Incontinence

Many people lose urine when they don’t want to. When this happens enough to be a problem, it is called urinary incontinence. Urinary incontinence is leaking of urine that you can't control. Many American men and women suffer from urinary incontinence. We don't know for sure exactly how many. That's because many people do not tell anyone about their symptoms. They may be embarrassed, or they may think nothing can be done. So they suffer in silence. Urinary incontinence is not just a medical problem. It can affect emotional, psychological and social life. Many people who have urinary incontinence are afraid to do normal daily activities. They don't want to be too far from a toilet. Urinary incontinence can keep people from enjoying life. Many people think urinary incontinence is just part of getting older. But it's not. And it can be managed or treated. Studies show that many things increase risk. For example, aging is linked to urinary incontinence. Pregnancy, delivery, and number of children increase the risk in women. Women who have had a baby have higher rates of urinary incontinence. The risk increases with the number of children. This is true for cesarean section (c-section) and vaginal delivery. Women who develop urinary incontinence while pregnant are more likely to have it afterward. Women after menopause (whose periods have stopped) may develop urinary incontinence. This may be due to the drop in estrogen (the female sex hormone). Taking estrogen, however, has not been shown to help urinary incontinence. Men who have prostate problems are also at increased risk. Some medications are linked to urinary incontinence and some medicines make it worse. Statistics show that poor overall health also increases risk. Diabetes, stroke, high blood pressure and smoking are also linked. Obesity increases the risk of urinary incontinence. Losing weight can improve bladder function and lessen urinary incontinence symptoms. Weakness of the pelvic floor muscles which form a sling or support around the urethra, vagina, and rectum may cause leakage of urine or prolapse of the bladder, uterus, or rectum. Pregnancy, childbirth, obesity, chronic coughing, chronic constipation, estrogen deficiency and improper lifting (while holding one’s breath) can weaken the pelvic floor muscles.

Other risk factors include:

• Immobility commonly associated with chronic degenerative disease
• Diminished cognitive status and delirium
• Medications; including diuretics
• Smoking
• Diabetes
• Stroke
• Low fluid intake
• Pelvic and abdominal surgery

A physical therapy program may include:

• Education on pelvic floor anatomy and function.
• Teaching you how to keep a bladder diary and form good bladder habits.
• Instruction in strengthening exercises or”Kegels” for the pelvic floor muscles.
• Instruction on using your pelvic floor muscles during common activities that stress the bladder such as lifting, walking, going up or down stairs and coughing or sneezing.
• Suggesting foods and beverages which may contribute to bladder leakage and irritability
• Designing an exercise program to address other areas of weakness or muscle imbalance such as the low back, thighs, and abdomen.

The most common types of incontinence are:

• Stress incontinence: Leakage of urine when you cough, sneeze, laugh, walk, lift or do other physical activities.
• Urge incontinence: leakage of urine that occurs with a strong desire to urinate with a few seconds to minutes warning - the bladder contracts when you don’t want it to.
• Mixed incontinence: a combination of stress and urge incontinence symptoms.

Why Physical Therapy?

Although incontinence is common, it is not normal and can be treated by a medical team approach including a physical therapist. A therapist can evaluate your problem and help you manage urinary incontinence through low-risk interventions which can be used alone or in conjunction with pharmacological and surgical options. If you think you may benefit from physical therapy ask your physician to refer you to a physical therapist who has received special training in this area. A pelvic exam and urinalysis are strongly recommended prior to referral in order to identify or rule out problems that may interfere with or be contraindicative of physical therapy treatment.