women health

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 problems 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.

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.

 

Conditions treated (both ante and post natally):

  • Pelvic pain – including pelvic girdle pain
  • Low back pain
  • Thoracic pain
  • Coccyx pain
  • Rectus abdominus divarication (a separation of the abdominal muscles)
  • Stress urinary incontinence
  • Urinary urgency and urge incontinence
  • Faecal incontinence
  • Pelvic organ prolapse
  • Weak pelvic floor muscles following childbirth
  • Bladder Problems

 

Do you have a bladder problem?

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.

Bladder Problems – What Goes Wrong?

Weak pelvic floor muscles – muscle weakness 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 usually responds positively to an exercise programme.

An over active bladder – if left untreated it can lead to urinary incontinence. The bladder is 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.

Bladder Problems – When does it affect us?

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.

Treatment:

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

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 and diaphragm 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.

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 prolapse, often eliminating the need for drugs or surgery.