Written by Tara Johnston PT, DPT
Urinary incontinence is defined as any undesired leakage of urine. People with the condition may have trouble starting the urine stream or holding urine. Urinary incontinence involves the muscles of the pelvic floor. These muscles attach to the bottom of the pelvic bones and run front to back, forming a hammock structure that lifts to support the internal organs and controls the sphincter muscles. The pelvic floor muscles also help support the low back, stabilize the pelvic bones, and help with sexual function. Bladder control problems are a common issue at any age, but tend to increase as women age with 1 in 3 women having issues by age 60. Most studies show that 50% of women will have incontinence during their lifetime. Although leaking urine is common, it is not normal at any age.
One major problem is that women tend to be embarrassed and, on the average, only 10% of women who experience urinary incontinence will seek professional medical help. If 50% of us are having trouble with leaking, why are we embarrassed? Let’s take control of our lives and get some help!!
There are 2 main types of incontinence and sometimes these can occur together. Stress Urinary Incontinence and Urge Incontinence. Fecal incontinence is also common and can be treated in similar ways.
STRESS URINARY INCONTINENCE (SUI)
The pelvic floor muscles surround the urethra, and help to keep it closed during times when pressure is placed on the bladder. Therefore, stress incontinence can result from a weakness and/or lack of support in the pelvic-floor muscles. It can happen with laughing, sneezing, or coughing, or with exercise or activities such as lifting. Women with stress incontinence often have pelvic floor muscle dysfunction as a result of pregnancy, childbirth, surgery, injury or trauma, changes in hormones that occur during menopause, obesity, or inactive lifestyle.
There is significant research showing that pelvic floor muscle training is a safe and effective treatment for stress urinary incontinence. A systematic review and meta-analysis in 2019 by Garcia-Sanchez, et al reviewed 10 randomized controlled trials, high quality studies, and concluded that pelvic floor muscle training, regardless of protocol used, age, or BMI, resulted in decreased urine loss and improved quality of life. This is great news! It tells us that by addressing the muscles, you can leak less urine and get back to doing what you love without embarrassment. This study also tells us that consistency and sticking with it is key. The women that did the best, trained their muscles 3-7 x/week and followed through with PT for 12 weeks. Those that dropped out sooner than 8 weeks had less optimal outcomes.
URGE INCONTINENCE (UI)
A strong and coordinated contraction of the pelvic floor muscles helps to decrease the urgency to urinate and helps keep the urethra closed. Patients with urge incontinence may lack this control due to pelvic floor weakness or tightness, or may experience spasms that contribute to uncontrolled bladder contractions. Urge incontinence may also be increased if your nervous system is on over drive from excessive stress, trauma, or chronic pain.
Urge incontinence can also be a learned behavior. For example, if someone always goes to the bathroom when arriving home from work, they can begin to associate getting home from work with going to the bathroom. After some time, that person can begin to feel the urge to go to the bathroom on the way home. This high urgency feeling may lead to urinary incontinence.
Foods, such as caffeine, sugar, and acidic foods can irritate the bladder and cause the bladder to contract more easily, contributing to urge incontinence.
Treatment for Urge Incontinence is often multifaceted and frequently requires a holistic approach looking at diet, exercise, stress levels, bathroom habits and muscle function. All of which a trained pelvic floor physical therapist can provide.
At the time of your evaluation, a pelvic floor physical therapist will determine the main areas to focus on and determine the best course of action for your specific condition. Treatment may include:
· Kegel exercises: The Kegel exercise is performed by squeezing the sphincter muscles or imagining that you are trying to stop the flow of urine.
· Manual therapy of your pelvic floor, low back, and abdomen
· Breathing exercises
· Biofeedback: Depending on your symptoms and level of comfort, your physical therapist may gently employ electrodes to measure your pelvic-floor muscle activity. The biofeedback obtained can help make you more aware of the correct way to use your pelvic-floor muscles.
· Muscle strengthening exercises: Your physical therapist will teach you specific exercises to stretch and strengthen other important muscles that help support proper bladder function.
· Electrical stimulation. Your physical therapist may apply gentle electrical stimulation to help improve your awareness of your muscle function.
· Changes to your nutrition
· Changing the behaviors that make your symptoms worse
· Techniques to decrease urinary urge and frequency
· Maintaining bowel regularity
· Maintaining a regular exercise regimen or active lifestyle
Contact Advanced Rehabilitation Services today to schedule an appointment with one of our two highly trained women's health specialists and start your path to leave incontinence behind you.
References:
Garcia-Sanchez, E, et all. What Pelvic Floor Muscle Training Load is Optimal in Minimizing Urine Loss in Women with Stress Urinary Incontinence: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health, 2019, 16, 4358.
www.choosePT.org. Urinary Incontinence, Accessed 5/19/2020.
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