Up to 3.3 million Canadians experience urinary incontinence,1 defined as an “involuntary loss of urine that is a social or a hygienic problem.”2 If you watch cable television you will have seen countless advertisements for products related to incontinence. Seeing those ads, you may think that this was a common and expected outcome of aging; however, though incontinence is common, it is also highly treatable and should not be viewed as a “normal” part of life.
Incontinence can affect both women and men.
Among adults the prevalence of urinary incontinence ranges from 9.9-49.2%.3,4,5
10% of children aged 7 years old, 3% of 11-12 year olds, and 1% of 16-17 year olds are not dry at night.4
Urinary incontinence affects 10-15% of women who have never given birth.6
Among women who have given birth, the prevalence of urinary incontinence is 30% among those who delivered by caesarian section, and 40.2% among those who delivered vaginally.6
The costs of urinary incontinence
It has been estimated that Canadians spend $8.5 Billion each year in incontinence products, lost work productivity, and direct health-care costs related to incontinence.7 Then there are the non-monetary costs of incontinence which include:
Reduced quality of life
Distress, social withdrawal, and social disability
Avoidance of sex
Embarrassment, depression and other mental health concerns
Decreased general health due to withdrawal from physical activity5
Types of urinary incontinence
There are several types of incontinence including stress incontinence, urge incontinence, and mixed incontinence. Stress incontinence is leakage of urine with sneezing, coughing or on exertion.2 Urge incontinence is involuntary leakage of urine that is immediately preceded by a sense of urgency and a feeling of not being able to get to the washroom quickly enough.2 Mixed incontinence is a combination of both stress and urge incontinence.2 Stress incontinence is the most common type of incontinence, effecting an estimated 50% of incontinent women.5
Causes and risk factors
Urinary incontinence can be related to a number of underlying causes and contributing factors; however, in many cases weakness or dysfunction of the pelvic floor is a significant contributing factor.
Urinary incontinence is associated with a number of known risk factors for both men and women.
Pregnancy and child birth
ncreased baby birth weight increases risk6
Incontinence pre delivery doubles the risk of having stress incontinence postpartum5,6
Obese or overweight3,6
History of hysterectomy combined with high BMI3
Ethnicity (Caucasians are at higher risk)3
History of thyroid problems3
High blood pressure8
Despite its prevalence, incontinence has long been a taboo topic. In fact, research has estimated that only 15% of women who experience stress urinary incontinence have sought help from a health professional about the problem.5 The reasons for this low consultation rate may include social class, severity of the symptoms and their impact on quality of life, embarrassment, disinclination towards treatment options, and perceived lack of effective treatment.5
Incontinence is so common and not often discussed, which might explain all the advertising mentioned earlier. After all, some may choose to go to their local store and purchase a product rather than seeking treatment from a health-care provider, creating a lucrative industry for those who sell incontinence products. The choice to simply put up with incontinence and not seek active treatment ignores strong evidence that such treatment can reduce or eliminate symptoms and improve quality of life.
How can physiotherapy help?
Treatment for urinary incontinence should be patient-focused and address the person’s concerns in a way that they find acceptable.2 Treatment can include medication, biofeedback, surgery, and exercise. Less expensive or invasive than medications or surgery, exercise is a method that physiotherapists frequently use in the treatment of incontinence, and one that has been recommended as a key component of “first-line conservative management programs for women with stress and any type of urinary incontinence.”9 Increasingly, evidence also supports pelvic floor muscle training for men experiencing incontinence.2,5
Pelvic health physiotherapy (and particularly the internal examinations associated with it) is a basic restricted activity for physiotherapists. While any physiotherapist can develop their skills in this area and provide care, it is not a significant portion of entry to practice education. What this means is that if you are looking for a physiotherapist who can help with incontinence, pelvic pain, or other pelvic health related conditions, you should look for someone with additional training in this area of practice. Ask questions about their training and how they developed their skills.
The Canadian Continence Foundation. FAQs. Available at: http://www.canadiancontinence.ca/EN/frequently-asked-questions.php Accessed on February 14, 2017.
Abrams P, et al. Fourth international consultation on incontinence recommendations of the international scientific committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse and fecal incontinence. Neurourology and Urodynamics 2009; DOI 10.1002/nau
Minassian VA, Stewart WF, Wood GC. Urinary Incontinence in Women: Variation in prevalence estimates and risk factors. Obstetrics and Gynecology 2008; 111(2):324-331.
Buckley BS, Lapitan MCM. Prevalence of urinary incontinence in men, women, and children-Current evidence: Findings of the fourth international consultation on incontinence. Urology 2010; 76(2):265-270.
Imamura M, et al. Systematic review and economic modelling of the effectiveness and cost-effectiveness of non-surgical treatments for women with stress urinary incontinence. Health Technology Assessment 2010; 14(40): DOI10.3310/hta14400
Gyhagen M, Bullarbo M, Nielsen TF, Milsom I. The prevalence of urinary incontinence 20 years after childbirth: A national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG: An international Journal of Obstetrics and Gynaecology 2013; 20(2):144-151. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2012.03301.x/full Accessed on February 15, 2017.
The Canadian Continence Foundation. The impact of incontinence in Canada: A briefing document for policy-makers. Available at: http://www.canadiancontinence.ca/pdfs/en-impact-of-incontinence-in-canada-2014.pdf Accessed on February 14, 2017.
Markland AD, Goode PS, Redden DT, Borrud LG, Burgio KL. Prevalence of Urinary Incontinence in Men: Results from the national health and nutrition examination survey. The Journal of Urology 2010; 184(3):1022-1027.
Dumoulin C, Hay-Smith EJC, Mac Habée-Séguin G. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews 2014; 5. Art. No.: CD005654. DOI:10.1002/14651858.CD005654.pub3. Available at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005654.pub3/epdf/standard Accessed on February 15, 2017.