Stress Urinary Incontinence – Pelvic Floor Physiotherapy

Have you ever laughed so hard you pee yourself?🤭 Perhaps you’ve been running down a single track trail and noticed each step squirts out a bit of wee 🙄. Maybe you’ve taken off for a hard sprint start during a game only to realise you’ve forced out a wet patch on your shorts 😧.

You’re not alone. It’s the same issue millions of women experience when they cough or sneeze. It’s called Stress Urinary incontinence (SUI) and it’s treatable.

At Vital Core Physiotherapy we want to help educate you about all of your body so you can enjoy life and not have problems getting in the way. Just as you may fall and hurt your knee on the netball court and come into see a physio here at Vital Core, we want you to know that if you’re not able to hold your wee with a cough or a sneeze or when you run and jump (we’re talking about all you awesome sports women out there) it’s time to come into see one of our very experienced Pelvic Floor Physiotherapists to address this issue. As stress urinary incontinence is common it is by no means normal.

What is stress urinary incontinence?

Stress urinary incontinence is the leaking of (often) small amounts of urine. It’s triggered by an increase in downwards pressure from your abdomen (like tensing your tummy muscles) without a matching upwards pressure from your pelvic floor. This increase in abdomen downward pressure can occur when you suddenly laugh, cough, sneeze or do something physical like play sport, run or lift something heavy.  As this leakage is caused by a mismatch in pressures of your abdomen and pelvic floor, you usually don’t have a feeling of ‘fullness’ in the bladder at the time of leakage – so it often catches you by surprise.

How do the Pelvic Floor muscles help?

The pelvic floor muscles sit like a tensioned hammock of inter-woven muscles in the bottom of your pelvis (literally the floor of the pelvis), they hold your organs in place and help to maintain continence of your bladder and bowel (as well as helping out with many other urogynaecological functions). Depending on how much load you are placing through your pelvic floor it may need some assistance from one of our Pelvic Floor Physiotherapists is it’s not working well enough.

How common is Stress Urinary Incontinence?

  • In 2010, nearly 4.8 million Australians – comprising over a quarter of the Australian population aged 15 years or over – had incontinence.
  • Incontinence affects both men and women – regardless of age, gender or cultural background.
  • Women are more likely to be incontinent than men – with the life stages of pregnancy and menopause are major contributing factors.
  • 80% of community-dwelling people with urinary incontinence are women.
  • 70% of people with incontinence DO NOT seek treatment.
  • Over half of the women living in the community with incontinence are under 50 years of age (1.7 million)

Who is at risk of Stress Urinary Incontinence?

Stress urinary incontinence often occurs around significant female life stages such as pregnancy, childbirth, perimenopause and menopause. Pregnancy and childbirth affects the pelvic floor from the obvious change in body shape, weight gain and hormones. Child birth lengthens, weakens and potentially damages the pelvic floor making it less effective at maintaining continence. Perimenopause through to menopause affects the pelvic floor due to the gradual decrease in the hormone Oestrogen. Oestrogen plays a critical role in urogenital function as it helps to moisten and puff up the the vaginal and urethral sphincter helping it to remain closed as appropriate. Oestrogen is also an essential component in muscle development so with less of it the pelvic floor muscles can become weaker (see below).

Other common SUI causes include;

  • training for a long distance running event or racing (especially downhill)
  • mid season training for basketball, footy or netball (or any other sport that requires a lot of hard and fast moves)
  • post-surgery (especially gynaecological surgery)
  • Heavy weight lifters
  • People with back pain
  • Chronic cough (smoking, asthma, bronchitis)
  • Diabetes
  • People who are over weight
  • Chronic Constipation

How do my hormones contribute to this?

Oestrogen (a female hormone) is produced in lower quantities during breast-feeding and perimenopause going forward. Oestrogen helps to maintain the thickness of the urethra lining to keep the urethra sealed after passing urine (much like a washer seals water from leaking in a tap). If it’s not as thick, it can be easier for urine from the bladder when it’s under pressure – say from a cough.

As a result of decreased oestrogen, some women experience stress urinary incontinence whilst breastfeeding or from the perimenopause years onwards. Oestrogen decline starts as early as 35, but it is most noticeable in the few years leading up to menopause (average age of menopause is 51). So for some ladies they may have had children and experienced no stress urinary incontinence until their oestrogen levels start to decline as they head towards menopause.

Oestrogen is also an essential building block in developing and maintaining muscle. Therefore as you age and your oestrogen levels decrease, your muscles decrease in size and strength. This occurs throughout your body including your pelvic floor. It doesn’t mean you can’t build muscle it means it is harder to build muscle requiring a strong exercise stimulus to retain and grow – this is especially true to maintain our pelvic floor muscles as we age too!

How can physio help stress urinary incontinence? 

All physiotherapy is about improving function of the body and this includes the pelvic floor.

Most importantly Physio’s are goal focused. We want to know what you want to be able to do that you can’t because of the problem with your pelvic floor. We will listen to your story and how stress urinary incontinence is impacting your life and hear what your goals are and why they are so important to you.

The first step in improving bladder control is to fully understand the bladder and pelvic floor function for you. This is best done by having a full pelvic floor assessment carried out by one of highly experienced and caring Pelvic Floor Physiotherapists.

During your assessment with your Pelvic Floor physiotherapist we will discuss your medical history, medications, diet and fluid intake, exercise and general lifestyle.

We then need to assess your pelvic floor muscles (usually) via a vaginal examination if possible. If necessary we can assess using an ultrasound machine however it isn’t as effective as the manual examination. But we always discuss the options of this with you.

Once we have all of the information we can develop a treatment plan that usually involves some pelvic floor exercises specific to you as well as some lifestyle modifications..

Take home messages

  • Stress Urinary Incontinence is very common in women across age groups but it is not normal
  • It can be treated conservatively (without surgery) with the help of an experienced Pelvic Floor Physiotherapist
  • Stress Urinary incontinence is caused by an increase in downward pressure in your abdomen, without a matching upwards pressure from your pelvic floor. For most people, improving the pelvic floor coordination, control and strength resolves the problem.
  • Pelvic Floor physiotherapy can assess your individual problem and recommend the best course of treatment for you.
  • Talk with your girl friends about the Stress Urinary Incontinence to get them thinking about it. Lets start the discussion in our communities to improve awareness and normalise treatment of stress urinary incontinence. Lets break the taboo!
  • There is help out there! No need to quickly throw the pads in the trolley at the supermarket each week. Let’s address the issue together!
  • An appointment with a Pelvic Floor Physio at Vital Core is a great starting point to getting you back control over your bladder and life!


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