Our pelvic therapists at Core Body Clinic are experts in treating Incontinence.
Incontinence is characterised by an inability to maintain control of your bladder causing leakage or a feeling that you need to do to the toilet even though you have just been.
Incontinence can develop, after having a baby: as we get older; because of gynaecological surgery; excessive strain during sport; because of pelvic pain; after strenuous and prolonged activity; and, sometimes during sex.
Incontinence is classified into 4 types:
1 – Stress Incontinence: You leak when the bladder is under stress because you laugh or cough. Sometimes when you are running.
It is caused because of damage or weakness to the pelvic muscles. They have been stretched during labour or injured in surgery. Sometimes activity and strenuous sports that place huge downward forces on the pelvis may develop stress incontinent condition. Rectifying the control is highly achievable and should be done to prevent chronic conditions.
2 – Urge incontinence: You feel a sudden need to void and you leak before making it to the toilet. This may be a change in position from sit to stand.
It is caused by instability of the detrusor muscle or overactivity. This can be the result of surgery, infection, interstitial cystitis. Sometimes it may occur during labour and as such there may be a combination of Urge and Stress incontinence.
3 – Overflow incontinence: This is also called Chronic Urinary Retention. It describes the bladder where it is still carrying water and has not emptied. Your body continues to fill more urine on top. You leak because the bladder is trying to empty.
The cause is usually a blockage within the bladder of urethra thus preventing the bladder from being able to pass urine out.
4 – Total Incontince: this describes constant leakage as the bladder cannot hold the urine in.
This is congenital abnormality developed from birth; it can be a result of spinal cord injury also.
Your physiotherapist will know how to assess this condition and provide treatment. By taking a careful history, the physiotherapist will detail the exact cause and therefore tailor a specific treatment protocol to rectify the problem.
Bladder habits and diaries are essential for us to understand the extent of your weakness or bladder activity. We can then modify your activities and prevent incontinence by using a combination of:
Pelvic floor activation protocols
Bladder behaviour modifications
Understanding how you live and making subtle changes can profoundly effect the bladder. It may be as simple as reducing alcohol, reducing caffeine and eating at set times.
Pelvic floor routines alter how you sense that there is a need to activate muscles. Training your body to control these muscles gives the patient back to the confidence to live normally while safe in the knowledge that their pelvic muscles will prevent leaking.
Understanding how these muscles work enables the patient to activate the muscles on demand. A common mistake is that the muscles are switched on all the time causing fatigue and weakness. It can also cause pelvic tension which in itself leads to incontinence.
Assessment will enable the physiotherapist to determine the muscle type. Is it s slow or fast twitch muscle response? By careful evaluation our pelvic therapists will determine the exercise protocol specific to the patient to develop a program that is time efficient and simple to implement.
After a careful set of questions, we will physically examine you.
This is done by Female Therapists. Most of the examination will be external and will include palpation of the abdomen. It may include direct palpation of the perineum or instruction to the patient to palpate their own perineum (saddle region between the anus and scrotum). We may also palpate on the inside of the pelvis. Gaining access requires palpation through the vagina or the anus. This is by no means an absolute necessity but remains the gold standard for assessment of the pelvic floor. Total understanding and a complete explanation, and only after consent in a written format are any form of internal examinations conducted. Dynamic ultrasound may also be used to achieve this. Internal examination, while useful, is not tolerated by all patients and is never forced upon a patient.
It may be necessary to use a stimulator like a Kegal 8. This can determine the extent of weakness in addition to providing a start to training.
The treatment plan will be discussed and commenced on the day of your first visit.