Have you ever leaked a bit of wee when you’ve coughed, laughed, jumped, lifted something heavy, or bounced on a trampoline? If you said yes to any of these, you might have Stress Urinary Incontinence (SUI for short).
And you’re not alone—SUI affects 1 in 3 women and 1 in 10 men. As a pelvic physiotherapist, this is one of the most common issues I see people for.
Why does SUI happen?
While the name “Stress Incontinence” might suggest it’s caused by psychological stress or anxiety, it’s more about physical pressure. For people with SUI, there is more pressure placed on the bladder (or within the bladder if it’s very full) than the pressure your pelvic floor muscles and bladder sphincters (the ring-like muscles that act as control valves around the bladder opening) can generate to keep the wee in. The amount of pressure it takes to cause leakage can vary from person to person. Some people may leak every time they get up from a chair or blow their nose, while others may be fine until they run, jump, or try to do a heavy squat in the gym.
What causes SUI?
There are a few different underlying causes of SUI, depending on the person.
In women, SUI can occur during pregnancy due to the pressure of the growing baby on the bladder and pelvic floor. Changes to the pelvic floor after childbirth can result in a weaker pelvic floor or less support for the bladder and urethra (the tube you wee from). Bladder prolapse (where the bladder descends and pushes on the vaginal walls) can also cause SUI.
After menopause, hormonal changes can lead to thinning of the walls of the vagina and urethra, which can result in less closure of the urethra from within and less support from the vagina to keep it closed.
On the flip side, I also see women who have never given birth (both young and old) who experience stress incontinence due to a tight pelvic floor. This can happen because a tight muscle is often a tired and ineffective muscle when you need that extra “oomph” for control under pressure.
This is why a good assessment by a pelvic physiotherapist is important. If we tell someone with a tight pelvic floor to do kegels, we won’t be helping them, and if someone has incontinence due to prolapse or low oestrogen, we need to treat the whole picture—not just prescribe pelvic floor exercises.
In men, SUI usually occurs after a prostatectomy for prostate cancer, but it can sometimes happen as a result of other prostate surgeries, such as TURP (transurethral resection of the prostate) surgery.
What can I do about SUI?
First things first—seek help! I often meet women in their 60s and 70s who have been dealing with leakage for decades because they were told, “It’s a normal part of being a woman.” While it’s true that SUI affects a large number of women, bladder leakage is NOT normal, and it’s treatable for the majority of women who experience it.
A pelvic physiotherapist can assess your pelvic floor muscles and help you identify any other contributing factors to your leakage, such as constipation, fluid intake, chronic cough, hypermobility, and more. A pelvic floor assessment may involve an internal examination to determine if there’s prolapse, assess your pelvic floor strength, and evaluate how tense (or not) your pelvic floor is. If you’re not comfortable with this, you can still see a pelvic physio! We can conduct a non-invasive pelvic floor assessment using an ultrasound over your belly to help you see if you’re correctly engaging your pelvic floor. We can also assess whether your pelvic floor gets tired and if you can keep it working while you stand up, squat, bend, and more.
Besides pelvic floor exercises, there are other options to help manage your leakage. These may include pessaries for women (a silicone device worn in the vagina to support the bladder), support underwear, strengthening other muscles, or continence clamps for men (similar to a pessary for women, a clamp is a device worn over the penis to apply gentle pressure on the urethra to reduce leakage). We can also advise you on when to consult your doctor about medical and surgical treatment options for your leakage.
The Take-Home:
If you’re experiencing bladder leakage like SUI, don’t let it affect your quality of life. Remember, while bladder leakage is common, it’s not something you have to live with. Pelvic physiotherapy can help you develop a tailored plan to get your leakage under control. Even if we can’t achieve 100% dryness, we can still teach you skills to improve your situation and make it more manageable.
References:
www.continence.org.au/types-incontinence/urinary-incontinence/stress-incontinence