CONTINENCE CORNER

Lets talk leaking: it's very common (according to the Continence Foundation of Australia, urinary incontinence affects 1 in 4 Australian adults, including up to 38% of Australian women). Over half of women in the community with urinary incontinence are under 50; and 65% of women waiting at a GP appointment will have some type of urinary incontinence (1)

So, its common, but it is not normal - and there are measures you can take to alleviate or eliminate symptoms in most cases (6) - you shouldn’t put up with it simply because you are pregnant or have recently had a baby! Read on to find out more on how to reduce leakage when you laugh, cough, sneeze (no more #peeze!).

There are 6 main types of urinary incontinence, but we will focus in this article on the 3 main common types of incontinence most common in the pregnant and postpartum population. These are stress urinary incontinence (SUI) urge urinary incontinence (UUI) and mixed urinary incontinence (combination of SUI and UUI).

#1 Stress Urinary Incontinence (SUI): this is one of the most common forms of leakage, and occurs when there is involuntary loss of urine during coughing, sneezing, laughing or jumping.  Stress urinary incontinence (SUI) is the most common type of urinary incontinence in pregnant women and is known to have detrimental effects on the quality of life in approximately 54.3 %. Pregnancy is the main risk factor for the development of SUI.(2) The average prevalence of SUI during pregnancy is around 40% (varying reports in the literature from 18% up to 75%), but with the trend to increase in prevalence towards the later end of pregnancy.  This is due to the increasing pressure placed on the pelvic floor muscles by the increasing weight of the baby as they grow in utero, as well as pregnancy related hormonal changes (increasing levels of progesterone, oestrogen and relaxin) which may lead to reduced pelvic floor muscle strength and reduced capacity of the sphincteric function of parts of the pelvic floor. There is also hormonal and mechanical effect on the mobility of the bladder neck and urethra, which leads to the urethral sphincter being less competent.  (4) The mobility of the bladder neck was significantly higher after vaginal delivery using a vacuum extraction compared to spontaneous delivery or c-section.

The pelvic floor is like a hammock which supports the pelvic organs, and also comprises the sphincteric muscles which control opening / closure of the urethra (tube from the bladder) and anus (anal sphincter). Repeated or long term high stress on these structures, such as from:

• increased weight on the pelvic floor and downward pressure due to a growing baby, 
• Weakening of the pelvic floor due to the effects of increased hormones of pregnancy
• increased weight and pressure due to obesity,
• chronic strain and weakening due to straining to go to the toilet (constipation), 
• chronic high impact activity

Can cause weakening of the pelvic and urethral sphincter muscles and lead to leakage when further stress is placed on the pelvic floor with a cough, sneeze, laugh or jump.

Research by Jundt, Scheer, Schiessl, Karl, & Friese (2010), found that the bladder neck in women with postpartum urinary stress incontinence was significantly more mobile than in continent controls.Spontaneous vaginal delivery or vacuum extraction increases the risk for stress or anal incontinence, delivery with vacuum extraction leads to higher bladder neck mobility and stress incontinent women have more mobile bladder necks than continent women. (4). We know from 2 Japanese studies (7,8) that specifically designed shaper / compression wear can assist bladder neck position and reduce incontinence episodes, which is why we have so passionately created Lenny Rose Active Support products, which include our patented FemmeCore (™) support sling for pelvic floor and bladder neck support. We are underway with formal research studies to show how our products support pelvic floor and pelvic floor muscle training - we can’t wait to be able to share this with you down the track.

#2 Urge Urinary Incontinence is when there is involuntary leakage of urine upon the urge to urinate - you are not able to hold on until such time as you are able to make it to the bathroom. According to the Continence Foundation of Australia, a healthy bladder can hold up to 600ml of urine (6) - but in someone suffering from Urge incontinence, they will have the urge to urinate even when the bladder isn’t full. You will definitely know about this if you have experienced “key in door syndrome” - the sudden urge to pee when you get to the front door and may or may not be able to hold til such time as you have opened the door and made it into the bathroom. 

Risk factors include stress, constipation, poor bladder habits (such as the habit of going “just in case”) which may cause the bladder to have reduced holding capacity. Consuming high amounts of caffeine can worsen urge incontinence.

