All-For-One. Continence Advice for people of all ages

Do you leak urine when you exercise, laugh or cough? Do you frequently have to visit the toilet day and night and or flood urine without warning? If you do, 70% of you can achieve dryness with some self help techniques.

Basically, the bladder and lower urinary tract have two main functions, to store urine and to empty it out at an appropriate and, an acceptable time and place.
The kidneys excrete urine into the bladder via two tubes called ureters. The bladder stores the urine and empties it through a tube called the urethra .
As the bladder fills with urine, nerves in the bladder wall send signals up through the nerve pathways to the brain which, monitors how full the bladder is getting. These signals are mild to begin with but as the bladder size increases to hold about 300 – 400ml, the signals get stronger and stronger signaling you to get ready to empty your bladder.
When you are ready to empty your bladder, say, when you are sat on the toilet, the pelvic floor muscles and urethral sphincter (a mechanism that squeezes the urethra shut or relaxes to open it) open to allow the urine out through the urethra. The bladder muscles contract, pushing all of the urine out. When the bladder is empty, the pelvic floor muscle contracts and the uretheral sphincter closes, ending urination.

Stress Incontinence

Stress incontinence can be identified by the leakage of urine when there is a sudden increase in pressure within the abdomen which presses on the bladder such as when coughing, exercising, laughing or lifting heavy objects. The urine loss is usually very small and occurs at the same time as for example the cough or laugh. It stops as the activity ends. Although the leakage is small in quantity, it can be very mild, only happening occasionally or, it can be severe, happening on any movement such as rising from a sitting position or walking. Stress incontinence is most commonly caused by pelvic floor weakness.

The pelvic floor could be described as a hammock of muscles stretching across the pelvis. In females the pelvic floor muscles are perforated three times, for the urethra (urine outlet tube), vagina (birth passage) and the anus. In men it is perforated twice, for the urethra and the anus.
Their role is to provide support for the contents of the pelvis, maintain continence of urine and faeces, allow evacuation of urine and faeces and, allow intercourse and childbirth.
There are two groups of muscles that make up the pelvic floor. For simplicity, they can be described as slow twitch and fast twitch muscles,
The slow twitch muscles are for endurance, supporting the pelvic contents. They are slow to tire. The fast twitch muscles are designed to contract in a strong and quick manner acting as an extra closing force around the urethra when you cough or laugh.

Pregnancy: Hormones circulate the body each month as part of the menstrual cycle and when pregnant. These hormones are responsible for softening muscles and ligaments of the pelvis. These hormones can effect stress incontinence and can make things worse prior to a period.
The weight of the pregnancy and vaginal delivery can put strain on the pelvic floor muscles and cause weakness.
Obesity: carrying extra weight causes strain on the pelvic floor, which can result in pelvic floor weakness.
Smoking: can cause a chronic cough, putting repeated pressure on the pelvic floor, possibly causing weakness.
Oestrogen depletion in post menopausal women: oestrogen is an important factor in maintaining continence, when the oestrogen levels fall after menopause, incontinence can be a result.
Poor exercise routines – such as star jumps: these type of exercises cause strain on the pelvic floor by pulling the muscles in the wrong direction. They are not recommended.
Prostectomy: stress incontinence can be suffered post operatively.

Exercise! First you must identify your own pelvic floor muscles. You can do the exercises in any position, lying down, sitting or standing, however you feel comfortable. Squeeze the muscles between your legs as if to stop yourself passing urine or wind, you should feel a slight lift as you contract the muscles.
The muscles in your tummy, legs or buttocks should not move.

Go to the toilet and pass urine. Once you have started the flow, stop. The muscles you have used to stop the flow are the pelvic floor muscles. This is a very simple way of identifying the muscle but the least effective way of exercising them

For females: place the tip of your index finger and middle finger just behind the vagina
For males: place the tip of the index and middle finger just behind the scrotum
now squeeze the pelvic floor muscles, you should feel a slight lift away from your fingers

Or if you are female, you could insert one or two fingers into your vagina, contract the pelvic floor muscles, you should feel a squeezing and lifting action.

Once you have identified them, remember them.

There are two types of muscles that make up the pelvic floor, and, there are different exercises for both of them.

The slow twitch exercises: you should contract (squeeze) them for 5 – 10 seconds – whatever you can manage, and repeat 5 times. Relax for 2 – 3 seconds between the contractions.

The fast twitch exercises: you should contract the muscles for 1 second. Repeat 10 times.

You should repeat the whole routine a maximum of 6 times a day. Pelvic floor muscles can suffer from fatigue just like any other muscles. You may need to take the exercises slowly to begin with and build up to the 6 regimes a day over a few weeks – listen to your body.

Example: if you can manage to hold a slow contraction for 6 seconds:

6 second hold – do 5
1 second hold – do 10
repeat the full regime, 6 times a day

If you do the whole regime only 3 times a day, you will maintain the muscle tone you have now and probably not see any improvement in your incontinence. Three regimes a day would be a good maintenance plan once you are dry. If you exercise more than 3 times a day you will see an improvement. Generally, improvement is noticed between 3 to 6 months of exercising.

