscles you need to train. It is very important to correctly identify your pelvic floor muscles before moving into a regular pelvic floor muscle exercise program.

Step 1: Finding Your Pelvic Floor Muscles

One way is to try to stop or slow the flow of urine midway through emptying the bladder. Stopping the flow of urine repeatedly on the toilet is not an exercise, but a way of identifying your pelvic floor muscles. This should only be done to identify which muscles are needed for bladder control.

If you can, stop the flow of urine over the toilet for a second or two, then relax and finish emptying without straining. This ‘stop-test’ may help you identify the muscles around the front passage which control the flow of urine. It is not recommended as a regular exercise.

Step 2: Getting the Right Technique

Imagine stopping the flow of urine and holding inflatus (wind) at the same time. This can be done lying down, sitting or standing with legs about shoulder-width apart.

  • Relax the muscles of your thighs, bottom and tummy.
  • Squeeze in the muscles around the front passage
    as if trying to stop the flow of urine.
  • Squeeze in the muscles around the vagina and suck upwards inside the pelvis.
  • Squeeze in the muscles around the back passage as if trying to stop passing wind.
  • The muscles around the front and back passages should squeeze up and inside the pelvis.
  • Women who are familiar with using tampons can imagine squeezing in the vagina as if squeezing a tampon up higher in the vagina.
  • Identify the muscles that contract when you do all these things together. Then relax and loosen them.

Step 3: Some Hints to get the Right Technique

  • Nothing above the belly button should tighten or tense. Some tensing and flattening of the lower part of the abdominal wall will happen. This is not a problem, as this part of the tummy works together with the pelvic floor muscles.
  • If you cannot feel your muscles contracting, change your position and try again. For example, if you cannot feel your muscles contracting in a seated position, try lying down or standing up instead.
  • After a contraction, it is important to relax the muscles. This will allow your muscles to recover from the previous contraction and prepare for the next contraction.
  • It is common to try too hard and have too many outside muscles tighten. This is an internal exercise and correct technique is vital. Doing pelvic floor muscle exercises the wrong way can be bad for you, so please see a health professional if you cannot feel your muscles hold or relax.

Step 4: Make it Functional!

Now that your pelvic floor is strong you need to start using it! Practise turning your pelvic floor on while walking and exercising, building up the length of time before you get tired.

Actively turning on your pelvic floor before coughing or sneezing can also help reduce the symptoms of stress incontinence.

Like all exercises, pelvic floor exercises are most effective when individually tailored and monitored.

For any further information on pelvic floor dysfunction and exercise, contact Southside Physiotherapy on 9527 4099.

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