Urinary Incontinence · Kitchener, Waterloo & Cambridge
Urinary incontinence is leaking urine when you do not mean to, whether that is a few drops when you cough or a sudden urge you cannot hold. It is common, and supervised pelvic floor muscle training has strong evidence behind it. At CARESPACE the first visit is with a pelvic health physiotherapist. A dietitian or a kinesiologist can be added for weight, bowel habits or getting back to exercise.
What urinary incontinence is
Bladder control depends on the pelvic floor, a sling of muscles at the base of the pelvis that supports the bladder and closes off the urethra. Leaks happen when those muscles are too weak, too tight or not switching on at the right moment, or when the bladder itself signals urgently and too often. Leaks are especially common during and after pregnancy and around menopause, but common does not mean you have to live with them.
Types and symptoms
- Stress incontinence. Leaking with pressure on the bladder: coughing, sneezing, laughing, lifting, running or jumping.
- Urge incontinence. A sudden, strong need to go that is hard to hold off, often with frequent trips to the washroom, including at night.
- Mixed incontinence. Both patterns together, which is very common.
What contributes to it
- Pregnancy and childbirth
- Changes around menopause
- Extra body weight
- Caffeine, and drinking a lot more or a lot less than usual
- Constipation
When it needs medical attention
See a physician or nurse practitioner first if you have bladder pain that does not go away, difficulty emptying your bladder, leaking of stool as well as urine, or a neurological condition: NICE lists these among the reasons for a specialist assessment. Blood in your urine, burning when you pee or a fever also need a medical visit, not a physiotherapy one. Go to an emergency department right away if you suddenly lose bladder or bowel control along with numbness around your genitals or anus, or new weakness in your legs.
The emergency departments in Waterloo Region are:
- WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
- WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
- Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge
If you cannot get there safely, call 911.
What the evidence says about treating urinary incontinence
- Pelvic floor muscle training is the first thing to try. A Cochrane review of 31 trials involving 1,817 women concluded that it can cure or improve stress incontinence and every other type, and a 2022 Cochrane overview rates that evidence as high certainty.
- It works better with guidance. The overview found the exercises are more effective when they are more intensive, supervised by a health professional and supported so that people keep doing them.
- Give it at least three months. The UK’s national guideline (NICE) recommends at least three months of supervised pelvic floor muscle training as the first treatment for stress or mixed incontinence, and at least six weeks of bladder training for urgency or mixed incontinence.
- Bladder training helps urgency incontinence. In the overview, adding pelvic floor training to bladder training gave better results than bladder training alone.
- Weight loss has good evidence. The overview found more cure or improvement with weight loss than without, and NICE advises weight loss when body mass index is above 30.
- Caffeine, fluids and constipation have weaker support. NICE recommends a trial of cutting back caffeine for an overactive bladder, and says to consider adjusting fluid intake if it is high or low. The Canadian Urological Association’s overactive bladder guideline adds weight control and avoiding constipation. The Cochrane overview did not report on caffeine or bowel habits.
- This research was done in women. The reviews and the NICE guideline listed below do not cover men.
- Medication, pessaries and surgery are options when these measures are not enough, and are arranged through a physician or nurse practitioner.
How each CARESPACE service treats urinary incontinence
Pelvic Health Physiotherapy
Pelvic health physiotherapists have additional training in the pelvic floor. They assess how the muscles are working and build a supervised training program, which is the approach the research supports. Depending on what they find, that can include strengthening, learning to tighten before a cough or a lift, and bladder training for urgency. NICE recommends confirming with an internal examination that the muscles are contracting correctly before training starts. At CARESPACE that examination is always your choice, and your physiotherapist can work without one. Sessions are private and one-to-one.
About pelvic health physiotherapy →
Nutrition & Dietitian
A Registered Dietitian works on weight, where that is one of your goals: it is the food-related factor with the strongest evidence. They also help with caffeine, with what and when you drink, and with avoiding constipation, which the Canadian urology guideline includes in its lifestyle advice.
