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Incontinence and Overactive Bladder

Common but Not Normal - and Highly Treatable!

1/3 of women and 1/6 of men have incontinence, you are not alone! But you do not need to suffer!

Pelvic Health concerns fall into three main categories:

  1. Pelvic floor muscles that are too weak.

  2. Pelvic floor muscles that are too tight (overactive muscles).

  3. Any combination of tightness and weakness.

Types of Incontinence highly treatable with physiotherapy : 

1. Stress Incontinence: urine or fecal leakage when you cough/laugh/sneeze/jump/run/exercise etc...

2. Urge Incontinence - urinary or fecal leakage that occurs following a strong, uncontrollable urge to go to the bathroom.

3. Mixed Incontinence: a mixture of urge and stress incontinence. 

What is Pelvic Floor Muscle Weakness?


Weak pelvic floor muscles contribute to urinary and fecal incontinence, as well as pelvic organ prolapse.


When the pelvic floor muscles are weak, they need to undergo a structured strengthening program that includes more than just doing a few “kegels” at the kitchen sink or the stop light. These are often the instructions that men and women get from their health care practitioners. On the opposite side of the scale, patients are also told that they need to do up to 1000 repetitions per day, which has no basis in exercise science. 30 repetitions once/day is the scientific dosage. 


Doing kegles daily while the muscles are weak are the key part of the prescription for resolving pelvic muscle weakness. The long-term strategy, however, is very simple: once you are strong, completing two kegels post-void will keep you strong for the rest of your life.  Don’t do kegels while you are voiding.  This stop and start of the urine flow will impair your bladder contractions which are very important in emptying your bladder!

The Cochrane Collaboration 2010, and 2014 concluded that physiotherapists with specialized training in pelvic floor rehabilitation (using internal examination to teach the exercises) should be the first line of defense, before surgical consultation, for stress, urge and mixed incontinence in women.

Kegels are the mainstay of our approach as backed by research.  However, for kegels to be effective, an internal exam must be completed to teach men and women proper technique for engaging the pelvic floor muscles.  These muscles are tucked away inside, and you have to feel them to see if they are engaging properly.

When strengthening your pelvic floor with the guidance of a physiotherapist, the research shows that it is 80% effective. This means for every 10 patients that would be appropriate candidates for surgery (sling repairs, TVT) only 2 require surgery after physiotherapy treatment.

In Britain, the National Institute of Health (NIH) requires that every person considered for surgical correction of stress incontinence should first be seen by a pelvic health physiotherapist for conservative care. Only those that are not able to strengthen their pelvic floors sufficiently with exercise alone are then considered for surgery.

The evidence and research strongly supports this approach, especially with the potential negative effects of having a sling repair. Surgery should always be approached conservatively and carefully.

What is Pelvic Floor Muscle Tightness?


Many people with pelvic pain have pelvic floor muscles that are too tight, or overactive. The pelvic floor muscles are a group of muscles that attach to the front, back and sides of the bottom of the pelvis and sacrum. They are like a hammock or a sling, and they support the bladder, uterus, prostate and rectum. They also wrap around your urethra, rectum, and vagina (in women).

These muscles must be able to contract to maintain continence, and to relax allowing for urination and bowel movements, and in women, sexual intercourse.

When these muscles have too much tension (overactive) they will often cause pelvic pain, or urgency and frequency of the bladder and bowels. When they are weak (hypotonic) they will often contribute to stress incontinence and pelvic organ prolapse.

You can also have a combination of muscles that are too tense and too relaxed.

Overactive muscles can generally contribute to the following symptoms:

  • Urinary frequency, urgency, hesitancy, stopping and starting of the urine stream, painful urination, or incomplete emptying

  • Constipation, straining, pain during or after bowel movements

  • Unexplained pain in your low back, pelvic region, hips, genital area, or rectum

  • Pain during or after intercourse, orgasm, or sexual stimulation

  • Uncoordinated muscle contractions causing the pelvic floor muscles to spasm 

When your pelvic floor muscles are tight and weak, the tension is treated before the weakness. Once the muscles have reached a normal resting tone, and are able to relax fully, their strength is reassessed and pelvic floor strengthening exercises are prescribed if appropriate.

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