Women’s Health

Bladder Issues

STRESS INCONTINENCE:

Do you leak when you cough, sneeze, laugh, jump, run or go on the trampoline?

Stress incontinence is more common in women than men and is mainly caused by weakness of the pelvic floor but in some cases, it may be caused by overactivity of the pelvic floor muscles.  Note it is common, but not normal.  You should never leak, not even a little bit.

Stress incontinence may occur due to pregnancy and childbirth (especially if you have had an assisted pregnancy or multiple pregnancies), chronic straining on the toilet or a chronic cough.  We would most commonly see women attend following childbirth or after menopause.  The first thing we do is to check that you can do a pelvic floor contraction correctly (50% of women can’t) and then we will give you a programme to get the muscles back working again.  This will involve a home exercise programme or we may use biofeedback or a muscle stimulator.

OVERACTIVE BLADDER:

• Do you have to rush to get to the toilet on time?
• Do you sometimes not get there on time?
• Do you go more than seven times a day?
• Do you get up more than once a night to go to the toilet?
• Do you know where every toilet in town is?
• Do you get the urge to pee when you put the key in the door?

These are all signs of an overactive bladder and happen when there are involuntary contractions of the bladder muscle.  In other words, the bladder muscle contracts to empty your bladder at a time when it is not convenient and you can’t switch off the sensation in the way you previously could.  If the contraction is very strong, it may squeeze out some urine on the way to the toilet.  The leaks with an overactive bladder tend to be quite large.  

People with overactive bladders often empty their bladder ‘just in case’ so go to the toilet more than seven times a day (four to seven times is normal).  Caffeine can exacerbate the issue as it acts as a bladder muscle stimulant.

Treatment for an overactive bladder will always start with a bladder training programme.  We may ask you to fill out a bladder chart so we (and you) get the full picture of what is happening.  It is important to strengthen the pelvic floor muscles if they are weak as they can help you hold on.  We will advise on caffeine and other fluid intake.  We may advise that you use a muscle stimulator.  Medications can be helpful in some cases and we will refer you to your G.P. if we think that would be appropriate.

If you have any of the above symptoms, please make an appointment to see and she will help you get dry.

Useful Links:
www.iuga.org – lots of patient information leaflets
www.continence.ie – Continence Foundation of Ireland

Pelvic Pain in Women

Pelvic girdle pain usually refers to pain in the pelvic area during pregnancy but it can occur at any time.  Vaginismus is a condition caused by spasm of the pelvic floor muscles.  Vulvodynia is pain in the external genitalia and dyspareunia is pain during or after intercourse.

There are many causes such as having overactive pelvic floor muscles, pregnancy, mesh surgery, endometriosis, haemorrhoids, fissures, scarring and nerve damage.  It is important that you are fully assessed to ascertain the cause or causes of the pain.

Treatment will usually consist of:

• training the pelvic floor muscles (maybe strengthening, maybe downtraining them if they are overactive)
• strengthening hip and tummy muscles
• soft tissue techniques
• defaecation techniques
• scar mobilisations
• biofeedback
• muscle stimulation
• advice

So help is available. Make an appointment to see Linda if you are suffering from pelvic pain.