If you’ve ever experienced light bladder leakage with a laugh, found yourself squeezing your legs when you cough or sneeze, or found yourself rushing to the toilet with no time to spare, you’re not alone! Incontinence, the leakage of urine or poo, is more common than you think, with incontinence affecting up to 38% of Australian women! While there can be many types and causes of incontinence, we have listed the main ones below. 

Types of Incontinence

1. Stress Urinary Incontinence (SUI)
   If sneezing, coughing, or exercising results in a small leak, you might have stress urinary incontinence.

Why does it happen?

• Pelvic floor weakness: The pelvic floor muscles act like a hammock supporting the bladder and urethra. If they’re not strong enough, leaks can happen.
• Urethral sphincter weakness: The urethral sphincter is a muscle that closes around the tube where urine exits. If its weak it may not be able to hold urine in. 
• Urethral hypermobility: If the urethra, the tube where urine comes out, is not supported by a solid back stop, this causes it to move too much. Imagine trying to stop water flowing through a hose—it’s easier if the hose is stable on solid ground rather than bouncing on a flexible trampoline.

2. Urge Urinary Incontinence (UUI)
   This type of incontinence feels like a sudden, intense need to urinate, and sometimes leakage happens before you reach the toilet.

What causes it?

• Bladder muscle spasms: These can occur when the bladder wall contracts unexpectedly.
• Bladder sensitivity: Sensitivity of the nerve fibres in the bladder can make you feel urgent and may contribute to urge incontinence.
• Urethral sphincter issues: Just as in SUI above, the sphincter might not close tightly enough. Sometimes this can cause a feedback loop to the bladder muscle, causing the bladder muscle to spasm.
• Pelvic floor overactivity: Symptoms may be caused/ worsened by too much tension of the pelvic floor and pelvic floor muscles that ineffectively relax.

3. Mixed Incontinence
   Mixed incontinence combines symptoms of stress and urge incontinence above. You may experience larger leaks with stress incontinence and bladder urgency.

•         Causes can be any one or combination of the SUI or UUI causes above.

4. Fecal Incontinence
   Fecal incontinence refers to leakage of stool, which can vary from minor smearing to larger accidents.

Why does it happen?

• Weak pelvic floor muscles: These muscles help maintain bowel control.
• Severe constipation: A buildup of stool can cause softer stool to seep around the blockage.
• Anal sphincter weakness or trauma: Previous injuries, such as childbirth trauma, may weaken the circular muscles around the anus.
• Incomplete bowel movements: The rectum is the place where poo goes, just before it exits the body. This part of the bowel is not for storage of poo- Its purpose is to let you know it’s time to go to the bathroom! If you do not completely empty your rectum you are at risk of further leaks! 

5. Flatal Incontinence
   Flatal incontinence is the involuntary release of gas or wind.

Why does it happen?

• Weak anal sphincter muscles: These muscles may not close tightly enough to retain wind
• Pelvic floor dysfunction: If the pelvic floor muscles are not coordinating well, or strong enough, they may fail to provide adequate support to the anal sphincter.
• Previous trauma: Childbirth injuries or surgeries in the area can sometimes affect the anal sphincter.
• Constipation or poo in your rectum: Its more difficult to control wind if you are constipated or have poo in your rectum!
• Dietary causes: If you produce larger amounts of flatus, it will naturally be harder to control!

6. Coital Incontinence
   Coital incontinence refers to involuntary leakage (usually of urine) during sexual activity. This usually either occurs with penetration or orgasm.

What causes it?

• Pressure changes: This can be a similar cause to stress incontinence and can caused by changes in pressure
• Prolapse and/or weak urethra sphincter muscles: It can be related to a combination of front wall prolapse and weak urethral sphincter muscles- when the bladder position is improved, its much more difficult to hold onto a larger amount of urine!
• Bladder spasms or urgency: Leakage with orgasm is often linked to urge urinary incontinence

 

If you feel like you have any of the above, seeing a pelvic floor physio or your GP is a great place to start! 

Pelvic floor physiotherapy offers evidence-based, non-invasive strategies to address the root causes of incontinence. Here’s what you can expect during a session with a pelvic floor physiotherapist:

1. Thorough Assessment: Your physio will firstly take a detailed pelvic floor and symptom history. They will then usually recommend an examination (with your consent) to check your pelvic floor strength and function and to check for prolapse, pain or other contributors.
2. Targeted Treatment Plan: Depending on your needs, your physio might recommend:
   • Strengthening or lengthening pelvic floor muscles.
   • Bladder or bowel retraining strategies.
   • Diet and hydration adjustments to support optimal bowel and bladder function.
   • Pessary insertion (where indicated), for better support of stress urinary incontinence
   • And much, much more!

Any questions? Please don’t hesitate to reach out!

Would you like more information on our incontinence appointments? See the following links!

Bladder Symptoms | Bowel Concerns | Pessary