Urinary Incontinence: why it happens and how Physiotherapy restores your confidence
Have you ever avoided leaving the house because you were afraid you wouldn’t reach the bathroom in time? Or stopped yourself from laughing freely because you were worried about leaking urine? If so, you are not alone, and there is a solution.
At Bwizer Health, we work every day with people who silently suffer from urinary leakage. That is why we created this clear and straightforward guide to help you.
Urinary incontinence (UI) is more common than many people realise and can significantly affect daily life, confidence, and even social and intimate relationships. Although it is more frequent in women, UI also affects men, particularly after prostate surgery. Nevertheless, it is often a topic that is “pushed into silence” due to embarrassment, normalisation (“it’s just age”, “it’s because of childbirth”), or lack of information.
The good news is that, in many cases, physiotherapy is a first-line approach with high effectiveness, especially when the intervention is based on an appropriate assessment and a well-structured treatment plan.
The fundamental role of the Pelvic Floor
The pelvic floor is a group of muscles and structures that functions like a “network” at the base of the pelvis. It performs crucial functions:
- Support: Helps support the pelvic organs, including the bladder, intestines and rectum, as well as sex-specific reproductive organs (such as the uterus and vagina in women, and the prostate and adjacent structures in men), contributing to the stability and appropriate positioning of these structures.
- Continence: It is essential for maintaining continence (urinary and faecal), in coordination with the sphincters.
- Sexual Function: Contributes to sexual function (sensitivity, lubrication and orgasmic capacity).
- Stability: Participates in lumbopelvic stability, as part of the core system that stabilises the spine and pelvis.
When this area loses strength, coordination, endurance, or experiences changes in muscle tone, symptoms such as UI may appear.
Types of Urinary Incontinence
UI is not “just one thing”. The main types are:
- Stress urinary incontinence: Characterised by urine leakage associated with physical effort, such as coughing, sneezing, laughing, running, jumping or lifting weights.
- Urge urinary incontinence: Urine leakage occurs alongside a sudden and intense urge to urinate that is difficult to postpone.
- Mixed urinary incontinence: Occurs when both stress and urgency characteristics are present in the same person.
Why does UI happen? Causes and Risk Factors
UI can have multiple causes, including:
- Anatomical and Structural Factors: Changes in the support of the pelvic organs.
- Hormonal Factors: For example, changes associated with menopause, where reduced oestrogen levels may contribute to decreased tissue elasticity and alterations in tissue quality.
- Pregnancy and Postpartum: During pregnancy, there is an increased load on the pelvic floor and hormonal changes (such as relaxin) that influence tissues and stability. All of this may increase vulnerability to dysfunction.
- Post-surgical situations: For example, in men following prostatectomy and in women after gynaecological surgeries (such as hysterectomy).
- Other factors may include neurological or pharmacological causes.
The Impact on Quality of Life
UI can have a significant impact on several aspects of life:
- Psychological consequences: It may cause anxiety, embarrassment and loss of confidence.
- Impact on sexuality: It affects intimate relationships and self-esteem.
- Functional limitations: It may lead people to avoid physical exercise, travel or social activities.
- Socioeconomic impact: It may generate costs and, in some cases, absenteeism.
How Physiotherapy helps with UI: First-Line Treatment
Physiotherapy is a first-line treatment for UI, with high effectiveness, particularly through:
- Pelvic Floor Muscle Training (PFMT): Specific training designed to improve the strength, endurance and control of the pelvic floor muscles.
- Biofeedback: A tool that helps individuals understand and optimise muscle activation, being particularly useful for those who struggle to identify the correct contraction.
- Behavioural Changes: Personalised guidance for daily life, according to individual assessment.
In some cases, advanced physiotherapy approaches may also be used, and when necessary, a multidisciplinary approach is recommended (for example, when pelvic pain, sexual dysfunction, relevant psychosocial factors or other associated conditions are present).
Prevention: What does it mean in practice?
UI prevention can be approached at three levels:
- Primary prevention: Reducing the risk before the problem develops through education and healthy habits.
- Secondary prevention: Early detection and prompt intervention to prevent worsening of the condition.
- Tertiary prevention: Reducing the impact and preventing further deterioration when UI is already present, through treatment and follow-up.
This reinforces the importance of education, early detection, and seeking specialised help without waiting for symptoms to “get much worse”.
When should you seek help?
1. When it is worth scheduling a Pelvic Physiotherapy assessment
A specialised assessment is recommended whenever symptoms affect comfort, performance or daily routine, such as:
Urine leakage, urgency that is difficult to control, or increased urinary frequency
A feeling of heaviness, pressure or pelvic instability
Pelvic, lower back or abdominal pain, or pain during sexual activity
Changes following events such as childbirth, surgery, periods of increased physical load or hormonal transitions
Difficulty returning to physical exercise without discomfort
Changes in bowel function or a sensation of incomplete emptying
Any change that makes a person feel that “their body no longer responds as it used to”
2. When a faster medical assessment may be justified
Some signs require medical assessment to rule out underlying conditions and determine the safest approach:
- Blood in the urine
- Recurrent urinary tract infections or episodes accompanied by fever
- Significant difficulty initiating or completing bladder emptying
- Severe, sudden or progressively worsening pelvic pain
- Neurological changes (strength, sensation, sphincter control)
- Persistent faecal incontinence
- Relevant changes following pelvic surgery
- Unexplained weight loss associated with pelvic symptoms
If you identify with any of these symptoms, take the first step. At Bwizer Health, assessment is the beginning of change.
Book your appointment now: Bwizer Health | Physiotherapy and Clinical Pilates
References
Mittal RK, Bhargava V. Anatomy and physiology of the pelvic floor. Gastroenterology Clinics of North America. 2008;37(3):585-596.
Mazur-Bialy AI, et al. Pelvic Floor Muscle Training as a Method for Prevention and Treatment of Urinary Incontinence - A Systematic Review. Journal of Personalized Medicine. 2023;13(12):1625.
Rosenbaum TY. Pelvic floor involvement in male and female sexual dysfunction and the role of pelvic floor rehabilitation in treatment. Clinics in Geriatric Medicine. 2007;23(3):643-658.
de Lira GHS, et al. Effects of pelvic floor muscle training with or without biofeedback and electrical stimulation in the treatment of urinary incontinence: a randomized controlled trial. Clinics. 2019;74.
Cohen D, et al. The Role of Pelvic Floor Muscles in Female Sexual Function and Dysfunction. Sexual Medicine Reviews. 2016;4(1):75-85.