What is Incontinence and How Can Pelvic Floor Therapy Help?

What is Urinary Incontinence?  

Urinary incontinence is the involuntary loss of urine. Urinary incontinence can happen in people of all genders and age, however, it is more common in women and older adults. Approximately 13 million individuals are affected by urinary incontinence, however this number is likely underestimated due to underreporting of the condition. Urinary incontinence is most common in people residing in nursing facilities (50%) with the number rising to 75% in long term care facilities. 

5 Types of Urinary Incontinence:  

Stress Urinary Incontinence:

Stress incontinence occurs when pressure in the abdomen exceeds the pelvic floor’s ability to block urine. The most common scenarios are when coughing, laughing, sneezing, or abdominal straining.  

Urge Urinary Incontinence:

Urge incontinence typically occurs when a person experiences a trigger that causes them to experience the sensation to urinate. This can include placing a key in a lock, running water, walking past a bathroom or others. Often, frequent urination, urgent urination and waking up in the night to urinate are also associated with urge incontinence.  

Mixed Urinary Incontinence:

Mixed urinary incontinence is the combination of stress and urge urinary incontinence. Typically, people that have mixed urinary incontinence have one type that is more dominant than the other. For example, someone will have more loss of urine when sneezing and occasionally experience loss of urine when coming home from work when they unlock the door.  

Overflow Urinary Incontinence:

Overflow urinary incontinence is involuntary leakage of urine due to the bladder being too full. This can be due to detrusor muscle inactivity or obstruction of the bladder outlet. Typically, detrusor function is impaired by neurologic diseases such as spinal cord injury, multiple sclerosis or even diabetes. Common causes of obstruction can be masses in the abdomen or pelvis, structures of the urethra or pelvic organ prolapse. Another common cause that can happen in male patients is prostatic hyperplasia. This is the only form of incontinence that can be potentially dangerous. Not addressing this form of incontinence may lead to renal failure or permanent damage to the bladder.  

Functional Urinary Incontinence:

Functional urinary incontinence is involuntary loss of urine due to barriers in physical ability or the environment. For example, if a person is unable to walk, they might not be able to make it to the restroom in time without help or use of a bed pan or foley catheter.  

What is Pelvic Floor Physical Therapy? 

Pelvic floor physical therapy is a specialized area of physical therapy that focuses on disorders involving the pelvis, reproductive system as well as the bowel and bladder. Pelvic floor physical therapists are trained beyond a typical physical therapy education to perform internal vaginal or rectal assessments in order to directly target the muscles of the pelvic floor.

Some of the most common conditions that pelvic floor physical therapists treat include:

1. Pelvic pain
2. Incontinence
3. Pelvic organ prolapse

A common misconception about pelvic floor physical therapy is that it is only based on Kegel exercises. Kegels may be appropriate for certain people and not for others. A session of pelvic floor physical therapy will be done to assess you and create an individualized treatment plan based on your needs. 

How Can Physical Therapy Help My Incontinence? 

• Assessment: During your first visit, an assessment will be performed on you to check for overall strength and mobility. Along with this, your physical therapist will check for things like bowel function, pelvic organ prolapse, scar tissue, and soft tissue disorders. An initial assessment may or may not include an internal vaginal or rectal assessment. Your therapist will decide this based on the appropriateness of the exam as well as your comfort level. An assessment will never be performed without your consent. 
• Testing: Severity of incontinence can be determined using a few different methods. Your physical therapist will ask if you wear pads or panty liners due to having urinary incontinence. The more pads or liners used in a day indicates a higher severity of incontinence. Your therapist may also ask if you leak in drops or substantial amounts. Lastly, they may have you complete a bladder diary. This will be a log of food and water consumed, activities completed as well as bathroom trips typically over a three-day period. This will allow your therapist to see what type of incontinence you have as well as assess your specific triggers.
• Treatment: Treatment will be individualized to you. Some people have too much tone and an inability to relax fully which contributes to incontinence, while others do not have enough strength. Based on how you present, your therapist will give you exercises to help with the problem. Often times, a Kegel is not a sufficient exercise to fix incontinence.
• Tools: Your therapist may prescribe other helpful tools such as Emsella, pelvic wands, dilators, squatty potties, or bladder diaries to help with self-management or muscle tone. Although these tools are optional, they may be helpful to manage your condition in a timely manner.

What Can I do to Help Incontinence Now? 

• Limit or eliminate “just in case” urination. Just in case urination is when you go to the bathroom every time you leave just in case you won’t have access to a restroom. This can actually train your bladder to send you the urge to urinate sooner than it actually needs to. 
• Limit bladder irritants: Bladder irritants can include citrus, caffeine and carbonated drinks. There are many more, however these are the most common. If the lining of the bladder is irritated, then the chance of incontinence occurring is more likely.
• Do not push your urine out: Many people will attempt to urinate faster, so they push to pee. This is not healthy practice because the pelvic floor should relax to allow for the passage of urine. Instead, sit with your feet supported on the ground with good posture and breath to urinate.
• Do not hover over the toilet to urinate: The pelvic floor must be relaxed to allow for the passage or urine. Again, make sure to sit with the feet supported on the ground to urinate. If the toilet is dirty, use a paper toilet cover or choose a different toilet.

Book an appointment with a pelvic floor physical therapist: Having the proper support to work through pelvic floor dysfunction can be a game changer! Request an appointment with one of our Pelvic Floor Physical Therapists at Vida!

References

Muinos L. Pelvic Floor Therapy: What It Is, Health Benefits, and How to Get Started. EverydayHealth.com. Published October 16, 2024. Accessed October 31, 2024. https://www.everydayhealth.com/womens-health/pelvic-floor-therapy/guide/ 

Tran LN, Puckett Y. Urinary Incontinence. PubMed. Published 2023. https://www.ncbi.nlm.nih.gov/books/NBK559095/  

Ghaderi F, Ghazal Kharaji, Sakineh Hajebrahimi, Fariba Pashazadeh, Bary Berghmans, Hanieh Salehi Pourmehr. Physiotherapy in Patients with Stress Urinary Incontinence: A Systematic Review and Meta-analysis. PubMed. 2023;49(5):293-306. doi:https://doi.org/10.5152/tud.2023.23018  

Knorst MR, Resende TL, Santos TG, et al. The effect of outpatient physical therapy intervention on pelvic floor muscles in women with urinary incontinence. Brazilian Journal of Physical Therapy. 2013;17(5):442-449. doi:https://doi.org/10.1590/S1413-35552012005000117 

Mazur-Bialy AI, Kołomańska-Bogucka D, Nowakowski C, Tim S. Urinary Incontinence in Women: Modern Methods of Physiotherapy as a Support for Surgical Treatment or Independent Therapy. Journal of Clinical Medicine. 2020;9(4):1211. doi:https://doi.org/10.3390/jcm9041211