If you suffer from incontinence, you’re not alone.
In fact, the Canadian Continence Foundation estimates 10 per cent of the population — or roughly 3.5 million Canadians — struggle with incontinence on a regular basis.
It can happen when you laugh, run or jump, and it’s almost always embarrassing and uncomfortable. The good news is, there are ways to treat it — and it starts with your pelvic floor.
“That’s a bowl of muscles, essentially, that sits at the base of your abdomen,” said Céleste Corkery, physiotherapist at the Toronto Academic Pain Medicine Institute.
“Your pelvis is a bowl-shaped group of bones, and your pelvic floor sits in the middle.”
A critical part of the human body
You might not know it, but your pelvic floor is responsible for several bodily functions. Perhaps most importantly, it stops your organs from “descending,” said Corkery.
“It also has a sphincteric function, which is essentially for continence, so being able to hold our urine and stool,” she said.
It’s integral for sex.
“Some of the muscles, especially the more superficial muscles, they work to help us achieve erection and orgasm,” Corkery said. “Both penis erection and clitoris erection.”
And it has a stability function, “where it contracts in conjunction or in co-ordination with our diaphragm, our abs and our back muscles,” she said.
“It’s able to harness inter-abdominal pressure that way so that we can do some heavy lifting.”
The pelvic floor is a key part of your body — it even plays a part in circulation — so when it doesn’t work, it’s important to figure out why.
The ways it can malfunction
Unfortunately, a lot of things can go wrong with your pelvic floor.
“It can be weak … It can be weakened and lengthened, it can be too tense, and it can be too tense and also leak,” said Corkery.
“Sometimes, it’s that our system isn’t doing a very good job of connecting to it. There may be some strength there, but we’re having a hard time actually engaging it.”
The pelvic floor can also struggle with timing, Corkery said.
“When we cough or sneeze or laugh, the pelvic floor needs to contract at the right moment so that pressure that’s being created in our abdomen doesn’t push down.”
It’s when there’s pressure in the abdomen that pushes down and the pelvic floor doesn’t contract that you experience leaking.
Incontinence is the most common symptom of these pelvic floor issues, and it can be experienced in two main ways.
The first, Corkery said, is “stress incontinence related to pure weakness.” This is leaking with laughing, running and jumping.
The second type is urge incontinence, usually associated with tension.
“That tends to be the feeling of, ‘All of a sudden, I have to go and I have to go now,'” she said.
In this scenario, it’s typically difficult to get to the bathroom in time and when you do urinate, there’s not very much volume.
Causes of malfunction
Surgery and giving birth are two of the most common ways people come to experience pelvic floor malfunction.
Lynda McClatchie, registered physiotherapist and clinic director at Elevation Physiotherapy, sees a lot of men after they’ve had prostate surgery.
Incontinence is a major side effect, but so is pain.
“Pain can be a really telling factor because some might experience pain without actually having incontinence,” she said.
This can include pain during urination, pain during sex or a general dull, aching pain at random points throughout your day.
How to strengthen your pelvic floor
If you’re experiencing any of the aforementioned issues, said McClatchie, you might want to consider seeing a pelvic physiotherapist.
“It would be fair to say that many people do not engage the pelvic floor properly,” she said. “For anybody interested in getting to work on their pelvic floor, at least have a pelvic physiotherapist look once.”
The assessment is not long or involved, but it will give you a good sense of what you need to strengthen, and ways to do that.
Kegels are a key exercise used by physiotherapists like McClatchie.
That involves engaging the muscles in your pelvic floor in a repeated motion and on a regular basis.
“Imagine a ping pong ball sitting right outside your vagina, and you want to lift it in,” she said.
If you were to see a pelvic physiotherapist, you would be given an internal assessment to see “how your pelvic floor engages” and to determine your “strength, endurance and control.”