Urinary incontinence. Have you heard of physiotherapy as an effective treatment?

Let's talk about the problem that is urinary incontinence, but also about the solution: uro-gynaecological physiotherapy.

Did you know that 10%-40% of women have urinary incontinence and because it is seen as such an intimate problem, many women do not mention it? Urinary incontinence does not only affect women in menopause. It can affect pregnant or postpartum women, female or male athletes involved in impact sports such as CrossFit or gymnastics and men with prostate problems. (Natalia Price, 2010).

The prevalence of this problem worsens with age, a factor related to the decrease in oestrogen levels in the body, which causes greater relaxation of the urethral sphincter.

Pregnancy and childbirth are risk factors for urinary incontinence due to weight gain, hormonal changes, and potential trauma to the perineum during vaginal births (e.g. episiotomy). A study by the author Brummer et al concluded that pregnant women who develop stress urinary incontinence have an 18-fold higher risk of developing stress urinary incontinence during the baby's first year of life. (Natalia Price, 2010)

Urinary incontinence is defined as any involuntary loss of urine, whether in men or women and regardless of its cause. There are two types of urinary incontinence: stress incontinence and urge incontinence, and when both are present, it is called mixed urinary incontinence. It is a problem that should not be trivialised and has treatment. (Natalia Price, 2010)

Stress urinary incontinence is characterised by the involuntary loss of urine when a person laughs, coughs or sneezes, which increases abdominal pressure and results in urine loss. Urge urinary incontinence consists of an urgent need to urinate, resulting in urine loss, sometimes in a gush or as drips. (Carvalho, Silva, & Silveira, 2018)

Urinary incontinence can cause significant disruption to people's lives and often leads to social isolation, the abandonment of sports and daily activities, which can, in turn, lead to depression. Fortunately, there is a branch of physiotherapy – uro-gynaecology – which consists of exercises to relax, stimulate and/or strengthen the pelvic floor muscles as part of conservative treatment. This approach has no side effects and a high success rate in treating this issue. (Natalia Price, 2010) (Carvalho, Silva, & Silveira, 2018)

The pelvic floor is a group of 12 muscles, divided into superficial and deep muscles, and its main function is to support the pelvic organs. The only voluntary contraction described is a lifting and tightening of the area of the urethra, vagina, and anus. (Gray & Moore, 2012).

Continence in adults consists of the ability to postpone urination for at least two hours during the day, and when sleeping, one can get up once during the night if under 65 years of age, or twice if over 65 years of age, to urinate. (Gray & Moore, 2012)

The need to wake up during the night to urinate has a name, it's called nocturia, and it can vary depending on the liquids a person drinks during the night or if they suffer from a condition, for example diabetes or congestive heart failure, which causes increased urine production during the night. (Nunes, 2010)

There is also a condition called an overactive bladder which is characterised by the need to urinate more than once every 2 hours, with or without urinary leakage, and at night translates to more than one episode during the night if the individual is under 65 years of age, or more than 3 nighttime episodes for the elderly, without any associated neurological or metabolic pathology. It is important to note that neither of these conditions are associated with pain when urinating, and when signs of inflammation such as swelling, pain, heat, and redness are present, the person suffering from these symptoms should be evaluated by a doctor.

Want to know how your bladder is behaving? Here's a tip: keep a bladder diary for a week, recording your urine volumes (using a measuring cup), the time intervals between urinating, and fluid intake daily. You can then present this to the healthcare professional monitoring your condition. If you have any questions about your diary, please send me an email at info@integrativa.pt.

In the face of all these urinary problems, physiotherapy plays a fundamental role in training the pelvic floor muscles. Following a detailed assessment, the patient learns to consciously contract their muscles and perform specific exercises, gradually increasing the intensity and effectiveness of the treatment. When voluntary contraction is not possible, electrostimulation can be used, helping to promote muscle awareness and strengthening in a safe and controlled manner.

Do not ignore signs of urinary incontinence; it can be treated and reversed.
If you experience involuntary urine loss, urgency to urinate, or pelvic discomfort, seek professional help.
Schedule an appointment Pelvic Physiotherapy and discover how pelvic floor training can restore your quality of life and confidence.

Does your bladder run your life? Find out more about uro-gynaecological physiotherapy on our website. Come and have your perineum assessed at Integrativa to regain the freedom you deserve in your life!

Reference articles

Carvalho, M. R., Silva, F. A., & Silveira, I. A. (2018). Alternative therapies for early recovery of urinary continence post-prostatectomy: a systematic review. Enfermeria Global.

Gray, M., & Moore, K. N. (2012). Nursing Care in Urology for Adults and Children. Lusociência.

Natalia Price, R. D. (2010). Pelvic floor exercise for urinary incontinence: A systematic literature review. *Maturitas*.

Nunes, J. G. (2010). Urology – Nocturia aetiopathogenesis and therapeutics (topic 1). Urology.

Silva, V. P., Lourenço, A., Cruz, F., & Monteiro, L. M. (February 2017). Overactive Bladder (OAB) Evidence-Based ICP (Portugal)