Urinary incontinence affects millions of women worldwide, and it can have a significant impact on their quality of life. From feeling embarrassed to avoiding social situations, urinary incontinence can cause physical, emotional, and social distress. However, with the right treatment and management strategies, women can regain their confidence and lead an active life. In this blog post, we'll discuss what urinary incontinence is, its causes, and how to manage it. As a pelvic floor physical therapist, I've helped many women overcome urinary incontinence, and I want to share my knowledge with you.
What is Urinary Incontinence, and Who is Affected?
Urinary incontinence can affect women and girls of all ages. Commonly, it is said to be “normal” after having kids and gets worse with age, but this is false. No matter the age, or if someone has kids or not, urinary incontinence is something that can be improved and resolved completely! Though the prevalence is high in women who have had kids, urinary incontinence should not be considered normal like it is stigmatized to be.
The 3 main types of urinary incontinence are stress, urge, and mixed incontinence. Stress urinary incontinence happens when extra force is placed on the body and causes leakage. For example, this would be if someone pees their pants while coughing, sneezing, laughing, jumping, running, etc. Urge urinary incontinence happens when there is a strong sudden urge to go, gets stronger on the way to the bathroom, and causes leakage on the way to the toilet. This may show up when getting home and there may be an urge to pee, which gets stronger walking into the house, and then gets to a point where it is impossible to make it to the bathroom in time. Mixed urinary incontinence is when someone experiences both stress and urge incontinence.
Causes of Urinary Incontinence
There are various factors that can lead to pelvic floor dysfunction and cause urinary incontinence. First, being pregnant and having a child can increase your risk for incontinence due to the pelvic floor possibly becoming weakened from pressure during pregnancy and delivery. There are instances where the pelvic floor may develop tension during this process and also cause issues with leakage. Second, menopause can bring about changes in urinary function and cause leakage due to hormonal changes during this time. Your diet can be contributing to leakage as well, since caffeine, alcohol, spicy food, and citrus can be bladder irritants and contribute to incontinence issues.
Certain medications can alter bladder function and cause incontinence like diuretics, sedatives, alpha blockers, opioids, and antidepressants. Obesity can lead to bladder issues since there is extra weight being placed on the bladder. Chronic coughing can also be a cause due to excessive pressure being repeatedly put down towards the bladder which can weaken the pelvic floor. Increasing age can increase your risk for incontinence due to muscles and tissue gradually weakening with age and possibly causing weakness in the pelvic floor. Lastly, there can be neurological causes of incontinence like with multiple sclerosis, Parkinson’s disease, and spinal cord injuries for instance.
How a Pelvic Floor Specialist Can Help
It is possible to overcome urinary incontinence without surgery or other invasive options. Finding a pelvic floor specialist that can create an individualized program to address the specific cause of the incontinence will be the best route to take.
A pelvic floor therapist will advise on proper breathing mechanics, posture, and toileting habits and more. They can determine whether it is appropriate to do kegel exercises or not, possibly work on timed voiding, and advise on fluid and diet management. Targeted exercises are also provided to address any deficits in strength, range of motion, flexibility, balance, and body mechanics that are contributing to the leakage. They are experts in body movement and will look away from the pelvic floor to help the body move more efficiently to make the pelvic floor happier. There is so much more involved in improving pelvic floor issues that likely will not include kegels at all.
The pelvic floor acts like a trampoline and does its best when it can lengthen down and contract back up fully. Think about if a trampoline was tight. It would not be able to do its job effectively to support you when you jump. This is why it is important to not be doing kegels all of the time or holding a kegel for long periods. The pelvic floor can get tight and not be able to hold back urine sufficiently because it is also weak and fatigued. If you have been doing kegels and not seeing progress, this is likely why. Learning how to get full mobility of the pelvic floor is very important and this comes with a full body approach. When your whole core and body system is working well, the pelvic floor will be able to do its job more effectively.
Tips for Managing Urinary Incontinence in Daily Life
A foundational exercise to work on and get good at is diaphragmatic breathing. This breathing pattern will allow your pelvic floor to have more mobility and improved coordination. When you breathe in, your belly, sides, and back should all expand. Think of your abdomen as a box. You want all 4 sides to expand, not just your belly. When you breathe out, the box collapses in and everything recoils back in. There should be little to no movement in your upper chest and shoulders. Practicing this daily and with your day to day tasks can make a big difference.
For managing urinary incontinence immediately, you may need to use absorbent pads temporarily, have extra clothes with you and wear clothes that are easy to change, and have a plan for outings and travel. Keep in mind these are short term coping strategies that you will no longer have to do once you are leakage free after pelvic floor therapy.
Conclusion
Urinary incontinence may be a challenging condition to live with, but it doesn't have to be a life sentence. With the right treatment and management strategies, women can overcome urinary incontinence and live an active, fulfilling life. As a pelvic floor physical therapist, I encourage all women to seek help if they're experiencing urinary incontinence. By addressing this issue, we can drastically improve women's health and quality of life.
I am a pelvic floor therapist who sees clients in person in McKinney, Texas but also offer online sessions accessible worldwide. You can find more information about me and my practice below.
Best wishes,
Dr. Miranda Morris, PT, DPT
Doctor of Physical Therapy & Owner, Infinite Radiance Wellness, LLC
Phone: 469-573-3183
miranda@infiniteradiancewellness.com
Sources
Urinary incontinence in women: a review. JAMA, 2017. (https://jamanetwork.com/journals/jama/fullarticle/2653737)
Urinary incontinence in men. BMJ, 2013. (https://www.bmj.com/content/346/bmj.f2018)
Urinary incontinence in neurological disease: assessment and management. The Lancet Neurology, 2015. (https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(14)70202-7/fulltext)
Urinary incontinence in the elderly. American Family Physician, 2014. (https://www.aafp.org/afp/2014/0201/p196.html)
Medications and incontinence. Urology Care Foundation. (https://www.urologyhealth.org/urologic-conditions/urinary-incontinence/causes/medications-and-incontinence)
Chronic cough and urinary incontinence: a true association? European Respiratory Journal, 2017. (https://erj.ersjournals.com/content/49/6/1601846)
Constipation and urinary incontinence: cause or effect? Current Opinion in Obstetrics and Gynecology, 2018. (https://journals.lww.com/co-obgyn/Abstract/2018/12000/Constipation_and_urinary_incontinence__cause_or.7.aspx)
