Urinary incontinence /leaking or weak bladder, or a lack of bladder control is not something people shout about yet it’s actually one of our major health concerns. It can prevent women from exercise, cause issues in their sex lives and can if unchecked, lead to discomfort and pelvic pain
Diastalis Recti Abdominis is a major cause of urinary incontinence. Here we will chat about what you can do to get back on track.
First, here are some statistics we picked up from the Continence Foundation of Australia.
- Urinary incontinence affects up to 37% of Australian women (Australian Institute of Health and Welfare report, 2006).
- 65% of women sitting in a GP waiting room report some type of urinary incontinence, yet only 31% of these people report having sought help from a health professional (Byles & Chiarelli, 2003: Help seeking for urinary incontinence: a survey of those attending GP waiting rooms, Australian and New Zealand Continence Journal).
- An Australian study found that over a three month period, 50% of women aged 45-59 years of age experienced some degree of mild, moderate or severe urinary incontinence (Millard, 1998: The prevalence of urinary incontinence in Australia, Australian and New Zealand Continence Journal).
For Women there are two main causes of urinary incontinence in women is age and pregnancy. Why is this?
The bladder is supported by ligaments and muscles in the pelvic region. While these are strong and healthy the bladder stays in position and can ‘contain’ the urine inside. However if there is a weakness in the support system the bladder will start to leak. During pregnancy the main abdominal muscle (the rectus abdominis) separates to allow space for the baby. By the third trimester 100% of women will have diastalis rectus abdominis(DRA) This is a normal part of pregnancy. However if the muscles do not ‘knit’ back securely then they are left with a weakened support system which leads to a lack of of intra-abdominal pressure to stablise the pelvis and lumbar spine.
Left untreated DRA will impact the urethral positioning and lead to incontinence. It may also lead to pain.
It does not necessary occur straight after delivery and in fact some women are ok after the birth but find they have ‘leaking’ problems later on. Studies show that more than half of the women diagnosed with DRA are in the 50s’ and beyond.
The age factor is to do with the menopause. Pre menopause our high oestrogen levels keep our muscles and ligaments stronger. When the oestrogen drops the muscles of the pelvic region can weaken leading to an inability to ‘hold’ up the urine. Dribbling or leakage can occur when coughing or sneezing.
What should a woman do?
First a woman should have her pelvic floor and abdominal muscles assessed by a women’s health physiotherapist. Gold standard is with a real time ultrasound. The ultrasound can accurately determine the level of damage. This can be done at ben&biao. Julie Chu, our in house physiotherapist will measure the inter-recti distance and confirm if there is a diastalis recti that needs treating.
If there is a diastalis recti Julie will determine if it can be treated by specialist muscle training or if surgical intervention should be considered
If there is no diastalis recti but there is age related weakness Julie can also determine the level of treatment required. Physiotherapy as well as acupuncture, moxibustion and Chinese herbs are offered at the clinic. The evidence supporting the use of acupuncture and moxibustion for urinary incontinence is below.
If you are having urinary continence issues and would like to know more – please book in for a session with Julie Chu, our physiotherapist, [BOOK NOW] who has advanced training in women’s health and 20 years experience. Julie can provide an ultra sound assessment and treatment plan.
*The evidence for acupuncture and moxibustion in urinary incontinence
Animal studies have shown that acupuncture treatment may specifically be of benefit in people with urinary incontinence by:
- decreasing the expression of c-Fos in the brain. Induction of stress urinary incontinence in rats has been shown to increase expression of c-Fos (Chung 2008).
- controlling nitrergic neurotransmitters in order to increase nitric oxide levels in bladder tissue, thus relaxing smooth muscle and allowing increased bladder capacity (Chen 2006).
There are systematic reviews for acupuncture in two particular instances of urinary incontinences: post-stroke (Thomas 2008) and bed-wetting in children (Bower 2005). Both reported consistently positive results but the poor quality of the component trials allowed only tentative conclusions. A general review found acupuncture to be the only CAM therapy with evidence of benefit (Hartmann 2009). Individual trials for a variety of types of urinary incontinence (urge, stress, diabetic, post-hysterectomy, post-stroke) have largely positive outcomes across a range of acupuncture interventions and control groups (Engberg 2009; Tang 2009; Kim 2008; Tian 2007; Yi 2008; Liu 2008; Yun 2007)
- Bower WF et al. Acupuncture for nocturnal enuresis in children: a systematic review and exploration of rationale. Neurourol Urodyn 2005; 24: 267-72.
- Chen YL et al. [Effects of electroacupuncture treatment on nitrergic neurotransmitter in bladder neck and detrusor of rats with unstable bladder] (Article in Chinese). Zhong Xi Yi Jie He Xue Bao 2006; 4(1): 73-5.
- Chung IM et al. Effects of acupuncture on abdominal leak point pressure and c-Fos expression in the brain of rats with stress urinary incontinence. Neurosci Lett 2008; 439(1): 18-23.
- Engberg S et al. The efficacy of acupuncture in treating urge and mixed incontinence in women: a pilot study. J Wound Ostomy Continence Nurs 2009; 36: 661-70.
- Hartmann KE et al. Treatment of overactive bladder in women. Evid Rep Technol Assess 2009; 187: 1-120.
- Liu ZS, Du Y. [Evaluation of the curative effect of electro acupuncture on post-apoplectic urinary incontinence](in Chinese). Zhen Jiu Tui Na Yi Xue 2008; 6/2: 97-8.
- Kim JH et al. Randomized control trial of hand acupuncture for female stress urinary incontinence. Acupunct Electrother Res 2008; 33: 179-92.
- Tang CL et al. [Observation on therapeutic effect of dog-day acupuncture and moxibustion combined with pelvic floor muscle exercises for treatment of female stress urinary incontinence]. Zhongguo Zhen Jiu 2009; 29: 879-83.
- Thomas LH et al. Treatment of urinary incontinence after stroke in adults. Cochrane Database Syst Rev 2008; 1: CD004462.
- Tian FS et al. [Study on acupuncture treatment of diabetic neurogenic bladder]. Zhongguo Zhen Jiu. 2007 Jul;27(7):485-7.
- Yi WM et al. [Effects of electroacupuncture on urinary bladder function after radical hysterectomy] Zhongguo Zhen Jiu 2008; 28: 653-5.
- Yun SP et al. Effects of moxibustion on the recovery of post-stroke urinary symptoms. American Journal of Chinese Medicine 2007; 35: 947-54.