Common Urinary Complaints that Pelvic Physiotherapists Manage

Urinary complaints in women are seldom talked about. For most, protective garments are used to manage urinary incontinence. Any other urinary “annoyances” are usually managed in the privacy of one’s own home. Sadly, whenever I have heard urinary complaints being talked about, humour is often used to mask, or worse, normalise the scenario. Urinary incontinence, retention, an overactive bladder, and the like are common, however, they are not normal. There are effective physiotherapy treatments and techniques that can alleviate, improve or help you manage your symptoms so that you can live a normal and functional life. Knowledge is power, and so, the first step that I would like to take towards empowering women to take control of their lives, is to provide education regarding some of the common forms of urinary dysfunction.

Stress urinary incontinence refers to the involuntary loss of urine during increased intra-abdominal pressure or exertion. This can include sneezing, laughing, running and lifting. In stress urinary incontinence, the detrusor muscle of the bladder does not contract as it does during normal voiding, but instead, the bladder experiences an external force that it greater than its ability to keep the opening of the bladder closed. When the pelvic floor adequately lifts the bladder and the opening of the bladder up inside the pelvic cavity, the force of the intra-abdominal pressure closes around the urethra/ bladder neck and assists in keeping it closed. When the pelvic floor is weak, and the bladder and its opening are sitting lower in the pelvic cavity and the intra-abdominal forces do not add to closing pressure. Rather, this force adds pressure that the sphincter around the bladder opening is not able to withstand. An involuntary loss of urine will most likely be experienced in this scenario. Thus, strengthening of the pelvic floor to hold the bladder and its opening higher during times of increased intra-abdominal pressure, can alleviate stress urinary symptoms.

Excess urine may be retained in the bladder despite attempts to void. This is called urinary retention. This dysfunction may occur due to an obstruction that blocks the flow of urine, an inability of the muscle of the bladder to contract strongly enough to push the urine out of the bladder, or a spinal cord injury that causes the sphincter around the neck of the bladder to remain contracted, (instead of relaxing to allow urine to pass). If urinary retention is not addressed, a person may be prone to frequent urinary tract infections (UTIs) and/or overflow incontinence. In cases of overflow incontinence, a person would experience a constant ‘dripping ‘of urine. A Women’s Health physiotherapist would be able to identify symptoms of urinary retention and guide you in the appropriate management steps.

It has been suggested that normal urinary frequency is around 4-6 times per day, or around every 3-4 hours. There are multiple factors that can contribute towards increased urinary frequency – despite simply consuming a lot of fluids. Some people are not able to fully empty their bladders when they void, leaving a smaller capacity for the urine to fill into. This decreases the time between voids, increasing frequency. Medical conditions, certain medications and fear of incontinence leading to “just in case” voids or factors that cause increased bladder sensitivity (including UTIs and bladder irritants) can also contribute to increased urinary frequency. A Women’s Health physiotherapist can help you identify the cause behind your increased urinary frequency and work with you to address the problem.

Nocturia is when an individual needs to wake from a state of sleeping in order to urinate. Nocturia is more common in females and its likelihood increases with increasing age. Nocturia causes sleep deprivation, depression and an increased risk of falls. Factors that contribute to nocturia include insufficient bladder emptying, increased bladder sensitivity and conditions that cause an abnormally large production of urine to occur at night, (including pooling of fluid in the lower limbs, hormonal alterations and sleep apnoea). Nocturia can be diagnosed by a trained Women’s Health physiotherapist, who can help you eliminate possible causal factors, or refer you to a relevant member of the medical team, if needed.

An overactive bladder is a term used to describe increased urgency to urinate. This is usually also accompanied by increased urinary frequency and nocturia. Increased bladder urgency is different from feeling the normal urge to urinate – that gradually increases as time progresses. During an episode of urgency, a person will feel a sudden and difficult to defer desire to pass urine. This may or may not result in an accidental urine leak. An overactive bladder creates anxiety and affects quality of life. In a 2009 study, 38% of women reported that having an overactive bladder negatively impacted their relationships. In clients with an overactive bladder, the detrusor muscle of the bladder contracts inappropriately to create the urge to urinate. While there are varying opinions as to why this happens, the most important consideration is that an adequately strengthened pelvic floor should be able to override this detrusor contractions in order to retain dryness. Through appropriate physiotherapy management, distraction techniques and pelvic floor strengthening, clients can be taught to combat this bothersome symptom.

If you suspect that you are suffering from any of the above urinary conditions, book in to see us at Function360 today. Incontinence and urinary symptoms are not normal. Help us to increase awareness and promote improved pelvic health for women of all ages.

What is Pelvic Organ Prolapse?

There are 3 pelvic organs inside a woman’s body, these are the bladder, uterus and rectum. These organs are held or suspended in place within the pelvic cavity by muscles and fascia. When there is weakening of either the pelvic musculature and/ or pelvic fascia, these organs can descend from their original position and potentially become visible at/ within the vagina. 

Research done in Australia has encouraged the acceptance of pelvic organ prolapse as being one of the most common health problems in Australia. Around 75% of women develop at least some degree of pelvic organ prolapse during their lifetime, but sadly the average woman waits 3-4 years before seeking help for her pelvic floor complaints due to embarrassment and lack of awareness of support options.

Owing to hormonal changes and the stress that the muscles of the pelvic floor endure during pregnancy and labour, women who have given birth are amongst those who are most at risk of developing pelvic organ complaints. Women who suffer from chronic respiratory conditions, lift heavy weights regularly and have competed at an elite sporting level can also be at risk.

Education is key in equipping women with knowledge to protect themselves from unnecessary injury, supporting them through their treatment options and opening conversations about pelvic health.

If you would like to be assessed for pelvic organ prolapse, or if you are experiencing vaginal fullness/pressure, lower abdominal ‘dragging’ or incomplete/obstructive emptying (of bladder and/or bowel), please book in to see our Women’s Health Physiotherapist.

What to Expect During a Pelvic Examination

Most women are quite apprehensive about coming for a pelvic examination. Unlike the training received by members of the multidisciplinary team, during post-graduate pelvic physiotherapy training, physiotherapists are expected to model for each other as assessment and treatment techniques are being learned. This means that most Women’s Health physiotherapists have been through a pelvic assessment and/or treatment many times before. We know how you feel! A lot of women are self-conscious about their anatomical differences. We all come in various shapes and sizes, and I would encourage any person who doubts this to have a look at the artistic works of Jamie McCartney, who aims to promote body image positivity through his castings called “The Great Wall of Vagina”.

Throughout your treatment you can be expected to be treated by one of our trained female Woman’s Health Physiotherapists. During the first consultation, you will be asked some personal questions pertaining to your bladder, bowel and sexual function. Open and honest answers are needed to accurately deduce a possible diagnosis. It will then be explained to you what may be occurring and the reason/s for this. It is likely that you will be asked to complete a bladder diary, which will require you to record the amount of fluid consumed and urine voided for a minimum of 24 hours (but three days is preferred). From this information, insight into the possible contributors to your discomforts can be gained. Lifestyle and behavioral modifications to ease your symptoms may also be suggested. In most cases, an internal vaginal examination is recommended to confirm what appears to be the issue. The need for this will be explained during your initial consultation and you will be given the opportunity to think about your comfortability with this in preparation for your next visit. Should you choose not to have an internal examination, your decision will be respected and alternative ways to continue holistic treatment can be explored.

We pride ourselves in creating a comfortable environment where you can rest assured that your right to respect, dignity and confidentiality will be held in the highest regard. In most cases, these types of conditions require patience and a committed investment in the journey to improved function.