Why do I leak? – Amanda Kot

Do you leak when you cough, laugh, sneeze, or exercise? – If so, you are not alone!

1 in 10 elite female athletes (International Continence Society, ICS) who compete at National level experience stress urinary incontinence (SUI), with a whopping 82.4% prevalence in high-impact sports like trampolining. 

So, what is stress urinary incontinence?

Stress urinary incontinence is an involuntary loss of urine on effort or physical exertion or on sneezing or coughing (ICS). 

Before we get onto the causes of stress urinary incontinence, we need to learn the simple physiology of the storing and releasing of urine:

Urine is produced by the kidneys and is transported to the bladder throughout the day.      

The bladder acts as a container during the storage phase. The base of the bladder is connected to the urethra. The urethra is surrounded by layers of muscles, imagine the urethra as a water tap/hose, when muscles are relaxed, urine comes out. In a normal functioning bladder, urine passes when the bladder squeezes, while the urethra muscles relax.

When we are exerting ourselves, e.g coughing or jumping, there is an increase in intra-abdominal pressure. Such pressure pushes onto the bladder and if this overcomes the urethral closing pressure, urine comes out involuntarily.

What are the causes of urinary incontinence?

  1. Pelvic floor muscle weakness
  2. Increased laxity of the fascia (connective tissue)

Pelvic floor muscle weakness

There are two groups of pelvic floor muscles:

  1. The extrinsic urethral sphincter muscles provide the closing force/pressure to the urethra to stop urine from passing. 
  1. The levator ani muscle provides an upward lift to the bladder neck. It works with the facial system to provide support to the bladder.

A test you can do to see if you have weak pelvic floor

Urine Stream Interruption Test

  1. Ensure you have a moderately full bladder
  2. Start passing urine as  usual
  3. Try as hard as you can to stop the urine, 5secs after you start the flow
  4. Count how many seconds you need to stop the flow completely 
  5. Then you can continue to finish peeing.

Results: If it takes more than 4s ecsto stop your flow completely, this may indicate a weakness in your sphincter muscles

Increased laxity of the fascia 

The endopelvic and pubocervical fascia support the bladder neck. When there is increased intra-abdominal pressure, the pressure not only pushes the bladder down but also pushes the neck of the bladder towards the above-mentioned fascia and helps closing the bladder neck/urethra. 

However, this only happens when the fascia is taut enough to provide sufficient support.

Interestingly, this may also cause cyclical SUI for young women, i.e. only experiencing SUI symptoms during a certain part of their cycle, due to hormonal fluctuation that affects fascial laxity.

Here are the recommended conservative managements for stress urinary incontinence:

  1. Pelvic floor muscle training (PFMT)

This may take at  least 3 months of training. Between one-third to one-half of all women completely stop leaking, while 75-80% will experience some, if not significant improvement.

  1. Consider pessary fitting

Pessaries are intra-vaginal devices that aim to provide support to the pelvic organs. A suitable pessary would augment bladder neck closure during increased intra-abdominal pressure

How can your Physiotherapist help?

  • A thorough assessment with your pelvic health Physiotherapist, this may involve internal vaginal assessment of the strength of the muscles and identify any scarring or prolapses of organs that can affect your strength.
  • A tailored programme to train your pelvic floor muscles and guide you through your rehabilitation.

Come and see one of our pelvic health Physiotherapists to begin your recovery journey today!

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