Continence problems are widespread and, contrary to popular myth, it is not the province of the bedridden and elderly patients. In fact, studies estimate as many as 1 in 4 women in the UK have a problem. This is common in young women following the birth of one or more babies or menopausal women.

Women’s pelvic floor muscles have a fundamental design flaw, they are not meant to be weight bearing. Since we have evolved onto 2 legs we have had no end of problems! These problems can be as mild as a slight leakage during your aerobics class, which is easily treatable and not the norm as certain sanitary towel advertisements would have us believe. However, these problems if left will get worse. Only a fraction of sufferers seek treatment for a problem that is often curable.

It has been estimated that this costs the NHS £50 million in pads alone and no allowance is made for the thousands of women who purchase their own continence related products.

Types of Incontinence:

1. Stress. This is characterised by leaking on coughing, sneezing, exercising or lifting.
2. Urge. This is characterised by the urgent need for the toilet with little warning. Toilet trips are frequent and through the night.
3. Mixed. It is common for people to exhibit a combination of these symptoms.

The Pelvic Floor

Pelvic floor muscles form a broad sling running from front to back toning the floor of the pelvis.

Diagram shows pelvic floor muscle.

The function of the pelvic floor muscles are:-

1. To support the pelvic organs
(bladder, uterus, vagina and anus)

2. Control the outlets from pelvic organs i.e. urethra, vagina and anus.

It is important to maintain the strength in these muscles to prevent problems occurring and to increase strength when problems do occur. Muscle weakness can be caused by damage due to childbirth, weakness as a result of constipation, chronic coughing, being overweight, menopausal changes, persistent heavy lifting, prolonged periods of inactivity due to illness or pelvic surgery.

Pelvic floor muscles adapt in a predictable way to poor usage, pain and in some 50% of cases studied pudendal nerve lesions. These adaptations are characterised by selective loss of the deep (red) muscle fibres. These red fibres give the pelvic floor postural tone to support the weight of the pelvic contents and they work 24 hours a day. Fast acting (white) fibres act under periods of increased abdominal pressure i.e. sneezing to prevent leakage.

Weak pelvic floor muscles have a depleted capillary bed and therefore reduced blood supply and oxygen. These muscles then exhibit fatigue. The age process shows a loss of this deep muscle throughout the body. Thus any pelvic problems will be compounded by the ageing process and escalate over time. Early treatment is very important.

CONTINENCE CHECK LIST

The following questions will guide you as to whether you need to seek treatment.

1. Do you get wet when you cough or sneeze?

2. Do you regularly pass water more than 10 times per day?

3. Do you wake up in order to pass urine more than 2 times a night?

4. Do you have only a short warning before needing to pass water?

5. Do you always make it to the toilet on time?

6. Do you ever have to wait for the stream to start?

7. Do you ever feel that you are unable to properly empty your bladder?

8. Do you ever leak slightly just after going to the toilet?

9. Does it ever hurt or burn to pass urine?

10. Do you ever use a towel between periods for urine leakage?

If you have answered yes to three or more of the above then it would be advisable to get a proper medical assessment by a urologist, gynaecologist, physiotherapist or continence advisor. Your GP will be able to sort out a referral for you. Alternatively our clinic will accept self-referral of patients. In many instances this is preferable to discussing such a private issue with the family doctor.

Our women’s health specialist has extensive experience in this area as well as in treating pain conditions such as vulvodynia. We are able to offer comprehensive assessments and easy to follow, personalised, discreet home treatment regimes. Problems can be dealt with in a relaxed, friendly and above all confidential atmosphere.

Physiotherapists have training in anatomy and physiology and, therefore, understand muscle function and more importantly what goes wrong with the system.

Assessment includes discussion about lifestyle, surgical and medical history including any pregnancies and labour. It is necessary to fill in a time/volume chart to look at bladder capacity and toilet habits. A full physical, internal examination will be required. Our clinic also uses electromyographic testing for exact information on muscle weakness. Occasionally it will be necessary to refer for further urodynamic testing.

There are a variety of treatment options available to the physiotherapist:

Pelvic floor and other exercises

Vaginal cones

Bladder training

Biofeedback

Trophic electrical stimulation.

All of these are simple, non-invasive techniques and are considered as a first line treatment option.

Trophic Electrical Stimulation is intended as a non-invasive conservative approach for the treatment of urinary incontinence. It can be used for stress, urge or mixed symptoms. It can also be used in cases of faecal incontinence where it is necessary to help re-establish and strengthen control of the external anal sphincter.

Trophic Stimulation builds up the red muscles and can be used on chronic problems with origins a number of years ago. It promotes continence through improved pelvic floor tone and by increasing awareness of the pelvic floor muscles. Farragher (1990) reported 80% of their patients to have regained control of the pelvic floor and no further treatment was deemed necessary as an added bonus increased muscle tone and sensation can increase a woman’s enjoyment of sexual intercourse.

Appropriate toilet habits and pelvic floor exercises maintain benefits. It is an appropriate and cost effective alternative to surgery. As a home based treatment with periodic physiotherapy reviews hospital admittance is therefore not necessary. This ensures that it is an acceptable treatment option and that compliance is high.

Improvements have social impact as a result of improved self esteem. Women attending our clinic have reported how they changed their clothes upto four times a day prior to treatment, would never go out for a drink for fear of leakage, wore many pads a day etc.

Units available are the Duet, the ETS90 and the Neurofour.

Always take medical advise regarding the appropriateness of this approach for your condition and regarding which unit to use. We can be contacted for further information.