The ads tell me leaking is normal – is that right?

Leakage is something that can be treated not just accepted. 1 in 3 women who have had a baby will leak. Do not accept this as status quo. You can do something about it.

Why do I leak?

There are many reasons why someone would leak. There are two main types of bladder leakage. Stress incontinence and urge incontinence and they are quite different mechanisms of leakage.

Stress incontinence is when abdominal forces from say, a cough, sneeze or jump push on the bladder so much that the resistance from the urethra can’t hold the urine in, causing leakage. This article will be talking about this type. A future blog will delve into the reasons and management for urge incontinence.

What can we do about stress incontinence?

There are some lifestyle changes that can significantly improve your leakage. If you are overweight or obese, losing weight can place less pressure onto the bladder causing less leakage. Minimising constipation is very important as regular straining will place unnecessary pressure onto the pelvic floor. Smoking and diabetes also are risk factors in developing stress incontinence.

There are several other options to manage or treat stress incontinence. One of the most important ways to stop leakage is to strengthen the pelvic floor muscles. This will create better support for the bladder and stiffen the bladder wall to create better resistance to stop urine leakage. However, this takes time so you need to be patient and consistent in a continual strengthening program. A big percentage of women who think they are doing their pelvic floor muscle exercise are in fact doing it incorrectly and could be doing more harm than good. This is why having an assessment of a women’s health physiotherapist is so important. This is an exercise to be done for the rest of your life. You want to be doing it correctly rather than incorrectly the rest of your life! She can also look at how you create abdominal pressures when loading your body and teach you how to minimise those pressures. A real time ultrasound can assist in assessing both the pelvic floor and abdominal function to get a more rounded picture of how your core system works.

Another option is to use a continence pessary. This is a mechanical device to better support your bladder neck by placing it into the vagina. Like a tampon, when fitted properly, you should not be able to feel it. Some people like to use this all the time if their leakage occurs frequently. Others who leak less frequently like to use it for when they are about to do a workout, a long walk, taking care of their grandchildren or have a cold and are coughing or sneezing a lot. Some women’s health physiotherapists, like at Inspired Physiotherapy, will be able to fit and insert a pessary for you.

Vaginal oestrogen has been proven in studies to reduce stress incontinence. This may be appropriate for women who have gone through menopause or women who are still breastfeeding. It is best to talk to your GP or gynaecologist to see if this is an appropriate medication for you to take.

Surgery is also an option for stress incontinence. There has been great controversy over this type of surgery with class actions occurring in the US as well as Australia. There are always risks to surgery and sometimes, surgeries like these may not last and may warrant another surgery in the future. However, this can be a great option for some people as the results are immediate and is a “quick-fix”. Talking to your GP and gynaecologist will determine whether this is a good option for you.

At Inspired Physiotherapy, we can assist you with a full assessment of how your core is functioning. This can be done internally or externally. A tailored exercise program can be prescribed for you. If you would like to also consider a pessary fitting, come talk to us about it. It is important to be proactive about our health rather than accept our ailments as a part of being a woman.