Urinary incontinence affects 35% of women in Poland. Find out how we define urinary incontinence. Is it a problem if you leak a few drops when you sneeze? Should you panic if you let go of urine while jumping on a trampoline? Check out what physiotherapy involves in the case of urinary incontinence. Evaluate your current toilet habits and modify those that may exacerbate the problem.
Hello, this is Adrianna Grobelna-Krajcer, and this is the first episode of the podcast where today we will answer the question, how to deal with the problem of urinary incontinence?
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At the outset, you need to know what urinary incontinence really is, because we treat the disease, which is really urinary incontinence, very binary. That is, either you have a given problem or you don’t. You can’t have urinary incontinence a little or sometimes.
Because it often happens in the office when we talk to patients, the patient says: “Sometimes I have urine leakage during sneezing or coughing, but it’s not really my problem.” And now you need to know that urinary incontinence is really any involuntary urine leakage, that is, urine leakage that happens against your will.
And it doesn’t matter if it happens sometimes when coughing, sometimes when sneezing, if a given problem occurs, then you have urinary incontinence. And here also notice that urinary incontinence is not such a rare disease, it is not such a rare ailment, because currently over 35% of women in Poland suffer from urinary incontinence. So if you looked at your circle of friends, acquaintances or maybe family, we could say that every third woman will have urinary incontinence.
We divide urinary incontinence into three types. The first, most common, is stress urinary incontinence and today we will focus a little more on it. The second type is urgent urinary incontinence, and the third is mixed. And mixed incontinence is a mix of stress and urgent. I promise you that we will talk a little more about urgent and mixed incontinence someday.
Jeżeli chodzi o wysiłkowe nietrzymanie moczu, to tutaj winowajcą mogą być mięśnie dna miednicy. Mięśnie dna miednicy, czyli ten lej mięśniowy, który utrzymuje Twoje narządy i który również będzie odpowiadał za kontynencję, czyli za utrzymanie moczu. Warto myślę zaznaczyć, że nie zawsze problemem będzie za słabe dno miednicy. Czasami nietrzymanie moczu może również brać się za nadto napiętego dna miednicy. Problem mogą być także więzadła łonowo-cewkowe, ale także stan śluzówki wewnątrz cewki moczowej.
When it comes to stress urinary incontinence, we divide it into three degrees. The first degree is such a leakage of urine that you can observe during coughing, sneezing, for example vomiting, when someone scares you and suddenly you have a urine leak. This is the weakest in terms of the intensity of urinary incontinence. The second degree is already leakage during physical activity, for example during running, jumping, some trampolines, dancing at a wedding, jumps.
We also deal with the third degree of urinary incontinence. Here we are talking about leakage during such trivial physical activities as walking, marching, getting up from a chair, turning in bed, and sometimes even during rest, for example sitting on a chair, bustling around the kitchen. This is really the most advanced form of urinary incontinence.
And why do we need this classification, someone might ask? First of all, so that we know whether we are able to help you at a given degree of urinary incontinence. That is, how to program the rehabilitation process so that you can enjoy full continence. And here you need to know that we are able to work with patients in the first and second degree of urinary incontinence.
So our physiotherapy is programmed in such a way that it brings nice effects indeed when you come to us with the second degree of urinary incontinence. It’s not that if you have urine leakage during walks or, for example, during position changes in bed, physiotherapy will definitely not help you. However, we must expect that the effects in the third degree of urinary incontinence may be weakened. Or for example, you will see improvement, but only up to a certain point.
So, according to the textbook and the assumptions of PTUG, the Polish Urogynecological Society, the third degree of urinary incontinence should be qualified for surgical procedures. Today we will not focus on surgeries. It is possible that we will discuss these surgical processes in urinary incontinence someday.
But today we are focusing on physiotherapy, i.e. rehabilitation. First of all, when starting such physiotherapy in urinary incontinence, we need to analyze your way of urinating. So we perform simple observational tests – a micturition diary. A micturition diary is a table for two days in which we observe how many times a day you urinate, how much urine is in one portion, how much you drink, what urge to urinate occurs during these toilet visits, and finally whether there is urine leakage.
Based on this, we can eliminate any errors in your toilet habits. Going to toilet habits, we also need to improve them a bit. You need to pay attention not to strain when urinating, when defecating, to put some stool under your feet when defecating, changing the angle of bending of the puborectal muscle. You need to pay attention to sit down primarily when urinating, that is, never urinate in the “skier” position, do not speed up this stream of urine. These are really the most important things you need to know.
My w trakcie fizjoterapii oceniamy sobie także stan Twojego dna miednicy. Jest to badanie przezpochwowe, które wykonuje fizjoterapeuta uroginekologiczny. I w trakcie takiego badania właśnie analizujemy pracę mięśni dna miednicy, oceniamy więzadła łonowo-cewkowe, stan błony śluzowej w pochwie, ewentualne obniżenia narządów rodnych. Musisz też posiadać umiejętność aktywizacji, czyli napinania, ale także rozluźniania swoich mięśni dna miednicy.
During the examination, we check how these muscles work, and then during the visit we teach you to tense and relax the muscles and give you the first homework in the form of training. At the beginning, it is isolated work, that is, usually one in which you lie down, fully focus on the muscles, and gradually over time we move on to muscle activation during general development exercises, squats, starts to run, so that you can fully return to physical activity.
Certainly during therapy, you also need to pay attention to modifying physical activity. So it should not be that we are conducting urinary incontinence therapy, and you are running, putting on, let’s say, thicker pads, larger liners. During therapy, we need to limit the activity that increases incontinence. And here it will probably be running and jumping. These will be strong, intense strength workouts and possibly strong abdominal workouts, i.e. crunches.
During therapy, we also use pessaries. Pessaries, i.e. silicone rings, silicone cubes, sometimes also soft ones, such as sponges, they look like tampons, which protect you from urine leakage, generating pressure on the urethra, or possibly pulling the organ upwards. This also changes the statics of the genital organs when it comes to the setting of the pelvis and does not exert such pressure on the bladder and urethra. With this, you can also train, you can exercise without worrying about urine leakage.
So, as you can see, we have a lot to do when it comes to urinary incontinence. Remember that this is not a problem that you have to live with, that you have to face every day. We are really able to help you, but the most important thing is for you to take the first step and try to visit a urogynecological physiotherapist in your area, who will guide you in further diagnostics and therapy. Thank you very much and see you in the next episodes of the podcast.