Kinesiology
If leaks show up when you run, jump or lift, a kinesiologist builds your pelvic floor exercises into a full training program and plans a gradual return to impact, working from what your physiotherapist has found.
Nurse Practitioner
A Nurse Practitioner can check for medical causes such as a urinary tract infection, review medications that affect the bladder, and discuss medication or a referral if training has not been enough.
About our Nurse Practitioner →
Where most people start
Book with a pelvic health physiotherapist. The first visit is a private conversation about what you are experiencing, an assessment you are comfortable with, and the start of a training plan.
How your team works together
The strongest evidence is for pelvic floor training, bladder training and weight loss, and those sit with different professionals. Your pelvic health physiotherapist leads the training. A dietitian can help with weight, fluids, caffeine and bowel habits, and a kinesiologist with the return to exercise.
Read about pelvic health physiotherapy and who offers it, or browse our dietitians.
What to expect at your first visit
- A private conversation. When you leak, how often you go, what you drink, your bowel habits, and any pregnancies or surgeries.
- An assessment you agree to. Your physiotherapist explains each step first. It may include posture, breathing and the abdominal wall, and an internal exam only if you choose.
- Which type of incontinence you have, and what your pelvic floor needs.
- The first part of your plan, usually two or three things to start that day.
What you can do at home
- If you get sudden urges, try cutting back caffeine for a few weeks and see whether it changes anything.
- Look at how much you drink. Both a lot and very little can be worth adjusting.
- Avoid getting constipated.
- If you already do pelvic floor exercises, keep going, and ask at your first visit to have your technique checked.
Urinary incontinence treatment in Kitchener, Waterloo and Cambridge
Kitchener. Pelvic health physiotherapy, Nutritionist & Dietitian in Kitchener and Kinesiology in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.
Waterloo. Pelvic health physiotherapy, Nutritionist & Dietitian in Waterloo, Kinesiology in Waterloo and a Nurse Practitioner in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.
Cambridge. Pelvic health physiotherapy and Nutritionist & Dietitian in Cambridge. Location: Hespeler Road.
The city pages linked above show the locations and practitioners for each service, with their next availability. The pelvic health physiotherapy page lists the current pelvic health physiotherapists and where they work, or call 519-208-2273 and the Central Reception Team will book you at the closest location.
Common questions
Is leaking normal after having a baby?
It is common, but it is not something you have to accept. Pregnancy and birth change the pelvic floor, and for many people it does not fully recover on its own. Pelvic health physiotherapy can help whether you gave birth a few weeks ago or many years ago.
Aren’t Kegels enough?
Sometimes. The research shows the exercises work better when they are supervised, more intensive and supported so that you keep doing them, and NICE recommends checking that the muscles are contracting correctly before you start. An assessment shows what your pelvic floor needs.
How long until I see a difference?
NICE recommends giving supervised pelvic floor muscle training at least three months before judging the result, and bladder training at least six weeks.
Do I have to have an internal exam?
No. NICE recommends an internal examination to confirm the muscles are contracting correctly, but at CARESPACE it is always optional, and your physiotherapist can assess and treat without one.
Where can I see a pelvic health physiotherapist in Kitchener, Waterloo or Cambridge?
In all three cities. The pelvic health physiotherapy page lists the current practitioners and the location each one works at.
Do I need a referral?
No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan; pelvic health physiotherapy is claimed as physiotherapy. More on fees and insurance →
Sources
- Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews, 2018.
- Todhunter-Brown A, et al. Conservative interventions for treating urinary incontinence in women: an overview of Cochrane systematic reviews. 2022.
- National Institute for Health and Care Excellence. Urinary incontinence and pelvic organ prolapse in women: management (NG123).
- Canadian Urological Association. Guideline on adult overactive bladder: executive summary. Canadian Urological Association Journal, 2017.
Related conditions
Ready to book?
Book online with a pelvic health physiotherapist, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.