Usually the initial onset of leakage is called “stress incontinence”. This is caused by a weakening of the muscles that keep the urine stored in the bladder. These muscles known as the pelvic floor muscles, fail to fight the forces which push down from the abdomen when you laugh, sneeze, run, jump or perform any other type of physical exertion.
If unchecked, simple stress incontinence can progress to include symptoms such as urgency and frequency in the following way. You’re running across the road and suddenly you feel dampness spreading between your legs, so you go to the toilet even though you don’t really feel the need to go, just to make sure it doesn’t happen again. Next time you go out, to avoid a re-run, you take yourself off to the toilet to empty your bladder, a pattern of frequency develops.
Urgency is the really strong need to pass urine which, if ignored, most women feel would cause them to be incontinent.
Most common causes of incontinence
Pregnancy
Hormones play a role during pregnancy as they soften the ligaments making them more extendable. The weight of the baby pressing upon the support structures can cause leaking. Damage to the pelvic floor muscles during vaginal delivery is very common. As the baby moves through the birth canal, the force on the bladder, urethra, nerves and the pelvic floor can cause damage.
Cystitis
The urine burns the inflamed area of the bladder and urethra causing the bladder to contract again and again, which when this happens regularly can result in ‘urge’ incontinence.
Menopause
Oestrogen levels fall during menopause causing the urethra, vagina and bladder neck to weaken.
Constipation and/or chronic cough
Every time a woman “strains at stools”, the bulging, downward pressure acts on the whole pelvic floor causing stretching and damage. This same pressure applies when you cough.
Pelvic organ prolapse
The bladder or uterus drop down caused by weak pelvic floor muscles and/or overstretched ligaments that normally support the abdominal organs.
Overweight
Every kilo that you are carrying over and above what would be the normal body-mass for you is placing an extra load on the pelvic floor structures. It may not be necessary for you to lose much weight to notice a difference of leakage.
Anatomy
The bladder is called the detrusor muscle. It is important to understand that urine does not run out. It is pushed out by the detrusor muscle. Stopping the leaks is actually the job of the pelvic floor muscles and your urethral sphincter. These are under voluntary control. The Urethral Sphincter holds on all day and your pelvic floor muscles help to hold tight when you cough sneeze etc.
The ability to control your waterworks depends largely on the ability to control your pelvic floor muscles.
If you strengthen the muscles you should regain control over your bladder.
Treatment
Physiotherapy treatment involves an assessment to find out exactly what kind of bladder problems you might have. It involves an internal examination to assess the position of your pelvic organs and the state of your pelvic floor muscles. You will then be given bladder training and / or a pelvic floor muscle exercise programme