Urinary Incontinence

A new born baby eliminates urine and feces at will. The bladder and bowel empty without thought or inhibition. At the end of life there often might be the same pattern. But between these two phases of life an important control function is toileting, releasing urine and bowel movement at the appropriate time and place. Day to day being dry and in control when urine or bowel movement is released is expected in our society. It is assumed that everyone is dry as they perform their daily activities at home and in the community. If an individual experiences leaking he or she often feels like “the only one”, “the weak one”, “the inferior one”. The truth is that 25 to 30% of adults 25-55 years old have experienced bowel and bladder problems at some time. 1-2 % of adults leak at night. 35-40% of community dwelling individuals have bowel and bladder problems. 10-15% of children 8-16 years old have night time wetting problems and 3-5 % have bowel dysfunction. Incontinence is twice as common in women than in men. Although, urine leakage is a very common problem it is not normal and should be addressed. 19.5 million dollars are spent on UI treatment annually but mostly on evaluation and not treatment.

Urine is stored in a muscular sac called the urinary bladder and passes out through a tube called the urethra. The bladder and urethra are supported by the pelvic floor muscles as well as ligaments in the pelvic cavity. The urethra has internal and external stoppers called sphincters that allow or prevent the passage of urine. When the bladder muscles contract suddenly or the sphincter muscles are not able to stop the flow of urine, is when involuntary leakage of urine occurs. Voiding mechanism is coordinated at several conscious and unconscious levels by the brain, spinal cord, nerves and muscles. At times when the pelvic organs like the rectum or uterus are displaced, they can start putting pressure on the bladder and lead to decreased ability to void or untimely leakage.

The most common type of urinary incontinence is stress incontinence which is increased abdominal pressure on the pelvic floor causing weakness and lack of support of the pelvic floor muscles which can lead to urine leaking during any type of physical activity (sports, laughing, sneezing). Stress incontinence can be caused pregnancy, labor, childbirth, episiotomy, an injury or trauma to the pelvic floor, organ prolapse, inflammation, infection, surgery or high impact exercise.

Urge incontinence is when a person suddenly has a strong need to pass urine or may leak before reaching the bathroom. This may be caused by the loss of coordination between the pelvic floor muscles and the urgency to urinate resulting in the inability to keep the urethra closed. Urge incontinence may also be caused my learned behaviors. For example, if you always go to the bathroom when you get home from work, your body may feel the urge to go to the bathroom on your way home before you reach your destination.

A combination of the above two problems is termed mixed incontinence.

Functional incontinence is the intense urge to urinate with leakage before reaching the bathroom. It could be caused by factors unrelated to the bladder of pelvic floor which include confusion and dementia, psychological problems, using walkers (slows down movements), or environmental barriers, such as rugs or furniture, that block easy access to the bathroom.

Many people experience an urge to urinate in the middle of the night or may unconsciously lose urine at night-termed as nocturnal enuresis.

If you suffer from any the above issues, do not hesitate to reach out to your healthcare provider to seek the root cause and appropriate treatment. Talking about your problem and just not keeping it a secret anymore might be a big step. Physical therapists being musculoskeletal experts, will be a big part of a team that will be involved in your treatment process.

Your Physical therapist will take a detailed history to understand your condition, evaluate your musculoskeletal system including your pelvic floor muscles and design a plan of care according to your functional goals. Physical therapy treatment will involve gentle manual soft tissue or joint mobilizations, manual stretching, strength training with manual cuing, relaxation and breathing exercises, tips on appropriate nutrition and lifestyle changes, bladder retraining and functional exercises to incorporate timely engagement of your pelvic floor muscles during activities ranging from child care to sports specific exercises. The Physical Therapist might also refer you to other healthcare professionals per your requirements. An open communication among your healthcare team and your compliance with your treatment instructions, will be instrumental in a successful outcome like regaining control over your symptoms, reducing the need for pads/special undergarments, medications, and avoiding possible surgery.

Stay hydrated, minimize foods that irritate the bladder wall like caffeine, alcohol, milk products, artificial sweeteners, citric fruits, avoid constipation and foremost- stay in tune with your body.

For further information call Synergex Physical therapy today to schedule a free 15 minute telephone consultation to determine if Physical therapy is right for you.