“Every time I cough, I leak. I can’t jump on a trampoline without getting my pants all wet. When I hear running water, my own water works start. Here I am in my doctor’s office, waiting for her to prescribe that medication I see on TV, the one that will make all my troubles go away. Instead, she gave me an order to go to physical therapy. Wait, did she hear me correctly? Surely she meant a urologist? Can’t she just give me that magic pill instead?” – These are all common questions for patients who are prescribed physical therapy for urinary incontinence.
Urinary incontinence affects more than 423 million people worldwide. It can affect up to 46 percent of women1,2 and one out of twenty men. Incontinence affects women most often during and after menopause and childbirth, and affects men most often over the age of 60. It can create a sense of loss of control, shame, isolation and depression, yet 50 percent of those affected will not seek help according to The Global Forum on Incontinence.3
There are two main types of urinary incontinence. To understand this, we must first understand a little about anatomy. The bladder is a vesicle that stores urine and empties through the urethra. For men, the urethra passes through the prostate. Beneath the bladder lies a beautifully woven group of muscles called the pelvic floor. This is a sling-like hammock that supports all the pelvic organs, including the bladder, rectum and uterus. This group of muscles controls the opening and closure of three things; the urethra, vagina and rectum. When the pelvic floor is strong, it holds back gas, stool and urine, and it should be able to relax to release these when you are ready.
Stress incontinence occurs when you leak when you cough, sneeze, lift, laugh, yell, run or exert yourself. The pressure in the abdomen exceeds the ability of a weak pelvic floor and urethral sphincters to close the urethra, resulting in dribbles.
Urge incontinence is altogether different. Urgency occurs when an external trigger, such as running water or arriving home, creates the sensation of “gotta go right now!” This occurs because the brain has associated certain things with urination, causing the bladder to contact abnormally. For example, because we associate running water with bathrooms, our brain triggers our bladder to contract at very inopportune times, and that is perceived as the urge to urinate. I have many patients who say that as soon as they begin washing dishes, or turn on the shower, or hear a water fountain, they immediately panic knowing that the inevitable is coming. Another example stems from when we were young and our parents told us to hold our urine until we arrived home. The brain then associates home with urination, so as soon as we pull into the driveway the brain tells the bladder, “let’s go!” and the bladder will contract. We then barrel over anyone or anything that stands between the bathroom and the front door! This is also called overactive bladder. Urgency can also be caused by dietary bladder irritants, such as cranberry, cola, coffee, carbonation, citrus, alcohol, artificial sweeteners and acidic foods.
Some people have both types of incontinence, which is called mixed incontinence.
I am so glad you asked! As mentioned above, the pelvic floor is a muscle, and muscles can be strengthened and re-trained. Physical therapy is a first-line treatment for incontinence, and yet so many people struggle in silence, spending hundreds of dollars yearly on smelly pads that irritate the skin and don’t address the problem at all. Worse, many people are taking medications that “dry up” the bladder, while they also dry up the eyes, mouth, bowels (constipation) and brain. In fact, a 2017 study by the European Association of Urology raised concern over the use of these medications and an association with cognitive impairment and dementia.4
A pelvic floor physical therapist is a specialized therapist trained in the treatment of many bowel and bladder issues. Your therapist can assess the causes of your incontinence and design a treatment that will address your specific needs. Physical therapy is not just a matter of “kegels.” Your therapist will assess your hip, pelvic floor, back and abdominal strength, as well as look at any triggers that can be aggravating your symptoms, such as diet and activity. Your therapist will take a holistic approach to treating all the factors that can be contributing to your incontinence and help you live a life free of pads, medications and embarrassing leaks.
Contact Athletico Physical Therapy today to speak with one of the certified Women’s and Men’s Health Physical Therapists in your area, and get back to living life!
The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.
1. Wilson L, Brown JS, Shin GP et al.: Annual direct cost of urinary incontninence. Obstet Gynecol, 2001, 98: 398-406.
2.Gharderi, F, Oskouei A: Phisiotherapy for Women with Stress Urinary Incontinence: A Review Article. J Phys Ther Sci, 2014, 26(9): 1493-1499.
3. Milsom, Ian. “How Big Is the Problem? Incontinence in Numbers.” Global Forum on Incontinence, www.gfiforum.com/Upload/43b34997-7408-4fa6-9547-72488e668060/I%20Milsom%20-%20Incontinence%20in%20numbers.pdf.
4. “Concern over High US Prescribing Levels of Common Drug Linked to Dementia.” ScienceDaily, ScienceDaily, 27 Mar. 2017, www.sciencedaily.com/releases/2017/03/170327083445.htm.