Many women suffer from bladder and gynaecological problems. Physiotherapy and minor lifestyle changes can help reduce symptoms. To find out more about your pelvic floor muscles, what can go wrong and what you can do to help, have a look at these short Pelvic Health Information videos.
Urinary incontinence is the involuntary loss of urine. This can be categorized into different types of urinary incontinence as described below:
Stress Urinary Incontinence
Stress urinary incontinence is when you leak urine when there is stress on the bladder. This can happen when you cough, sneeze, get up from a chair, run, lift something, laugh or during sexual intercourse.
What can you do?
- Find out more about stress incontinence in the Lothian patient information leaflet on SUI.
- Find out about your pelvic floor muscles and how to strengthen them by reading the POGP Pelvic Floor Exercises Leaflet.
- There are a number of pelvic floor training apps that you can download for free or you can purchase the NHS Squeezy App for a small fee which is a useful visual tool and exercise reminder.
- Read about physiotherapy treatment options here POGP Continence Leaflet
- IUGA SUI leaflet
Overactive bladder (also called irritable bladder)
There are three common problems experienced by people with Overactive Bladder.
Firstly you may experience urgency. This is when you need to go to the toilet suddenly and if you do not get there quickly enough, the bladder muscle starts to squeeze and you may leak urine.
Secondly you may experience frequency. This is when you need to go to the toilet a lot, but only pass small amounts of urine. It is normal to be going to the toilet to pass urine approximately every 2-3 hours, this is about 6-8 times a day.
Finally, you may experience nocturia. This is when you have to empty your bladder several times in the night. If you are over 65 then it is normal to get up to pass urine once in the night, if you are under the age of 65 then you should be able to go through the night without waking to pass urine.
What can you do?
- Find out more in the NHS Lothian /urgency overactive bladder leaflet
- Read about physiotherapy treatment options here POGP Continence Leaflet.
- Fill in this NHS Lothian Bladder chart to record information about your drinking and bladder habits.
- Follow the 6 Week Bladder Retraining Programme from the National Association for Continence.
- Fill in another bladder diary when you have finished it or just before your physiotherapy appointment to show us how well you have done.
- IGUA bladder training guide for women
Menopause
Please note, this is not something that we treat in isolation. However, as you read on, you may find that you are experiencing some urinary symtoms as a result of menopause, therefore you may be referred to our service because of this.
The menopause is a natural stage in a woman’s life when she stops having menstrual periods. This happens when the ovariesno longer release an egg each month and production of the hormone oestrogen declines.
Structures within the pelvic area for example, the vagina, vulva, urethra, bladder and pelvic floor muscle are all responsive to changes in oestrogen levels. Oestrogen is a hormone that increases blood flow to the tissues which gives them stretch; enables strength and helps produce healthy vaginal bacteria. Less oestrogen makes your vaginal tissues thinner, drier, less elastic and more fragile.
Each woman’s experience of the menopause is different. As hormone production by the ovaries start to reduce most women do experience some kind of symptoms, although the type and extent of these can vary widely.
These symptoms could be as follows:
- Vaginal dryness
- Vaginal burning or burning with urination
- Vaginal discharge
- Genital itching or pain
- Nerve pain in the vulva
- Bladder urgency and frequency
- Recurrent urinary tract infections
- Urinary incontinence
- Decreased vaginal lubrication during sexual activity
- Light bleeding after intercourse
- Discomfort with intercourse
- Vaginal heaviness and symptoms of prolapse
- Physical changes of the clitoris, labia, vagina, urethra and bladder
- Shortening and tightening of the vaginal canal
What can you do?
- Do regular pelvic floor exercises POGP booklet: Pelvic Floor Muscle Exercises (for women)
- Information on menopause from the POGP
- POGP booklet: Promoting Continence with Physiotherapy
- POGP booklet: Pelvic Organ Prolapse
- www.managemymenopause.co.uk
- www.menopausematters.co.uk
- www.rockmymenopause.com
- https://www.nhs.uk/conditions/menopause/pages/introduction.aspx
- www.menopausedoctor.co.uk
- https://thebms.org.uk
- www.menopausesupport.co.uk
- www.menopausedoctor.co.uk
- www.mymenopausalvaginal.co.uk
Urinary Tract Infections
This is not an area that we as physiotherapists directly treat. However, this often occurs in conjunction the some of the above urinary symptoms that we have discussed, such as overactive bladder or stress urinary incontinence.
A urinary tract infection is an infection that can occur anywhere along the urinary tract (waterpipe). Urinary tract infections have different names, depending on what part of the tract is infected. Most urinary tract infections are caused by bacteria such as E.coli that live in the colon (especially the rectum).
There are many different symptoms of a urine infection. In general, it is important to look out for changes in how often you pass urine; a change in sensation when passing urine or feeling unwell. You may feel pressure in the lower pelvis or lower back ache. There may be stinging, painful or frequent urination along with urgent need to urinate often with little or no urine being passed. Often there is need to urinate at night and the urine may also become cloudy or smell unpleasant. Blood in the urine and fever can also occur along with nausea, vomiting and chills indicating a severe infection.
If you are unable to pass urine; have pain or burning when passing urine; notice blood in the urine or if you are concerned that you have a urinary infection it is best to contact your GP or visit an urgent treatment centre as soon as possible.
What can you do?
- The international Urogynecological Association (IUGA) have information on urinary tract infections
- Pelvic health advice on a healthy bladder
- Read about physiotherapy treatment options here POGP Continence Leaflet.
- Information from The British Association of Urological Surgeons (BAUS) about bladder infections
Prolapse
Prolapse is a change in the vagina, where one, or a few, of the pelvic organs moves down into the vagina. It can feel like a heaviness or as if there is something coming down. You may notice a bulge inside or outside of the vagina.
What can you do?
- Find out more about prolapse and how to manage it in the NHS Lothian prolapse leaflet
- More detailed information can be found in the POGP Prolapse Information Leaflet
- Find out about your pelvic floor muscles and how to strengthen them by reading the POGP Pelvic Floor Exercises Leaflet
- Squeezy app Pelvic Health Information videos
Resources
NICE Guideline NG123
Urinary incontinence and pelvic organ prolapse in women: management
NICE Guideline CG148
Urinary incontinence in neurological disease: assessment and management
