Pelvic Floor Dysfunction Causing Urinary Incontinence: Part 1

Picture this: you’re enjoying conversation with family and friends when someone tells a funny story that sends everyone in an uproar of laughter—you included. It’s a deep, uncontrollable, contagious laughter. You’re laughing so hard your sides begin to hurt, laughing so hard that… oops!! You just peed a little. “Oh well,” you think, “sometimes that happens when I laugh hard.”

Here’s another scenario: the kids are playing on a trampoline, urging you to join them in a game of popcorn. After a bit of coaxing, you decide, “oh sure, I’ll give it a try.” A few bounces builds confidence. Watching your kids fly higher and higher grows your ambition. You decide to give it all you’ve got to send them flying high in the air. You jump and then…oops!! It happened again.

The daily scenarios are endless but the result is nearly the same. The problem may or may not be overly obtrusive to daily life. Urinary incontinence, or the inability prevent urine leakage, can be occasional or persistent. It might frighten you to know that the frequency of occurrence may actually increase as time passes. If these scenarios sound familiar to you, then you may have urinary incontinence as a result of pelvic floor dysfunction.

Pelvic floor dysfunction or PVD is defined as, “the complaint of any involuntary leakage of urine.”(1) Stress urinary incontinence (SUI) is one of the few categories of PVD. SUI is defined as, “an involuntary leakage of urine upon stress or exertion”(1). The scenarios previously described are examples of stress urinary incontinence. Another type of PVD is urge urinary incontinence, which is defined as, “leakage of urine immediately proceeded by urgency.”(1).

Risk Factors for Pelvic Floor Dysfunction

Pelvic floor dysfunction including stress urinary incontinence occurs in approximately 27.4% of women postpartum (2). Factors that increase your risk of developing postpartum PVD include:

    1. Multiple births
    2. Instrumental births
    3. Long 2nd stage of delivery (greater than 1 hour)
    4. Perineal tearing
    5. Baby >4kg or 8.8 pounds (4)

However, PVD is not limited to only women with recent pregnancy. PVD can also occur in the elderly, post-menopausal women and even in female elite athletes. The highest prevalence of PVD occurs in elite athletes participating in trampoline, gymnastics, tennis, and track and field. (1).

What is Pelvic Floor Dysfunction?

urinary, incontinence, leakage, pelvic, floor
The above illustration is a gross simplification of what causes urinary incontinence. Activities that result in an increase in abdominal pressure cause a downward pressure (#1 – black arrows), which is conteracted by the muscles pushing back (#2 – red arrows). If #1 is greater than #2 leakage results.

So what is the pelvic floor and why does it have dysfunction? The pelvic floor is a group of muscles that act as a supportive sling for the uterus and bladder. There are three openings in the pelvic floor: the anus, vagina, and urethra. The muscles of the pelvic floor are constantly active to varying degrees, keeping the urethra (drainage tube from your bladder) closed (3). Knowing that your pelvic floor is in constant state of varying contraction to prevent leakage, it’s important to understand the function during activity. Deviation from ‘ideal’ function at the pelvic floor ultimately yields incontinence.

Increasing intra-abdominal pressure is accompanied with any activity that requires bearing down (i.e. sneezing, coughing, laughing, exercise, etc.). Downward pressure exerts a force on the bladder and the pelvic floor. Strength of the pelvic floor must be great enough to counteract the downward pressure to prevent leakage (2). With a normal resting pressure hovering around 100cmH2O even weakened muscles can prevent leakage; however, a cough increases downward pressure on the floor to 150cmH20. The increase in pressure must be combated by upward muscle force to keep the opening to the urethra closed.

Preventing or abolishing urinary incontinence as a result of pelvic floor dysfunction is fairly simple. It requires strengthen of specific muscles that counteract the downward pressure exerted as a result of daily life. Part two of this series will highlight strengthening exercises that can be used to prevent and improve pelvic floor dysfunction. Stay tuned!

References

1. Bo, Kari. Urinary Incontinence, Pelvic Floor Dysfunction, Exercise and Sport. Sports Med. Volume 34, issue 7. 2004. 451-464.
2. Serati, M et al. Prospective study to assess risk factors for pelvic floor dysfunction after delivery. Acta Obsetricia et Gynecologica. 87. 2008. 313-318.
3. Bo, Kari, Berghmans, B, Morkved, S, Van Kempen, Marijke. Evidenced Based Physical Therapy for Pelvic Floor Dysfunction Bridging Science and Clinical Practice 1e. Philadelphia, PA. 2007.
4. Pelvic floor first. Continence Foundation of Australia. http://www.pelvicfloorfirst.org.au/. Updated 2013. Accessed July 12th 2014.

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