Dare to Jump – Dealing with Pelvic Floor Disorders and Incontinence
Though many women experience a pelvic floor disorder such as incontinence, they are often reluctant to discuss their symptoms – even with their doctor.
Dr. Jane Schulz, MD, FRCSC, a urogynecologist at the Lois Hole Hospital for Women’s Pelvic Floor Clinic, thinks this reluctance stems from the stigma attached to incontinence. “Women just don’t want people to know that they pee their pants,” she says. “But it can affect enjoyment of life, and can get progressively worse over time if not treated.”
What is the pelvic floor?
The pelvic floor is a ‘hammock’ of muscles and ligaments that runs from your pubic bone to your tailbone and from each hipbone on the side. It provides support to the pelvic organs, including the bladder, uterus and rectum. Some of the muscles also provide support and closure to the sphincters in your urethra and help to keep urine in.
What are pelvic floor disorders?
Pelvic floor disorders can occur when the ‘hammock’ that supports the pelvic organs becomes weak or damaged. This can result in:
- Urinary incontinence
- Bowel incontinence
- Pelvic organ prolapse
- Recurrent urinary infections
- Interstitial cystitis
- Pelvic pain syndrome
Of these, urinary incontinence is a prevalent disorder. In fact, one in four women will experience an incontinence issue during their lifetime.
What is incontinence?
Incontinence is the accidental or involuntary loss of urine from the bladder. There are a few types of incontinence, but the most common are stress and urge (also called overactive bladder). About a third of women will have both types of incontinence.
Stress incontinence is a leak of urine when there’s any increase in inter-abdominal pressure brought on by activities such as coughing, sneezing, jumping, running, or standing up from a sitting position. This type of incontinence gradually increases over time but generally plateaus at menopause.
Overactive bladder (urge incontinence) is the urge to pee and the inability to make it to the toilet in time. It’s caused by unstable contractions in the bladder which signal the urge to go before you’re ready. Overactive bladder is marked by urgency and frequency. It can triggered by cold temperatures, running water, or just not being able to get to the bathroom fast enough.
Normally, a woman should urinate about once every 3-4 hours, and no more than twice per night. With overactive bladder, women may find they’re going every 30-60 minutes, which can affect sleep. This type of incontinence tends to increase in women over their lifetime.
When to seek help?
“If incontinence is impacting what you’re doing in your day-to-day activities, then you should seek help,” says Dr. Schulz.
Depending on where you live and your circumstances, you can speak with your general physician or other primary care provider. They can often help to diagnose and treat the issue, but can refer you to a gynecologist or urologist if needed.
How is it diagnosed?
It’s important to complete a basic medical assessment with your primary care provider to be sure of what’s affecting your bladder health. For instance, certain conditions or medications can affect how your bladder behaves.
You may be asked to keep a ‘bladder diary’ to record frequency and volume of urine for three days. You may also need to record what you eat and drink for those days. This will help your health care provider determine what type of incontinence you are experiencing.
What are the treatments?
Treatment depends on the type and severity of your incontinence, though conservative strategies are usually tried first. These include:
- Lifestyle changes, including dietary modifications and weight loss
- Bladder training
- Kegel exercises
- Vaginal pessaries
- Incontinence products – while not a treatment, these may help in the management of your condition. Make sure to use pads specifically for this purpose, and not sanitary pads.
Half of women experiencing incontinence don’t need to see a surgeon after trying these strategies. But if your incontinence doesn’t respond to conservative strategies or medication, surgery may be an option. For stress incontinence, surgery options are:
- Injection of a bulking agent around the bladder neck to improve the ‘squeeze’ in the urethra.
- A procedure to lift and support the urethra using a sling made from mesh or from your own tissues.
For overactive bladder, surgery options are:
- Injection of Botox into the bladder to relax the muscles.
- Insertion of a small pacemaker-like device to reset bladder control.