The Australian Physiotherapy Association’s women’s health physiotherapist Jenny Phillips tells us what to expect when seeking help from a physio for incontinence problems.
Incontinence, or poor bladder or bowel control, is a condition commonly associated with pregnancy, childbirth, menopause or a range of chronic conditions such as asthma, diabetes or low back pain. Urinary incontinence affects twice as many women as men, due partly to the reproductive health events unique to women. However, despite how common the condition is, it can still be embarrassing for many women to discuss.
Working up the courage to see someone about your incontinence can be hard, but knowing what to expect at your first appointment can help dissipate some of the worries you may have.
Physiotherapists who treat incontinence understand that these symptoms can be embarrassing and difficult to talk about. They are accustomed to discussing these issues and will try to put you at ease. All discussions you have with your continence physiotherapist will remain confidential and will be carried out in a private area so there’s no fear of being overheard. In some cases, your physio may need to communicate with other health professionals, including your GP – but they will ask your permission first.
In your first appointment, your physio will want to find out as much as they can about what you’re experiencing, so they can make an accurate diagnosis and know how best to help you. It can be helpful for you to know about the kinds of things they may want to ask about and the type of examination that may occur at your first appointment.
Before your appointment
Many continence physiotherapists will send out information before your first appointment. This may include:
- A questionnaire asking about various aspects of your bladder, bowel and sexual symptoms. This helps gain a thorough understanding of the extent of your problem and can be used as a reassessment tool as you improve.
- A bladder diary. This will chart your fluid intake (what you drink) and fluid output (how much and when you urinate) over two days. This can be very useful for diagnosing and reassessing the issue.
It can also be useful to think about what you might want to discuss with your physio, including:
- How long you’ve had the problem, and whether it’s improving or becoming worse
- What you’ve tried to do to improve things so far, and whether that’s helped
- Whether you have problems with your bladder, bowel, prolapse, sexual problems or maybe a combination of some - or all - of these issues
- Any past medical problems, including childbirth history and any previous operations.
How long will the appointment be?
Most physios who treat incontinence will allocate an hour for the first appointment. This allows them to get a thorough history of your problem and ask about all possible related concerns. Follow-up appointments will usually be 30-45 minutes.
What kind of questions will I be asked?
Your physio will ask you a number of questions to fully understand your problem. Some of the questions may seem unrelated to your incontinence. However, it is important to understand that the pelvic organs (the bladder, bowel, vagina and uterus) sit closely in the pelvis, and problems with one area can cause problems in adjacent organs as well. Your physio may ask:
- What is the problem that is bothering you the most?
- Some questions about your bladder function, including how often you go to the toilet during the day and night, if you leak urine (and if so, how much and how often), if you feel you have to rush to get to the toilet on time, and the kinds of symptoms you have when urinating, including any pain or feelings of incomplete emptying.
- About your bowel function, including how often you empty the bowel, whether you find this difficult or painful, the consistency of your bowel motions, any loss of control from the bowel or any sense of having to rush to get to the toilet on time.
- Questions about your childbirth history, including how many children you’ve had, the types of deliveries and the weight of the babies.
- If you have any symptoms of prolapse, including a feeling of something dropping internally or a heaviness, lump or bulging inside the vagina or rectum.
- Questions about sexual intercourse, including whether you find this painful or if you have any difficulties or concerns.
- About your medical history, including current medical problems, the medications you are taking and any past operations.
- What you do for work and in your leisure time, so they can understand how your problem may be impacting on your daily life.
- Your physio may also ask you what you already know about your pelvic floor muscles and their function. They will often provide you with information on this before performing an examination, so you understand where they will be examining and why.
What kinds of examinations will be performed?
When seeing a physio for incontinence, it is likely that at some stage they will need to examine your pelvic floor muscles. This will commonly occur at the first appointment, but not always. Your physio will always ask you for permission before performing any examination, and you have the right to say no. However, this may mean they cannot diagnose and treat your problem to their best ability, and they can discuss that with you.
A typical examination may include:
- An examination of the external genital area. While this may be uncomfortable for some, it is important for your physio to check the skin for signs of infection, age-related changes and prolapse.
- When performing an external examination, your physio may also ask you to try to contract the pelvic floor muscles, so they can see what happens from the outside in the vulva and your abdomen when you do this.
- An internal vaginal examination may be performed. Your physio will use one or two gloved fingers to check the pelvic floor muscles internally. They can also check for prolapse and any tender or tight areas internally. They will ask you to contract and relax the muscles several times. This will usually be done lying down, but sometimes your physio may ask to check these muscles while you stand or sit.
- A rectal examination may be performed instead of a vaginal examination if your main problem relates to bowel incontinence or a large tear resulting from childbirth. The physio will use one gloved finger to assess the pelvic floor muscles in the rectum. They will ask you to contract and relax the muscles several times.
- Sometimes your physio may check other things like your posture in standing and sitting, and the way you move.
- Some physios may check your pelvic floor muscles using real time ultrasound. They may either use a probe placed over your low abdomen, or over the outside of your perineum (between the vagina and anus) to check the pelvic floor muscles.
What kind of treatments might be suggested?
Of course, the types of treatment(s) your physio recommends will depend on your individual problem. However, common treatment options can include:
- A prescription of pelvic floor muscle exercises. Typically, these will be exercises to strengthen your pelvic floor or improve how well these muscles work when you cough, for example. Some women may be given exercises to learn to relax their pelvic floor muscles if their problem relates to the pelvic floor muscles being too tight or tense.
- Bladder training strategies may be used if you often get an urgent or frequent need to go to the toilet. These strategies are used to help you gain back better control over your bladder habits.
- You may be asked to do a bladder diary if you have not done one already.
- Modifying the amount and type of fluid you drink or modifying your diet and fibre intake can sometimes be recommended.
- Modifying various factors in your lifestyle may be recommended, such as the type of exercise you do or reducing heavy lifting. In many cases these modifications will be temporary until you can get better control over your incontinence.
- If you have a prolapse that is influencing your incontinence, some physios may offer to fit you with a support pessary to assist. This is a silicone device fitted inside the vagina. Your physio will discuss this with you if they think this might be helpful.
Questions you may have for your physio
You should never worry about asking too many questions of your physio! They’re there to help, and are happy to elaborate on areas you want to know more about. Some questions you might consider asking your physio are:
- What do you think my issue is?
- What has caused this issue?
- What kind of treatment will help me and how long will it take for things to improve?
- How many appointments will I need and how often?
- What can I do to help myself?
- If I don’t do anything, will my problem get worse or better by itself?