Stress Urinary Incontinence: a Muscular Problem

Urinary incontinence amongst women is an unreported epidemic. Reportedly 30 to 40% of women will suffer from incontinence of some form by the time of menopause and then rises steadily between the ages of 60 and 80. It does also occur in men, but for the sake of this article, I will be predominantly addressing the problem in women. There is little research to show the true causes of incidences but are likely be a result of bladder dysfunction, sphincter dysfunction or a combination of both.1

9e309625-de78-47bb-8b7c-1afe86633f93Determining whether the condition is stress or urge incontinence, or a mix can be difficult, based on symptoms alone.

The major symptom of stress incontinence is the loss of bladder control during physical activity. Such as experiencing anything from a few drops of urine to a larger involuntary flow while exercising, during sexual intercourse, coughing, sneezing, laughing or other kind of physical exertion.

The cause of stress incontinence is when there is tension and/or weakness in the muscles that control and support the bladder and the release of urine (urinary sphincter). These muscles include the pelvic floor muscles (otherwise known as the Kegel muscles, named after Dr. Arnold Kegel, American gynaecologist who invented the Kegel exercises), the deep gluteal muscle that attaches to the sacrum  and coccyx, Piriformis; and the large inner thigh muscle, Adductor Magnus that attaches to the pelvic bones.
The pelvic floor muscles act as a sling from the coccyx to the pubic bone supporting the bowel, bladder, the uterus and vagina in women. If they are tense or weak, the downward pressure of these organs can easily cause problems, and problems with these organs are likely the only symptoms you may have from these kinds of muscular tension or weakness.

What can cause these muscles to be tense or weak?

Injury or overuse, like any other muscle, can cause these muscles to be tense or weak. This could be from exercise, childbirth, constipation, heavy lifting, chronic coughing. Excess weight can cause undue pressure on these muscles and to cause weakness. Surgery, such as prostate surgery in men, can also cause weakness.

How can stress incontinence be treated?

Massage of the gluteal and thigh muscles and pelvic floor muscle exercises are the best way to treat and maintain muscular health and avoid incontinence, and maintain bladder control.
Massage has been shown to reduce incontinence by more than 20% after the first treatment and up to 100% within a month of regular treatments.2

How to locate your pelvic floor muscles


Pelvic floor in women

Sit or lie down with the muscles of your thighs, buttocks and stomach relaxed.
Squeeze the ring of muscle around your anus, as if you are trying to stop passing wind. Now relax this muscle. Squeeze and let go a couple of times until you are sure you have found the right muscles. Youre not just squeezing your buttocks, but deeper, down to the tailbone.
When sitting on the toilet to empty your bladder, try to stop the stream of urine, then start it again. Do this to learn which muscles are the right ones to use – but only once a week. Your bladder may not empty the way it should if you stop and start your stream more often than that.
If you don’t feel a distinct “squeeze and lift” of your pelvic floor muscles, or if you can’t slow your stream of urine, ask for help from your doctor, physiotherapist, or continence nurse. They will help you to get your pelvic floor muscles working right. All women can benefit from pelvic floor muscle training.

How to exercise your pelvic floor muscles

Sit or lie in a relaxed position. Squeeze and draw in the muscles we just identified. Lift them up and squeeze them away from the tailbone. Hold them strong and tight for 8 seconds and then relax, letting all the muscles go.
If you can’t hold for 8 seconds, hold for as long as you can. Gradually build up the length of time you can hold them for.
Do 8 to 12 squeezes, three times, daily. If you do not see a marked improvement within three months seek help from your doctor, physiotherapist or continence nurse.
Once you get used to doing them, you can do them sitting, lying or standing. Be sure not to hold your breath while holding the muscles, oxygen will help the muscles stretch and release tension.

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