There are several conditions that can cause loss of bladder control. The most common cause however, are weak pelvic floor muscles. The effects of poor bladder control can vary from being a slight inconvenience to seriously affecting a woman’s quality of life. Most women say they first notice bladder problem during their first pregnancy but that it becomes worse with future pregnancies and vaginal deliveries. Years down the line women’s lives can become dominated by bladder problems causing them to feel self conscious, lose confidence and even become depressed.

Many women adapt their lifestyles and struggle on with a condition that is often easily treatable, not seeking treatment as they feel the only treatment on offer is surgery. This could not be further from the truth.

NICE guidelines recommend physiotherapy as the first treatment option for most people experiencing incontinence or bladder problems.

Physiotherapy focuses on eliminating the symptoms of incontinence, urinary urgency, over active bladder and improving the quality of life of women. This is done through the correct education of pelvic floor muscle training, breathing coordination and advice on fluid intake, bowel control and exercise programmes.

For some women bladder problems have become part of their lives and they have adapted their daily routines to manage their condition. Take a look at the questions below and if you are answering yes to any of them, it could be that you are adapting your lifestyle to manage your symptoms:

• Do you leak when you run, jump, cough or sneeze
• Do you empty your bladder more than 6-8 times a day
• Do you have to get up more than twice in the night to empty your bladder

If you have answered yes to most of the questions, then you do not have good bladder control and physiotherapy may be able to help you.

There are several problems that can cause bladder leakage:

Weak pelvic floor muscles – muscle weakness in this area means there is lack of support for the bladder neck. Leaking occurs when the area is put under strain ie coughing and sneezing. The pelvic floor muscle is an extremely under rated and often neglected muscle complex, luckily it is quite resilient and forgiving. It usually responds positively to an exercise programme.

An over active bladder – if left untreated it can lead to urinary incontinence. The bladder is basically a muscular sack which should only empty when it is completely full. There are a complex set of reflexes that control the bladder and ensure the bladder empties effectively, but sometimes these reflexes do not work effectively causing the bladder muscle to contract without warning, creating a strong urge to pass urine which can result in urinary incontinence.

There are two main events in our lives that will have an effect on the structure and function of the pelvic floor muscle structure:

After childbirth – problems with both bladder and bowel control are often first noticed during pregnancy and after the birth. Post natally we can sometimes be left with stretched stomach muscles, poor posture and weak pelvic floor muscles.
We sometimes remember to do our pelvic floor muscle training but often with the demands of motherhood we forget about our exercises and our pelvic floor muscles never build up enough strength to provide us with the necessary support when put under strain. As well as this our deep stomach muscles are weak providing less support to our lower back, leaving our spine less supported.

The menopause – hormone levels change during the menopause which can result in a change in the tissue in the vagina, urethra and bladder area leaving us more prone to continence problems.

Specialist Women’s Health physiotherapy is available for the treatment of weak pelvic floor muscles and over active bladder syndrome and is recommended as the first line of treatment, according to NICE.

Physiotherapy treatment options are varied and can consist of:

Exercises – many women only need an intensive programme of pelvic floor muscle training to see a noticeable improvement with their symptoms. Learning to contract these muscles correctly with the lower abdominal muscles is really important.

Bladder training – there are specific techniques that can be taught to train the bladder to hold more urine and therefore need emptying less often.

Biofeedback – equipment can be used to teach us how to use the pelvic floor muscle correctly and effectively. It can also be used to assess if there is any improvement in the strength and endurance of the muscle.

Muscle stimulation – in cases where the pelvic floor muscle is very weak and unable to contract independently equipment can be used to remind the muscle how to work. The equipment stimulates the pelvic floor muscle and as the muscle remembers how to contract exercises are then added into the treatment programme.

Relaxation techniques – anxiety and tension make bladder problems worse. Specific relaxation techniques can help to gain control over your bladder.

General advice – about fluid intake, bowel control, exercise levels and setting achievable goals.

There is so much that can be done and the research has shown that physiotherapy can be effective in the treatment of urinary incontinence and pelvic organ prolapsed, often eliminating the need for drugs or surgery.

Your initial appointment will take 45 minutes. Your physio will ask some questions about your general health and medical history. More detailed questions about how your bladder problems affect your quality of life will also be asked. For example:

• How long have you had bladder problems?
• Do you need to wear a pad?
• How often do you leak?

By asking these questions the physio is able to assess the severity of the problem and decide on the most effective treatment programme.

Routine tests include:

A bladder chart – this is a simple diary which you may be asked to complete over a 3 day period. It provides information about how much and how often you drink, how often you pass urine and how much fluid you are able to hold.

Examination – research indicates that the only effective way to assess the pelvic floor is working correctly is to perform a vaginal examination. This examination is done for several reasons:

• To ensure nothing else is causing your bladder problems (such as a prolapse).
• To ensure you are contracting the pelvic floor muscle correctly. It is possible to make symptoms of incontinence worse if the pelvic floor is not contracting correctly.
• To assess the quality of the muscle so that an exercise programme can be designed specifically for your needs.

If you do not want an internal examination it is possible to learn how to check the muscle yourself.

Once your assesment has been completed, your physio will design your personal treatment programme.

If you have any questions or would like to speak with a therapist before booking your appointment, please contact us.