Bladder Health & Incontinence Therapy

What is the pelvic floor?

The pelvic floor is a series of muscles that support your bladder, uterus, bowels, as well as your bony structures such as your spine. Issues in this area can result in leakage, ‘having to go’ all the time, constipation, painful intercourse, and pain in the low back, hips, and tailbone. While these symptoms are common, they shouldn’t be labeled as normal. These issues are often long-lasting, and people feel awkward talking to their physician or health care provider but waiting will only make the issues worse. Unfortunately, when not treated by a proper pelvic health specialist, these issues are often misdiagnosed, or the symptoms are treated but the cause is missed. Our team of specialists uses education, electrical stimulation, home units, and biofeedback as needed to improve incontinence issues for both men and women.

What is incontinence?

Urinary incontinence is the leakage of urine at inappropriate times. With incontinence, you may have trouble starting the urine stream or holding urine when you feel a strong urge to go. This condition involves the muscles of the pelvic floor, which attach to the bottom of the pelvic bones and run front to back, forming a bowl-like structure that lifts to support the internal organs and controls the sphincter muscles. The pelvic-floor muscles also help support the low back, stabilize the pelvic bones, and help with sexual function. Women are more likely than men to have urinary incontinence, but men can have it, too.

Types of incontinence

• Stress incontinence – small amounts of urine leak when there is increased pressure on the bladder
• Urge incontinence – your bladder muscle goes into spasm, and, if the spasm is severe enough, medium to large amounts of urine may leak; this might happen only occasionally or as often as every 15 to 20 minutes
• Mixed incontinence – you have both stress and urge incontinence
• Functional incontinence – urine leaks when you can’t get to the bathroom in time

Stress incontinence

Stress urinary incontinence usually results from weakness and lack of support in the pelvic floor muscles. It can happen with laughing, sneezing, or coughing or with exercise or activities such as lifting. This happens due to weakness or lack of support in the pelvic floor muscles, which are responsible for maintaining bladder control. Women with stress incontinence often have “underactive” pelvic floor muscles as a result of:

•  pregnancy and childbirth which can put stress or pressure on the bladder and possibly cause trauma to the pelvic floor muscles, injury or trauma
• surgery in the vagina or rectum
• episiotomy
• lack of exercise and lack of use
• after delivery women also can have fecal incontinence (leakage of stool) if there was tearing of the vaginal opening that extends to the anal sphincter

Urge incontinence

Urge incontinence happens when the bladder muscle suddenly contracts or spasms, causing an urgent need to urinate that can result in medium to large amounts of urine leakage. This can occur occasionally or frequently, sometimes every 15 to 20 minutes. Pelvic floor muscle weakness, tension, or spasms may contribute to symptoms.

Mixed incontinence

Mixed incontinence is a combination of both stress and urge incontinence. Individuals experience symptoms of urine leakage related to increased bladder pressure as well as sudden, strong urges to urinate. Because mixed incontinence involves multiple causes, it often requires a comprehensive pelvic floor physical therapy approach that addresses both muscle weakness and bladder spasms.

Functional incontinence

In functional incontinence, the cause isn’t related directly to the bladder or pelvic-floor muscles:

• Joint pain or muscle weakness that limits mobility and delays getting to the bathroom
• Confusion, dementia, or delirium
• Environmental barriers, such as the bathroom being too far away, the use of a walker that slows you down, or too many obstacles that you have to walk around to get to the bathroom
• Psychological problems such as depression or anger that interfere with timely bathroom use
• You can also have an “overactive bladder” where your bladder empties frequently throughout the day (more than every 3 or 4 hours during the day) or makes you get up more than once to urinate at night. There is a variety of causes, such as sensitivities to certain foods or beverages.

How can a physical therapist help with urinary incontinence?

Based on our evaluation results, we will individualize treatments to strengthen your pelvic floor muscles and improve their function. We can help you:

• Regain confidence and control over your symptoms
• Reduce the need for pads and special undergarments, incontinence medications, and possibly surgery
• Strengthen your muscles and make them work better for you
• Urge Incontinence