Pelvic Health Information

Incontinence

Just how common is this problem? Here are the facts on prevalence of urinary incontinence in Canada: 20-30% in young women, 30-40% in middle aged women and 30-50% in elderly women. In men, 1 in 9 will experience urinary leakage.

There are different types of incontinence. Pelvic floor rehab can help with:

Stress Incontinence: Occurs when urine leaks from the bladder when pressure is applied to it suddenly. High impact activities, coughing, sneezing, obesity and constipation can put pressure and stress on the pelvic floor muscles.
Urge Incontinence: Occurs when there is an inability to control urine leakage from the bladder when the “urge” to urinate occurs.
Mixed Incontinence: Occurs when both stress and urge incontinence are experienced

Pelvic floor physiotherapy has been effective 80-90% as urinary incontinence treatment. It is now the first line of treatment recommended by the International Incontinence Society.

Prolapse

The pelvic floor functions as a hammock of muscles lining the pelvis girdle in order to support the organs. Patients affected will often describe an annoying bulge at or near the vaginal opening which may or may not be accompanied by pressure. This pressure is aggravated by standing or relieved by lying down.

Different Organs Prolapses :

Cystocele : bladder
Uterine prolapse : uterus
Urethrocele : urethra
Rectocele : rectal wall
Enterocele : intestines

There are 4 different grades of prolapse

1st degree : Into vaginal space
2nd degree : To the vaginal opening
3rd degree : Past the vaginal opening
4th degree : Total inversion

Treatment recommendations:

Grade 1 & 2: Recommendation is pelvic floor physiotherapy; Prolapse can often be reversed

Grade 3 & 4: Recommendation is surgical intervention. Pelvic floor physiotherapy should be done pre-operation and post-operation to reduce the likelihood of future surgeries.

Research and Medical Guidelines

Financially, incontinence is a costly problem for patients, with up to $1000 a year spent on products alone. Research has shown that therapists qualified in pelvic floor muscle training promote continence in patients with stress and mixed incontinence, and reduce the severity of urgency incontinence. These results are often gained in as few as 5 sessions.

Note that the Society of Obstetricians and Gynecologists of Canada recommend that Kegel exercises should be confirmed by internal palpation. Simple written or verbal cueing is NOT sufficient for a Kegel exercise program.

Kegels are NOT always indicated for pelvic floor problems. Sometimes they do more harm than good and often they are NOT performed correctly.