Urinary Incontinence

 What is Urinary Incontinence?

There are several types of urinary incontinence, but in general incontinence refers to the

photo by Maegan Tintari
photo by Maegan Tintari

leakage of urine at inappropriate times.

Stress incontinence   is leakage of small amounts of urine when there is increased pressure on the bladder. This can happen with exercise or with sneezing, coughing, lifting or other activities.

Urge incontinence is the leakage of medium to large amounts of urine when a person feels a sudden strong urge to urinate.

Mixed Incontinence includes symptoms of both stress and urge incontinence.

Functional Incontinence is urine leakage that occurs when a person can not get to the toilet in time.

What causes Urinary Incontinence?

Stress incontinence usually results from weakness and lack of support in the muscles of the pelvic floor. These are the muscles that attach to the bottom of the pelvic bones and run front to back, forming a bowl-like structure that lifts to support the internal organs and controls the sphincter muscles. The pelvic floor muscles also work to strengthen the low back, stabilize the pelvic bones, and help with sexual function.

People with stress incontinence often have “under active” pelvic floor muscles. Causes of under active pelvic floor muscles include

  • Pregnancy and Childbirth
  • Injury or trauma
  • Surgery in the vagina or rectum
  • Episiotomy (during childbirth)
  • Lack of exercise and lack of use
  • Chronic constipation or coughing
  • Overweight

Women with urge incontinence often have weak and “over active” pelvic floor muscles.

Possible causes of mixed incontinence can include any combination of the causes of stress and urge incontinence.

Functional incontinence can be caused by:

  • Joint pain or muscle weakness
  • Problems with mobility
  • Confusion, dementia or delirium
  • Environmental barriers (i.e., the bathroom is too far away, use of a walker or cane, too many obstacles to navigate around)
  • Psychological problems such as depression or anger

How can physical therapy help?

Because many symptoms of urinary incontinence are caused by pelvic floor muscle weakness and dysfunction, a specially trained Women’s Health Physical Therapist is the ideal provider to help you gain control over your symptoms. (Many treat men with urinary incontinence as well). Physical Therapists use their specialized medical training to completely evaluate and design a treatment program that is individualized for each patient.

Physical Therapy can:

  • Give you control over your life and your bladder
  • Save money and embarrassment by allowing less use of pads and undergarments
  • Reduce use of medications for incontinence
  • Possibly prevent the need for surgery

Physical Therapy Treatment may include:

  • Education on diet and nutrition to avoid food and drinks that may irritate the bladder
  • Advice on how to change behaviors that make symptoms worse
  • Techniques to help you find the right muscles and learn to use them correctly
  • Pelvic floor exercises to strengthen the pelvic muscles
  • Exercises to stretch and strengthen other important muscles
  • Ways to decrease urinary urge and frequency
  • Biofeedback that shows you how your muscles are working
  • Electrical stimulation to improve awareness and strength of the muscles

Who Should be Referred to a Pelvic Physical Therapist?

Those with:

  • Trouble leaking urine during normal daily activities
  • Urine leakage with sneezing, coughing, or laughing
  • Trouble starting the urine stream
  • Trouble holding urine when feeling a strong urge to go
  • Trouble with frequent urination (more than every 3-4 hours during the day, up more than once to urinate at night)
  • Trouble getting to the bathroom because of other problems such as knee or hip pain or balance problems
  • Men about to undergo prostatectomy

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