Urinary incontinence is becoming increasingly frequent and unpleasant problem especially for many women. Involuntary urination is such intimate problem, that many women instead of dealing with the problem, choose the easiest way, which is buying sanitary pads/menstrual pads, limiting their social life and “risky” activities. It is unnecessary for them to limit themselves and feel bad, which is a mistake because stress incontinence has other more elegant and effective solution. Which is permanent solution of the causes and consequences.


Incontinence is affecting 50% of women. We distinguish several different types of incontinence. “Stress incontinence” is the most common one, result is a release of a small amount of urine during laughter, coughing, sneeze, hard physical activity (lifting something heavy) or during intensive cardio exercise. This type is also the easiest one to cure, and it is also important to consult it in time with your doctor and afterwards with physiotherapist. This article is focused mainly on the stress incontinence.


By a healthy person it is caused by increased intra abdominal pressure (coughing, laughing, lifting heavy objects,...) with simultaneous automatic contraction of the pelvic floor muscles and balancing of the intra abdominal pressure. If the muscles don’t work correctly, it can result in uncontrollable release of urine.


The occurrence of incontinence is increasing with age, when the level of female hormone estrogen drops and at the same time the muscles of the pelvic floor are getting loose, and especially after menopause. The reasons can be several, such as whether you underwent a complicated childbearing, long-term excessive physical pressure, lifting heavy objects or intensive cardio training (runners, divers, bodybuilders,...).

Spontaneous release of urine can also result from disease such as diabetes mellitus (diabetes) and various neurological diseases. One of the possible causes is also urinary tract infection. There is also a higher risk during obesity, or during chronic coughing when the urinary bladder is exposed to higher pressure.


We need to understand the muscles of the pelvic floor in the context of the musculoskeletal system as a whole, because the relaxing tension and the correct function of the muscles of the pelvic floor have effect on the position of the sacrum and lumbar spine and vice versa. In coactivation of the diaphragm, the muscles of the pelvic floor participate on breathing and dynamic stabilization of the trunk in postural and movement chains. Deep stabilization system is made of the pelvic floor muscles, diaphragm, abdominal muscles (especially m. transversus abd.) and back muscles (m. multifidus).


Physiotherapist will first show you on pictures the muscles of the pelvic floor, explaining their function. Then he/she will examine you and find out whether you are able to activate these muscles or not.

The patient should be completely examined before the start of the therapy, because there are often functional disorders during the dysfunction of the muscles of the pelvic floor. We often discover impaired breathing stereotype, static and dynamic disorders of the spine and pelvis, blocked ribs, increased tension in the psoas major muscles, adductor muscles of the hi, spinal erectors and dysfunctional abdominal wall.

Based on this examination we treat these discovered blockages, painful points, muscle hypertonia (increased muscle tension) etc. For treating we use the soft tissue techniques, mobilization and treatment of the pelvic floor per rectum. For treatment of the muscles we use techniques of the post-isometric relaxation and anti-gravity relaxation. We mobilize the blockage in the spine area. It is also important to give a special care to the lumbar spine, SI joints, tailbone and hip bones.

Large number of patients can’t effectively activate the pelvic floor. Instead they usually activate buttocks and abdominal muscles or the adductor muscle group and involve the pelvic floor muscles very little. By these patients we focus on training the “isolated” activation and further involvement of these muscles into correct stereotypes, and “securing” the continence (ability to hold the urine in). We therefore use manual feedback, exercising and later exercising on a neurophysiological basis where we try to involve the pelvic floor within the stabilization system.


YTMojzisovaYTPNFYT YarnYT relaxing lower backYT relaxing buttocksYT intraabdominal pressure


If you are already suffering from incontinence, forget the shame and deal with it! If you belong to the risk group and you constantly deal with back pain - if you learn how to activate the muscles of the pelvic floor, then you will elegantly prevent this problem with benefit of removing the back pain.

Last crucial group worth the mention are young female athletes who plan to have a baby. They usually suffer from urinary incontinence during pregnancy or after the birth. If you work on your pelvic floor before the pregnancy, you will significantly lower the risk of formation of these problems.

 FYZIOklinika physiotherapy Ltd., Prague, Czech Republic

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