When I was at university we covered anatomy in great detail from head to waist then somehow seemed to skip the tricky parts of the pelvis and move down to hip, knee and ankle. That was 20 plus years ago. Thankfully now there is a trickle (excuse the pun) of good quality studies focussing on that part of our anatomy, how it functions and how it affects us. For example, we know there is a significant link between lower back pain and urinary incontinence in women. A Swedish study in 2008 found 78% of women with lower back pain also had symptoms of urinary incontinence and this was in 17-45 year olds.
We also know that 1 in 3 three women leak. That is a pretty horrendous statistic. It doesn’t get much better for men – if you are unlucky enough to have to require prostate surgery, it is common to experience some urinary/bowel incontinence issues post-surgery. Depending on the type of surgery you have, most men will recover bladder control within 3-12 months but a small percentage will have ongoing problems.
Your pelvic floor is a group of muscles and fascia which lie like a trampoline underneath your pelvis. The only transverse muscles in the body. Its’ purpose in life is to prevent your abdominal organs from falling out as well as assist with essential bladder and bowel function. Pelvic floor function can be compromised by a multitude of factors – childbirth, surgery, injury (eg. pelvic fracture), excessive weight lifting, pregnancy, neurological disorders such as MS, respiratory disorders such as chronic bronchitis or cystic fibrosis, prolonged bed rest or immobility, obesity, menopause, aging or chronic constipation, even trampolining!
How do you know if you have a problem? There are three types of urinary incontinence:
- Stress Incontinence – leakage with coughing, laughing, running, changing position.
- Urge Incontinence – Increased frequency of urination, feeling like you ned to go often or going “just in case”
- A combination of stress and urge symptoms.
So what can be done? There are many different treatment options available. A physiotherapist with a special interest in pelvic floor function or continence nurse can assess and manage you conservatively if deemed appropriate. Conservative management commonly involves bladder training advice (just like training for a marathon, your bladder may need to train as well!), functional pelvic floor exercises, dietary advice and ongoing reassessment via bladder diaries. Real-time ultrasound can also be used for biofeedback. Your GP can refer you to a urologist or uro-gynaecologist for assessment and advice if required.
If you feel you fit into any of the above categories then I encourage you to check out the Continence Foundation website on www.continence.org.au for more information or call their free National Continence Helpline on 1800 33 00 66.
- http://www.manualtherapyjournal.com/article/S1356-689X(07)00026-4/abstract (accessed 26/11/14)
- http://www.sciencedirect.com/science/article/pii/S0004951406700575 (accessed 26/11/14)
Image curtesy of freedigitalphotos - renjith krishnan
Author: Sally Postma – Focus Physiotherapy