It is believed that up to 75% of women will experience some level of stress incontinence in their lifetime and while less common, you men aren’t immune; it can affect you too. While I’m presuming that most of you reading this blog know exactly what I’m talking about when I talk about stress incontinence, the official definition can be defined as the unintentional loss of urine while performing an activity that increases the stress on the body. That means that it can be anything from laughing, to sneezing, to jumping on the trampoline, to running. Or to put it simply; someone peeing themselves (even just a little bit) when they aren’t planning on it. 

Most people who suffer from stress incontinence will first visit their doctor about it. While it isn’t common to seek out manual therapy for this issue solely on its own, often patients may present with a related musculoskeletal symptom such as lower back pain, SIJ or pubic bone pain. Additional symptoms such as this are often considered an orange flag. What this means, is that while it may not be the priority of treatment, it helps add to the picture of what is going on within the musculoskeletal system as well as the within the internal organs, that is contributing to the incontinence.

There are numerous reasons and contributions as to why stress incontinence comes about such as:

  • Child birth
  • Prostate surgery
  • Abdominal/pelvic surgery 
  • Age
  • Body weight
  • Nutritional factors

How each of these factors can lead to stress incontinence is completely individualised to the person.

Let’s look at a different way outside of the standard treatment options, which could help address this issue. Typically, one of the first places to start would be accessing the range of movement around the abdomen and hips with the main priority on assessment of the pelvic floor. Assessment of the pelvic floor is complicated and often relies on verbal cues and feedback from the client. What we have come to learn though is that while you may be able to get a sense of activation in the muscles of the pelvic floor, it is possible to be activating all the muscles within the pelvis and abdomen without activation of these muscles, conversely resulting in making matters worse by reinforcing a bad habit in the way muscles are activated. The desired way of making sure that the pelvic floor is activated is by assessment and cued with real-time feedback via an ultrasound machine. Which is something we have handy here at the Lab (wink).

ultrasound

While we often look at using strength around the pelvic floor as a way of alleviating symptoms, another way of looking at further improving the way the body functions is by releasing the internal pressure within the abdominal cavity.

The bladder itself sits just above the pubic bone and goes down towards the pelvic floor and has visceral ligaments that attaches the structure to the other organs within the abdominal cavity. Often when we talk of ligaments, we think of ligaments within the musculoskeletal system (such as the ACL in the knee) which are structures made of highly dense connective tissue. Musculoskeletal ligaments connect bone to bone, whereas visceral ligaments connect organ to organ. How these structures slide and glide around one another can impact the way they both function, but can also impact how our muscles and hard structures move around them. 

Alongside improving how these structures move around one another, we can look at changing the internal pressure that is generated by effectively ‘lightening’ the load on the bladder from the downwards pressure that the weight of these organs have, but also the effects of gravity have on the pelvis and pelvic floor.

While this is a different way of approaching the issue of stress incontinence, we believe in looking at all areas of ones health to help improve symptoms and function. By incorporating different modalities into treatment, we can assure that no stone is left unturned and help the person get back to doing the things that they love without fear about movement…. or accidents. 

Luke McCallum is a Sports Lab Massage Therapist. He is passionate about recovery and how effective recovery can improve performance- whatever performance looks like to each of his clients.