Van Vuuren Physiotherapist


Urinary Incontinence



o Stress incontinence: Involuntary loss of urine during effort or physical exertion e.g. cough, laugh or sneeze


o Urgency: Sudden, strong desire to void with difficulties to suppress the desire


o Urge incontinence: Sudden, strong desire to void, the bladder contract, can’t inhibit it, involuntary loss of urine. Triggers can be: key in the lock, running water, changing body positions e.g. getting in and out of bed.



Causes of Urinary Incontinence



1. Pregnancy and childbirth

a. Hormonal changes, especially progesterone, relax the smooth muscles, thus the tone in the bladder and the urethra. Relaxin change the connective tissue during pregnancy thus increasing the joint mobility. During childbirth, there may be injuries to the muscles,fascia or the nerves.


2. Aging and menopause

a. Due to loss of estrogen, which causes a decrease intra-urethral pressure and loss of mucosal vasculature.


3. Pelvic surgery a. Disruption of normal anatomy, pelvic nerve injury, loss of thetissue elasticity and loss of vascular cushion.


4. Medication

a. Loss of urethral tone.


5. Alcohol

a. Increase the urine production and frequency.


6. Caffeine- coffee, tea, cola, chocolates a. Increase the urine production and frequency and the urge to urinate


7. Athletes

a. High impact activity


8. Increased intra abdominal pressures

a. Constipation

b. Chronic chest problems

c. Obesity



TREATMENT OF URINARY INCONTINENCE



1. Physiotherapy rehabilitation:



a. Correct activation of the pelvic floor muscle:


i. “Close and lift” (closing the rose bud and opening the rose bud)

ii. 70% of the muscle fibres are for endurance and 30% are for strength



2. Education on correct toilet position:



a. Knees higher than hips

b. Feet resting on a step, no heel raising

c. Elbows resting on knees

d. Back straight, belly button relaxed

e. Belly button breathing (diaphragmatic)

f. Pelvic tilt forward

g. The pelvic floor muscle (Puborectalis) needs to relax to urinate and evacuate.



3. Diaphragmatic breathing



Breathing is done by contracting the diaphragm, a muscle located horizontally between the thoracic cavity and abdominal cavity. Air enters the lungs and the chest rises and the belly expands during this type of breathing.

a. Inhale through the nose into the belly button. The belly button expands during inhalation
b. Exhale through the mouth, dropping the belly button
​c. Visualise an umbrella: Inhale, opening the umbrella in all direction. Exhale, closing the umbrella.



4. TENS: Trans Cutaneous Electrical Stimulation



Trans Cutaneous Electrical Stimulation is a neuromodulation therapy where a low voltage electrical current is used to stimulate the nerves in the pelvic floor or lower back via a vaginal or an anal electrode to strengthen the pelvic floor muscle or to inhibit the detrusor overactivity.



5. Biofeedback:



a. Biofeedback shows you when your bladder and urethral muscles contract, to help you gain awareness and control of your urinary tract muscles.


b. This means that weak muscles can be better activated on demand, muscles that are too tense can be relaxed, and overall muscle activity can be coordinated.


c. Sensors can be placed on the abdomen, perineum, anus or vaginally or rectally.


d. The monitor will show you which muscles are contracting, and which are at rest.


e. Biofeedback can take different forms.

i. The physiotherapist's hand: Squeezing a finger with your pelvic muscles

ii. Manometry: Small balloons are inserted into your vagina or anus and filled with air or water. You contract your pelvic floor muscles and the pressure inside the balloons measures the strength of the muscles in your pelvic floor.

iii. Electromyography (EMG): electrical sensors are placed on the skin inside the vagina to measure the electrical activity of your muscles at rest and when they contact. The reading is shown either on a graph or screen.



6. Vaginal weights:



a. Vaginal weights are plastic cones (variable sizes and weight) inserted into the vagina for progressive length of time during daily activities to strengthen the pelvic floor muscles.



7. Advice



a. Preventing recurrent urinary tract infection

b. Prevent post void residuals

c. Avoid bladder irritants

d. Control the urge of urination due to overactivity of the Detrusor muscle.

e. Correct amount of fluid and fibre intake during a day

f. Bladder chart evaluation and advice



8. Medication: Referral to your doctor for a script



a. Stress incontinence

i. Estrogen- topical cream

ii. Ephedrine- alpha stimulant (helps the contractibility in the urethral sphincter)


b. Overactive bladder/Urge

i. Tri-cyclic anti-depressant - to inhibit the bladder muscle contractibility

ii. Anticholinergics - to decrease force of contractibility of the bladder muscle

iii. Ca channel blockers - to decrease bladder contraction

iv. Capsaicin (chilies)



9. Surgery: Done by a surgeon



a. Stress incontinence

i. Urethral sling

ii. Collagen Injections


b. Overactive bladder

i. Botox

ii. Sacral nerve stimulation



Interstitial cystitis



A painful bladder that is often mistaken for urinary tract infection (UTI) but there is no infection.

Symptoms include:

o bladder and pelvic pain

o pressure and a frequent urge to urinate.



Van Vuuren Physiotherapist


Suite 13, Netcare Pretoria East Hospital
Cnr Garsfontein Road & Netcare Ave
Pretoria East