Many of you will achieve dryness if you follow the exercise regimes strictly. If you are unable to identify your pelvic floor muscles, or unable to do the exercise or, if you can do the exercises but there is insufficient or no improvement in your symptoms by 6 months, please seek advice from your Continence Advisor or GP.

The exercises are for life, stop doing them and the pelvic floor will weaken over a time period.

There are other causes of stress incontinence such as low oestrogen levels in post menopausal women, prolapse, urethal sphincter incompetence. There are also other treatments available. These conditions and treatments require detailed assessment by a qualified health professional. Please seek advice from your Continence Advisor or GP. Your local hospital will be able to direct you to your Continence Advisor.

The bladder muscle becomes over stimulated. The bladder contracts and attempts to push the urine out before you are ready. You may feel this as a very strong sense of urgency to urinate and or, a feeling that you frequently need to go to the toilet day and night. You may or may not be incontinent of urine.

Urgency is when you have little or no warning to pass urine. Urge incontinence is when you don’t actually make it to the toilet in time and become wet.

Frequency: it is normal to visit the toilet 4 to 6 times a day, over 6 times is frequent.

First things first:

If you suffer any of the above symptoms, you must have your urine tested as the symptoms described can also suggest a urinary tract infection – contact your Continence Advisor or GP for urine testing.

In a lot of cases, the cause is unknown, there are aggravating factors such as long term poor toileting habits like, for example, going to the toilet ‘just in case’ instead, of going to the toilet when the bladder signals it needs emptying. This can result in the bladder muscle not being stretched and therefor ‘shrinking’, reducing its ability to hold a reasonable amount. Emotional factors such as anxiety have also been associated with these symptoms, the fear of incontinence alone, can send someone rushing to the toilet. Caffeine is a bladder stimulant, this is found most commonly in every day drinks like tea, coffee and coke. An excessive fluid consumption of over 2 litres a day will cause frequency, so will an insufficient amount of drinks. 1.5 litres a day is a good average.

Start simply, get your urine tested. If you have a urine infection, your GP will prescribe the appropriate treatment.
If you do not have a urine infection, consider eliminating caffeine from your drinks, choose the decaffeinated version of your own brand – you wont notice the difference in taste. After several days, you may notice an improvement in your symptoms.
If you are drinking excessively, try to reduce your intake to an average of 1_ litres a day.
Not drinking enough will have as bad an effect as drinking too much, you will still experience frequency and urgency, increase your amount of daily drinks. Do this slowly over several days until you have an average intake of 1.5 litres daily.
1.5 litres is the same as 6 x 250ml drinks.

The above maybe all that is needed to reduce or eliminate your symptoms, if you are still suffering, additional self help methods are needed:

Bladder re-training:
Your bladder may need retraining. Before you start the bladder retraining, for 3 days, record the times of when you pass urine and the amounts passed. Identify at what times you are wet. Keep this as a record. Your description of your toileting habits that you are experiencing and factual information will be different. This information will also tell you how much urine your bladder will hold when it is ‘full’. You could record the information again over 3 days, at two monthly intervals. By doing this you can visualize your progress.

The purpose of bladder retraining is to increase your bladder’s capability for holding urine and to give you confidence in predicting your bladder’s behavior.

Re-training your bladder into a more acceptable timetable for you is not easy and takes dedication and time. It may take weeks or months to have any effect.

How can you re-train your bladder?
You need to resist the urge. When you feel the urge to go to the toilet to pass urine, don’t, hold on for 1 minute before you go. You will need to take your mind of the toilet and passing urine otherwise, the minute will seem unbearable – read a paper, watch TV anything to distract you.
As you become confident that you can hold on for 1 minute, increase the time delay to two minutes, gradually increasing the delay until, lets say that you currently visit the toilet every two hours, over the next few weeks and months, increase gradually to 2_ then 3 hours. Don’t attempt to resist the urge while you are away from a toilet, say when you are out shopping, you will need the confidence that you can get to the toilet without getting wet. Remember, bladder retraining takes time to take effect, persevere.

Pelvic floor exercises. Good pelvic floors muscles will increase your ability to ‘hold on’, giving you more confidence in your ability to remain dry. See the advice on pelvic floor exercises within the previous stress incontinence section. As well as the pelvic floor exercises, it is also advisable for you to contract your pelvic floor muscles when you are resisting the urge and, when you are getting to the toilet. Contracting your pelvic floor muscle as you feel the urge will help to relax your bladder allowing the to urgency pass.

If you do not see any improvement in your symptoms within 6 months or you have any concerns, contact your Continence Advisor or GP. Your local hospital will be able to direct you to your continence Advisor.

There are other causes and treatments of urgency and frequency that require detailed assessments by a qualified Health Professional. Please seek advice from your Continence Advisor or GP.