Urinary incontinence (UI) is the leakage of urine from your bladder. About 30% of adult women and 3-11% men are affected by UI. The most common types of UI are stress incontinence and urge incontinence. Stress incontinence means that you leak urine with a physical pressure on the bladder, such as a cough, laugh, sneeze or heavy lifting. It can also happen with exercise like running or jumping. Stress incontinence normally happens because the muscles and tissues in the pelvis are not strong enough to resist extra pressure. When external pressure is placed on the bladder, from a cough for example, urine is forced past the muscles that keep the urethra closed. Some reasons why these muscles and other tissues can be weakened or damaged include having babies, chronic constipation, obesity or simply getting older.
Urge incontinence is when you feel a strong need to urinate and leak before you get to the bathroom. While stress incontinence happens with external pressure on the bladder, urge incontinence happens because the bladder itself is overactive and is contracting before you want it to! Some people don’t have a warning that this is going to happen and others are overwhelmed by the urge. Common triggers for urge incontinence include hearing running water, going out into the cold, arriving home (key in the door phenomenon), or standing up from a chair or bed.
Some people have a combination of stress and urge incontinence, which is called mixed incontinence.
Many people struggle with urinary incontinence as they age. If this is a problem for you, there are things that you can do about it! Pelvic health physiotherapy is a great place to start. In fact, The Cochrane Collaboration concluded that there is Level 1 evidence (the strongest level of evidence) for pelvic floor strengthening in the case of urinary incontinence and recommend that this is best done by a pelvic health physiotherapist, who can use internal assessment and treatment techniques. This means that pelvic health physiotherapy is the first line of defense against incontinence, before considering medications or surgery.
Anal incontinence means there is unwanted leakage from the rectum, be it gas or liquid or solid stool. Anal incontinence can happen for a variety of reasons: weakness of the pelvic floor (Kegel) muscles or muscles around the anus, constipation, damaged to the supporting tissues and muscles from childbirth or ano-rectal malformations (e.g. Hirschsprung’s).