Have you ever wondered, what the magic muscles are that stop you from voiding (peeing your pants) when you are busting, jumping or simply suffer a fright? Well think yourself lucky, some people (more commonly women) are unable to control when and where they go to the toilet, leaving them in quite the social, practical and emotional predicament.
Urinary stress incontinence (USI) involves involuntary leakeage related to activity. It is a common problem, and is believed to affect between 4-35% of people (Luber, 2004). Well since you have read this far, I believe you have earned the names of the aforementioned ‘magic muscles’. They are the coccygeous and levator ani muscles which form a hammock, holding all the precious visceroabdominal organs inside your body, as can be seen in the image below:
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| Pelvic Floor Muscle Hammock |
This collection of muscles is known as the pelvic floor and is vitally important for internal support, helping to prevent the descent of the bladder neck during rises in intra-abdominal pressure. Another vital function performed by the pelvic floor muscles (PFM) involves the occlusion of the urethra, which helps prevent embarrassing situations, placing such great responsibility on such little muscles.
Well it seems most of the time my pelvic floor is functioning at full capacity, and for that I am grateful, however some people are not so fortunate. There are many factors affecting pelvic floor function, with the most prevalent disruptor being a common and rather traumatic event known as childbirth. It not only can cause mechanical damage to the PFM in the order of muscle tears, but neural damage may also occur to nerves originating from spinal segments S2 & S3. These disruptions lead to the development of urinary incontinence and is reported to be as high as 22% in women after a vaginal delivery (Baessler et al., 2008).
Obesity is a growing problem amongst the western population, and with an increase in body mass index (BMI) there is a proportional rise in intravesical pressure. This can potentially decrease the continence gradient between the bladder and the urethra, amplifying the chance of leakage with exercise (Luber, 2004).
Other conditions with the possibility of disturbing the PFM include having a:
Other conditions with the possibility of disturbing the PFM include having a:
prostatonomy, hormone imbalance or chronic constipation (Baessler et al., 2008). Well seeing as there are a wide variety of contributing factors, I am going to look into what treatments are available and how I could help someone experiencing this situation.
REFERENCES:
Baessler, K., Schussler, B., Burgio, K. L., Moore, K. H., Norton, P. A., Stanton, S. L. (2008). Pelvic Floor Re-education. Springer. London.
Luber, K. M. (2004). The Definition, Prevalence, and Risk Factors for Stress Related Incontinence. Reviews in Urology. 6(3): S3-S9.
A good simple and clear introduction. Some additional info here (or later) would be that, given muscle weakness is the problem, it is not illogical for physiotherapists to be involved in its management. Also that the proper term for the specific condition is genuine stress incontinence, because there are other types of incontinence that require other approaches to treatment. Learning all the time....CY
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