By: Shannon Stoby, PT, MScPT

Being in control is comforting. Things are safe and predictable. We know what’s going to happen. We’ve got this. Any health issue can challenge our idea of the control we think we have, but perhaps the body’s most glaring indication of the lack of control is incontinence.

Whether a woman post-pregnancy, a man post-prostate surgery, or anyone who is ‘getting older’, the causes of incontinence are many, but the physical and mental outcomes are often the same—the loss of control and the loss of confidence.

As an adult with incontinence, you may lose your confidence to exercise, to travel, to engage in social situations due to uncertainty or fear of embarrassment. Often times, treatment recommendations may include medication, incontinence hygiene and support products, or even surgery. While these may offer some relief or be a way to cope, they may come with side effects and there seems little hope for actual resolution.

Pelvic floor physiotherapy can help. The muscles of the pelvic floor lie between your pubic bone and tailbone, front to back, and your sits bones side to side. Among the many nerves, vessels, and other organs, the bladder and rectum are also within the muscles and fascia of the pelvic floor. In some instances, the muscles may be overstretched and the reduced contractility can lead to the loss of control or some degree of prolapse may occur. In other cases, the muscles are tight, there are fascial restrictions, and the bladder may be unable to expand. In either instance, the muscles and structures are unable to appropriately respond to the usual cues. Regardless of the circumstances that lead to your incontinence, a proper assessment is important to determine the muscle tone of your pelvic floor, so treatment can proceed appropriately. Muscle tightness and fascial restrictions need to be addressed prior to strengthening for optimal function of the pelvic floor. Trying to strengthen muscles that are already tight is not going to yield the desired result, and can actually be counter-productive.

Pelvic floor physiotherapy involves internal assessment and treatment of the structures of the pelvic floor—vaginally for women, rectally for men. If this may seem outside of the comfort zone, think of it this way: your physiotherapist does not treat any other part of your body without seeing it, palpating it, and assessing it’s strength. The internal assessment is the gold standard of pelvic floor physiotherapy and guides the appropriate progression of treatment. I know it’s tempting to just quietly do the kegels like you researched on Google, but merely knowing the technique does not guarantee proper execution, nor does it mean that it is even the right treatment for you.

Although incontinence and the pelvic floor are not often talked about, the problems are very common. Unfortunately, the silence and embarrassment can also lead to depression and poor self-esteem; that loss of confidence can have widespread effects.

Regardless of your situation, incontinence does not have to be your ‘new normal’. Empower yourself by talking about it and seeking appropriate treatment. Regain control of your bladder and bowel to increase your freedom in the other areas of your life.