#3 Mixed Urinary Incontinence is when Stress and Urge incontinence are present together, which is associated with much lower quality of life for sufferers than those who suffer from stress incontinence alone. (3)

#4 Fecal incontinence is also prevalent in approximately 6% of Australian men, and 10% of Australian women. (1) For further information stay tuned for our upcoming article, or head over to The Continence Foundation.

So you may have gathered that incontinence is very common - you are most definitely not alone. You are among 50% of pregnant women, 25% of the general female population in your suffering - BUT, you do CAN do something about it and we urge you to! Life is too short not to run after your kids, to be embarrassed in social situations, stressed about where the closest toilet stop is when you are out and about or at the park. Your first point of call is to see a professional  - a women’s health physiotherapist, (there are also a growing number of women’s health osteopaths in Australia with a similar skillset and very passionate about pelvic health and continence)

You can find a list of women’s health physiotherapists near you by checking out the APA’s Find A Physio. A physio will help diagnose the type of incontinence, as well as assess for other potential issues such as prolapse, pain, or other pelvic health symptoms.

There is evidence to suggest that pelvic floor exercises can be beneficial in improving the symptoms of stress urinary incontinence in pregnancy (6) and in postpartum (7), it is key to conduct PFE’s with correct technique to see improvement in symptoms. Working with a physio you may also

• be given education on bowel and bladder habits, be asked to complete a bladder diary to help diagnosis, including fluid intake and bowel motions
• suggestions to improve constipation symptoms
• work with breathing mechanics and how to engage your core and pelvic floor effectively with movement
• be taught “the knack” - pre emptive pelvic floor contraction before you strain (cough, sneeze, etc)
• be assessed for appropriateness of high impact activity and offered alternatives
• be offered continence support products such as pessaries, specifically designed compression and support wear, continence underwear, pelvic floor muscle training devices
• be referred to a urologist or gynaecologist for further help if more than conservative treatment is needed (for example when there is nerve damage from childbirth).
• be referred to a dietician or nutritionist where obesity is a contributing factor

We believe in a multi-modal approach to pelvic health - and that making pelvic floor education and exercise accessible, affordable and doable is key to improving continence and pelvic health outcomes for Australian women and women across the globe. You can check out our pregnancy and postpartum support products, or subscribe to our newsletter to find out about upcoming product releases for prolapse and continence.

Please note this advice is general in nature and does not replace advice of your medical practitioner or team.

1. Key statistics on incontinence | Continence Foundation of Australia
2. Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment - PubMed (nih.gov)
3. Mascarenhas T, Coelho R, Oliveira M, Patricio B (2003) Impact of urinary incontinence on quality of life during pregnancy and after childbirth. Paper presented at the 33th annual meeting of the International Continence Society, Florence, Italy, October 9, 2003
4. Jundt K, Scheer I, Schiessl B, Karl K, Friese K, Peschers UM. Incontinence, bladder neck mobility, and sphincter ruptures in primiparous women. Eur J Med Res. 2010;15(6):246–252. [PMC free article] [PubMed] [Google Scholar]
5. Urge Incontinence | Urinary | Continence Foundation of Australia
6. Is a 6-week supervised pelvic floor muscle exercise program effective in preventing stress urinary incontinence in late pregnancy in primigravid women?: a randomized controlled trial - PubMed (nih.gov)
7. Long-term effects of motherfit group therapy in pre-(MOTHERFIT1) and post-partum women (MOTHERFIT2) with stress urinary incontinence compared to care-as-usual: study protocol of two multi-centred, randomised controlled trials | Trials | Full Text (biomedcentral.com
8. Taniguchi T1, Kobayashi Y1,Takaoka S1, Kobayashi H2, Mitsui T1,Yoshiyama M1, Takeda M1. University of Yamanashi, 2. Kobayashi clinic. PELVIC FLOOR SUPPORTIVE UNDERWEAR ENHANCES ALLEVIATING EFFECT OF PELVIC FLOOR MUSCLE TRAINING ON LOWER URINARY TRACT SYMPTOMS IN PELVIC ORGAN PROLAPSE PATIENTS
9. Taniguchi T1, Kobayashi Y1,Kobayashi H1,Mitsui T1,Takaoka T1,Yoshiyama M1,Takeda M1. University of Yamanashi EVALUATION OF A NOVEL UNDERWEAR WHICH SUPPORTS THE PELVIC FLOOR IN PELVIC ORGAN PROLAPSE PATIENTS.