What is urinary incontinence and how do we treat it?

What is urinary incontinence?

Urinary incontinence is the loss of bladder control. This ranges from occasional leakage to complete loss of bladder control. Urinary incontinence comes in many forms. Stress incontinence is when urine leaks once pressure is exerted on your bladder. Examples include, leaking when sneezing, laughing, coughing, exercising, during intercourse, or lifting. Urge incontinence is when there is a sudden and strong urge to urinate with an involuntary loss of bladder control. Overflow incontinence involves dribbling of urine on a frequent basis related to a bladder that does not empty completely. Functional incontinence is when a mental or physical impairment (such as dementia or arthritis) prevents you from making it to the bathroom in time to void. Mixed incontinence is when a person experiences one or more of the above types of incontinence.

How do we treat urinary incontinence?

This may shock you, but believe it or not, urinary incontinence does NOT always come from weak muscles. It actually can also come from tight muscles, poor coordination, dietary irritants, nerve damage, poor fluid intake, poor intra-abdominal pressure management, pain, etc. We treat what we find. Depending on your evaluation, we may give you a bladder diary to fill out to examine voiding habits, leaking patterns, and how they correlate with fluid and food intake. We also often use this to set up a program and goals for bladder retraining which is a fancy way of saying retraining your bladder muscles to decrease urgency and decrease voiding frequency so you 1. Are not constantly running to the bathroom and 2. You can stop leaking/incontinence. Depending on what we find, we may work on strengthening (of pelvic floor, core, hips), relaxation techniques, manual PT, scar tissue mobilization, improved coordination of your pelvic floor (ex: “the knack” with coughing, coordination with jumping, etc), breathing patterns (yes, there is an optimal way to breathe!), improved management of intra-abdominal pressure, and so much more! I want to reiterate that your comfort level and beliefs dictate treatment. If you are opposed to any of the above, there are always several ways to “get things done.” Just because you do not feel comfortable with one option, this does not mean that we cannot help you get better.

For those who have determined it is “normal” to leak…

I often hear people say, “I leak because I am old. I am too old for pelvic floor PT.” Or “I had a baby. Leaking is normal.”  This simply is not the case. It truly makes me sad that we as a society have decided it is normal to leak after pregnancy and with age. While there is no need to be embarrassed about leaking or incontinence, you should not have to just accept it. While there are some cases that may not be a candidate for pelvic floor PT, do not write yourself off until you have tried it or have gotten a consult.

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