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Urinary Incontinence and Physical Therapy

It can happen to the best of us when we least expect it. Sharing a good laugh with friends when the unexpected leakage of urine shows up. Or perhaps it was during pregnancy, for some us, that occasional leakage just came with the territory….or so we thought.

Urinary incontinence is the leakage of urine at inappropriate times. With incontinence, you may have trouble starting the urine stream or holding urine when you feel a strong urge to go. This condition involves the muscles of the pelvic floor, which 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 help support the low back, stabilize the pelvic bones, and help with sexual function. Women are more likely than men to have urinary incontinence, but men can have it, too.

There are different types of incontinence:
Stress incontinence – small amounts of urine leak when there is increased pressure on the bladder.
Urge incontinence – your bladder muscle goes into spasm, and, if the spasm is severe enough, medium to large amounts of urine may leak; this might happen only occasionally or as often as every 15 to 20 minutes.
Mixed incontinence – you have both stress and urge incontinence.
Functional incontinence – urine leaks when you can’t get to the bathroom in time.

Stress Incontinence
Stress incontinence usually results from weakness and 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 “underactive” pelvic floor muscles as a result of:
– pregnancy and childbirth which can put stress or pressure on the bladder and possibly cause trauma to the pelvic-floor muscles, injury or trauma
– surgery in the vagina or rectum
– episiotomy
– lack of exercise and lack of use
– after delivery women also can have fecal incontinence (leakage of stool) if there was tearing of the vaginal opening that extends to the anal sphincter

Urge Incontinence
With urge incontinence, you may or may not have pelvic-floor muscle weakness or pelvic muscle tension or spasm.


Functional Incontinence

In functional incontinence, the cause isn’t related directly to the bladder or pelvic-floor muscles:
– Joint pain or muscle weakness that cause you to move with difficulty
– Confusion, dementia, or delirium
– Environmental barriers, such as the bathroom being too far away, the use of a walker that slows you down, or too many obstacles that you have to walk around to get to the bathroom
– Psychological problems such as depression or anger
– You can also have an “overactive bladder” where your bladder empties frequently throughout the day (more than every 3 or 4 hours during the day) or makes you get up more than once to urinate at night. There is a variety of causes, such as sensitivities to certain foods or beverages.


How Can a Physical Therapist Help with Urinary Incontinence?

Based on our evaluation results, we will individualize treatments to strengthen your pelvic-floor muscles and improve their function. We can help you:
– Gain control over your symptoms
– Reduce the need for pads and special undergarments, incontinence medications, and possibly surgery
– Strengthen your muscles and make them work better for you


Your physical therapist will:

– Show you how to “find” the right muscles and use them correctly.
– Use pelvic-floor exercises to help you strengthen your muscles so that you can better control your bladder. Pelvic-floor exercises include “kegels,” in which you gently squeeze the sphincter muscles and squeeze the buttocks, thighs, and stomach muscles.
– Instruct you in exercises to stretch and strengthen other important muscles, so that they can support proper bladder function.
– Depending on your symptoms and level of discomfort, your physical therapist may decide to use biofeedback to make you aware of how your pelvic-floor muscles work and how you can control them better. Electrodes attached vaginally or rectally will provide measurements of muscle activity and display them on a monitor, and the therapist will work with you to help you understand and change those readings. The therapist also may use electrical stimulation to improve your awareness of your muscles and increase muscle strength.


Remember: Knowledge Is Power

We can provide information regarding your diet and nutrition, including food and drinks that may irritate the bladder, changing behaviors that make symptoms worse, and ways to decrease urinary urge and frequency. At Northern we have a number of physical therapists who are trained extensively in treating pelvic floor issues as well as women’s health. Call the location closest to you to find out how we can begin helping you today.

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Urinary Incontinence and Physical Therapy

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