Urinary incontinence – causes, treatment, how does physiotherapy help?

Urinary incontinence is a common condition that affects over 2 million people in Poland. Women are more prone to this condition (25–45%), but it also affects men (10–15%). Many people avoid visiting the doctor because they are embarrassed, which means that the problem is often underestimated. Ignoring the symptoms can lead to their worsening, so early diagnosis and appropriate help can significantly improve quality of life and prevent the condition from developing further.

There are several basic types of urinary incontinence:

• Stress urinary incontinence (SUI)
  This is the most common type of urinary incontinence in women, occurring in about 50% of cases. It manifests itself as urine leakage as a result of increased pressure in the abdominal cavity, e.g. when coughing, sneezing, running or lifting heavy objects. Stress urinary incontinence can be the result of weakened pelvic floor muscles, which often occurs in people who train intensively, e.g. at the gym or running.

• Urge incontinence (IUI)
  This is characterised by a strong, sudden and difficult to control urge to urinate. The incidence of urge urinary incontinence increases in women after the menopause.

• Mixed urinary incontinence (MUI)
  This is a combination of stress and urge symptoms that occur simultaneously, significantly impairing daily functioning. People with mixed urinary incontinence experience both urine leakage when abdominal pressure increases and an uncontrollable urge to urinate.

Each of these types of urinary incontinence requires an individual approach to diagnosis and treatment, as they differ in their causes, symptoms and severity. Depending on the type, treatment for urinary incontinence may include lifestyle changes, drug therapy, physiotherapy or surgery. Proper diagnosis allows for effective treatment, which improves patients’ quality of life.

Urinary incontinence is a health problem that affects both women and men, although the causes and mechanisms may differ depending on gender. In women, it is most often caused by weakening of the pelvic floor muscles after pregnancy and childbirth, but it can also be related to menopause, hormonal disorders, obesity or prolapse of the reproductive organs. In men, urinary incontinence is often the result of prostate problems, such as benign prostatic hyperplasia (BPH), or following surgery, such as prostate removal. In both cases, early diagnosis and appropriate treatment can significantly improve patients’ quality of life.

Women

• Pregnancy and childbirth – during pregnancy and after childbirth, the anatomical structure of the urinary tract changes. A decrease in pelvic floor muscle tone and physiological hormonal changes can lead to urinary incontinence, especially stress incontinence.
• Menopause – as a result of a decrease in oestrogen levels, the pelvic tissues become more flaccid, which can lead to weakening of the muscles responsible for supporting the bladder.
• Chronic urinary tract infections – especially in the case of recurrent infections, can lead to bladder irritation and cause a feeling of urgency, and in extreme cases, urinary incontinence.

Men

• After prostate surgery – Surgical procedures involving the prostate (e.g., prostatectomy) can damage the nerves or muscles responsible for controlling the bladder, leading to urinary incontinence. This is particularly common after prostate removal surgery to treat prostate cancer.
• Chronic prostate conditions – prostate problems, such as benign prostatic hyperplasia, can affect bladder function, leading to urinary incontinence, especially in cases of urinary retention and inability to empty the bladder completely.

Both sexes

• Neurological disorders – conditions such as multiple sclerosis, Parkinson’s disease or spinal cord injuries can interfere with bladder control, leading to incontinence.
• Chronic cough (e.g. as a result of smoking) – people who suffer from chronic coughing put frequent strain on their pelvic floor muscles, which can lead to abnormal tension and difficulty controlling the bladder.
• Obesity – excess body weight increases pressure on the bladder and pelvic floor muscles, which can lead to weakened function and urinary incontinence.
• Ageing – with age, muscles and connective tissues can lose elasticity, which contributes to urinary incontinence.
• Chronic diseases (e.g. diabetes) – especially when poorly controlled, can lead to nerve damage, which in turn can cause urinary incontinence. Men may also experience erectile dysfunction, which affects the functioning of the urinary system to some extent.
• Pharmacological treatment – certain medications, such as antihypertensive drugs, diuretics and sedatives, can lead to increased urine production or make it difficult to control the bladder.

Urogynaecological/urological physiotherapy is the first-line treatment for urinary incontinence in women and men. It mainly involves pelvic floor muscle exercises and bladder training, which improve control over urination and reduce symptoms. Depending on the patient’s needs, the goal may be to strengthen weakened muscles or relax overly tense muscles. With appropriately selected physiotherapy techniques, patients under the care of a specialist can regain bladder control and significantly improve their quality of life.

• Pelvic floor muscle exercises (Kegel)
  These exercises strengthen or relax the muscles responsible for supporting the bladder and urethra, promoting their proper functioning. Regular pelvic floor muscle exercises improve muscle tone, which helps to manage stress urinary incontinence. They are also recommended for men, especially after prostate surgery, to prevent uncontrolled urine leakage.
• Biofeedback and electrostimulation
  Biofeedback allows patients to monitor their pelvic floor muscle tension in real time. This makes it easier to learn how to tense and relax these muscles correctly. Electrostimulation, on the other hand, involves the use of electrical impulses that cause the pelvic floor muscles to contract and support the improvement of their function.
• Respiratory and postural therapy
  Proper breathing and posture support the work of the pelvic floor muscles. Disorders in these areas can cause tension, weakness, and coordination problems, which affect stabilizing functions. Breathing exercises using the diaphragm relax the pelvic structures, improve flexibility, and regulate abdominal pressure. Posture correction ensures optimal alignment of the pelvis, spine, and chest, facilitating cooperation between the diaphragm, deep muscles, and pelvic floor.

Urinary incontinence is an embarrassing condition, but in many cases it can be effectively treated. One simple and safe method involves appropriately selected pelvic floor muscle exercises, which strengthen weakened muscles or relax overly tense muscles.

People with urinary incontinence – whether stress incontinence, postpartum incontinence, or incontinence occurring after prostatectomy or during menopause or andropause – are invited to take advantage of the medical program prepared by specialists at the NAMI Medical Resort and Clinic in Sopot. The urological and urogynecological program combines comprehensive diagnostics, daily therapy, regeneration, prehabilitation, and rehabilitation, as well as education to support patient health.

NAMI Medical Resort and Clinic exclusively offers medical programs.