Urinary incontinence?  Talk to a physical therapy specialist

By Terri Sullivan DPT, OCS

There seems to be a social stigma regarding urinary incontinence and even when a patient sees their medical provider, they are reluctant to divulge it is a concern. Many patients may write in their health intake that they have urinary incontinence, but they usually won’t speak of it during their initial examination, because they feel like it’s not important to their overall function.

Two types of patients specifically come to mind. One is the patient who says that they expect to be incontinent as they are getting older. The other is the active individual who has leakage when running or squatting and assumes it’s normal. It may not be meaningful for them at the moment, but urinary incontinence is a health concern as it can result in more problems in the future.

Urinary incontinence involves muscles of the pelvic floor, which are the muscles which form a bowl-like structure that supports the internal organs and sphincter muscles. These muscles also play a role in supporting the low back, sexual function, and stabilizing the pelvic bones. Incontinence is more common with women, but can also occur with men.

There are 4 types of incontinence: stress incontinence, urge incontinence, mixed incontinence (both stress and urge), and functional incontinence. Stress incontinence is usually the result of pelvic floor muscle weakness. It can occur with sneezing, coughing, lifting, or when performing physical activity or exercise. Some reasons why women have stress incontinence are pregnancy and childbirth, injury or trauma, surgery to the vagina or rectum, episiotomy, and lack of use or lack of exercise. Urge incontinence occurs when there is a strong need to urinate and the bladder contracts, resulting in leakage. Functional incontinence is not directly related to the pelvic floor muscles or bladder. Functional incontinence can be caused by joint pain or weakness that makes a person less mobile in order to reach the bathroom, environmental barriers such as being too far away or blocked from getting to a bathroom, confusion or dementia, and psychological problems such as depression or anger. One other instance of incontinence is an overactive bladder, which occurs when someone needs to void at a greater frequency than what is normal (every 3-4 hours) and can be caused by food or beverages.

How can you find out whether or not you have incontinence? A physical therapist, who specializes in incontinence and/or women’s health, can help diagnose urinary incontinence and also determine if a referral to a physician is necessary. Treatment can include the following: pelvic floor strengthening exercises, strengthening of other abdominal and hip muscles, discussion of appropriate undergarments, diet and nutrition recommendations, and education about behavior change and ways to decrease incontinence frequency.

Lastly, there was a study performed in 2008 that compared physical therapy to other forms of treatment, such as drug therapy and medical devices, for treatment of incontinence. The study, which reviewed 96 journal articles over 17 years, concluded that physical therapy including pelvic floor muscle training and bladder training education was more successful than the other medical options. Information about the article is cited here: http://www.apta.org/Media/Releases/Consumer/2008/9/17/. Urinary incontinence can be debilitating condition, but it doesn’t have to be if you seek out the appropriate physical therapist and have it treated.