Urinary incontinence is the involuntary loss of urine and is a common condition that affects ~30-50% of women at some point in their life, particularly during and after pregnancy, childbirth, and menopause. It can range from occasional leakage to more frequent and urgent episodes.

Types of Urinary Incontinence:

• Stress Urinary Incontinence (SUI): episodes of leakage with activities like coughing, sneezing, laughing, or exercise.

• Urge Urinary Incontinence (UUI): leakage due to a strong and sudden urge to urinate (void).

• Mixed Urinary Incontinence (MUI): a combination of both

Causes:

• Pelvic floor muscle weakness or overactivity

• Trauma/injury to the pelvic floor muscles, fascia and/or ligaments during childbirth

• Hormonal changes

• Ageing/pelvic floor de-conditioning

• Chronic conditions (constipation, obesity, diabetes, neurological disorders)

Pelvic floor physiotherapy is considered the first line of treatment for urinary incontinence. Treatment can involve pelvic floor muscle training, bladder retraining, lifestyle modifications, continence pessaries, or medical management.

Overactive Bladder (OAB) is when the bladder contracts or spasms abnormally and causes a strong and sudden urge to urinate. It can happen when you may not be ready to empty your bladder, when your bladder isn’t even full, or in response to learnt triggers e.g. arriving home, putting key in the door, or hearing running water.

Symptoms can include:

• Urinary urgency

• Increased voiding frequency

• Nocturia (voiding more than 1x at night)

• Urinary incontinence

OAB is diagnosed from a discussion about your history and symptoms, a pelvic floor exam, a bladder diary and ruling out the presence of bladder infections.

Pelvic floor physiotherapy treatment involves an individualised approach of management strategies including lifestyle modifications, optimising pelvic floor muscle function, and urge suppressant techniques.

If required, other medical management of OAB can include medication, botox, transcutaneous tibial nerve stimulation, sacral neuromodulation (bladder pacemaker), or surgery.

Voiding dysfunction refers to a range of conditions where there is poor coordination between the bladder and urethra and disrupts the ability to pass urine. This can be caused by neurological, anatomical, obstructive or infectious urinary tract abnormalities.

Symptoms include:

• Difficulty in emptying bladder

• Hesitancy when attempting to urinate

• Straining to urinate

• Slow, weak or stop/start urine stream

• Urinary urgency and/or frequency

• Dribbling of urine

The role of pelvic floor physiotherapy in treatment and management is to guide bladder retraining strategies and treat pelvic floor dysfunction such as down train overactive pelvic floor muscles, correct anatomical obstructions such as pelvic organ prolapse, and improve defecation dysfunction.

Other medical management strategies can include medication, botox, sacral neuromodulation, and self catheterisation.

Bladder pain syndrome (also known as interstitial cystitis) is a chronic paincondition that affects the bladder. The cause is unknown but it is often associated with other chronic pain syndromes such as persistent pelvic pain, endometriosis, fibromyalgia, vulvodynia, rheumatoid arthritis and irritable bowel syndrome.

Symptoms include:

• Pain, pressure or discomfort perceived in the bladder. Pain can also be perceived in the urethra, vulva, vagina and rectum.

• Can have urinary urgency

• Can have increased urinary frequency

• Pain with intercourse

Bladder pain syndrome is commonly associated with overactive and tight pelvic floor muscles. Pelvic floor physiotherapy can help to down train and release tight muscles to reduce pain and improve function as well as guide bladder retraining strategies. Treatment and management can also include assistance from a urologist, gynaecologist, dietician, psychologist, and pain specialist.