Urinary incontinence, also known as accidental bladder leakage, is an embarrassing problem that affects millions of women. Although it is more common in older women, it can affect younger women too. It is not a normal part of ageing or something that you just have to live with. The World Health Organization (WHO) reported that bladder control problems affect more than 200 million people globally. The WHO also said that incontinence  is a largely preventable  and treatable condition and that it’s “certainly not an inevitable consequence of ageing”. The WHO adds “the most typical reaction exhibited by patients when they are diagnosed with poor bladder control was not fear nor disbelief, 
but relief.”   

The NHS of UK estimates that between 3 and 6 million people in the UK have some degree of urinary incontinence. Women are more likely to suffer from stress urinary incontinence than men. That’s because of the effects of childbirth and the menopause. In 2004 an American survey (by the National Association for Continence) reported that women wait 6.5 years and men 4.2 years after beginning to experience bladder control problems before seeing a healthcare professional.   
Women are 5 times more likely to develop urinary incontinence compared to men.

What is Urinary Incontinence (UI) in women?
Urinary Incontinence (UI) is the loss of bladder control, resulting in the accidental loss of urine. Some women may lose urine while running or coughing, called stress incontinence. Others may feel a strong, sudden need, or urgency, to urinate just before losing urine, called urgency incontinence. 
UI can be slightly bothersome or totally debilitating. For some women, the chance of embarrassment keeps them from enjoying many physical activities, including exercising. 

Causes 
Urinary incontinence in women results when the brain does not properly signal the bladder and the sphincters do not squeeze strongly enough, or both. The bladder muscle may contract too much or not enough because of a problem with the muscle itself or the nerves controlling the bladder muscle. Damage to the sphincter muscles themselves or the nerves controlling these muscles can result in poor sphincter function. These problems can range from simple to complex   

Birth defects—Problems with development of the urinary tract   

Genetics—A woman is more likely to have UI if other females in her family have UI   

Race—Caucasian women are more likely to be affected than Hispanic/Latina, African American, or Asian American women   

Childbirth—The childbirth process can damage the muscles and nerves that control urination   
Chronic coughing—Long-lasting coughing increases pressure on the bladder and pelvic floor muscles   
Menopause—Reduces production of the hormone that keeps the lining of the bladder and urethra healthy   

Neurological problems—Women with diseases or conditions that affect the brain and spine may have trouble controlling urination   

Physical inactivity—Decreased activity can increase a woman’s weight and contribute to muscle weakness   

Obesity—Extra weight can put pressure on the bladder, causing a need to urinate before the bladder is full   

Older age—Bladder muscles can weaken with time, leading to a decrease in the bladder’s capacity to store urine   

Pelvic organ prolapse—Causes sagging of the bladder, bowel, or uterus out of their normal positions   
Pregnancy—The fetus can put pressure on the bladder during pregnancy   

Types of UI in women

The two most common types of urine leakage in women are stress incontinence and urgency incontinence. Incontinence may be caused or worsened by medical problems, medications, and/or problems with the brain due to a stroke or dementia.   

Stress incontinence — Stress incontinence occurs when the muscles and tissues around the urethra (where urine exits) do not stay closed properly when there is increased pressure (“stress”) in the abdomen, leading to urine leakage.  

Urgency incontinence — In people with urgency incontinence (also called overactive bladder), there is a sudden, uncontrollable urge to urinate. You may leak urine on the way to the toilet. ‘Normal’ frequency is considered to be eight times per day and once at night, but this depends on how much you drink and may increase if you drink more than 64 ounces of fluid in a day.   

Mixed incontinence — Women with symptoms of both stress and urgency incontinence are said to have mixed incontinence.   

Overflow incontinence — Overflow incontinence occurs when the bladder does not empty completely, causing leakage when the bladder becomes overly full. It may result in symptoms of either stress or urgency incontinence or both.   

How physiotherapy can reduce urinary incontinence 
Physiotherapy is one of the best and most effective treatments for urinary incontinence. Not only is it a low-risk solution, but a good physiotherapist can help you retrain your bladder and strengthen your pelvic floor muscles.   

1. Stress incontinence: This refers to the involuntary need to urinate when there is increased intra-abdominal pressure – such as coughing, jumping or running. 
2. Urge incontinence: Also known as an overactive bladder, this is characterized by an overwhelming need to urinate and the involuntary passing of urine because of this.
3. Mixed incontinence: This is a combination of both forms.   
A physiotherapist should be able to diagnose the type of incontinence following a short examination which includes obtaining details about your bladder control, your health history including any surgeries or pregnancies, your diet and your current lifestyle.   

Exercises and treatments

One of the methods physiotherapists’ uses is behavioral modification, which involves re-learning how to go to the toilet and learning how to effectively empty the bladder. 

Pelvic Floor Exercises are probably the most well-known forms of exercise for pelvic dysfunction. 
Neuromuscular stimulation is another method used which activates nerves and their associated muscles. 

Weighted vaginal cones are plastic, cone-shaped devices which the physiotherapist inserts into the vagina to help exercise the pelvic floor muscles. Weights can be added to them or removed and they work by gradually stretching the vaginal opening as the cone drops lower. This stimulates the pelvic floor. Bladder retraining literally means retraining the bladder how to work. 

These are some tips:
1. Don’t pee “just in case”: Try to wait a little longer when you feel the need to urinate, which will stretch the bladder and encourage it to hold bigger volumes.   
2. Keep calm: When the urge to go appears, try to sit down and hold a pelvic floor contraction hard enough to prevent leakage.  
3. Keep hydrated: Don’t restrict your fluid intake.
4. Limit caffeine and alcohol: Some bladders react negatively to caffeine and alcohol.   

How can a physio help?
Physiotherapists have an essential role to play in the assessment, treatment and prevention of urinary incontinence.   

A physio can: 

• Help prevent and manage incontinence.   
• Assist with bladder retraining and calming techniques.   
• Demonstrate correct coughing, sneezing and bracing techniques.   
• Liaise with other health professionals.   

A physio can- 

• Help prevent and manage incontinence by teaching how to locate and effectively strengthen pelvic floor muscles.   
• Assist with bladder retraining and calming techniques.   
• Demonstrate correct coughing, sneezing and bracing techniques.   
• Liaise with other health professionals.   

Prevention
Pregnancy and childbirth are the greatest risk factors for developing UI in women. It is essential that all women receive information on how to exercise their pelvic floor muscles during pregnancy. There is no need to suffer the embarrassment of incontinence in silence – seek help.   Physiotherapy is a cost-effective, low-risk solution.  Access to practicing pelvic floor exercises during pregnancy decreases the risk of incontinence following childbirth.   

(The writer is the National Organizer of the Chartered Society of Physiotherapists)