Incontinence – Ladies – You Don’t Have to Live With It!

Urinary incontinence can be frustrating, inconvenient, and can even limit social outings.  In the elderly population, it is sadly a large contributing factor to nursing home placement.  While some medical conditions can contribute to urinary incontinence and should be treated medically, quite often there is an underlying musculoskeletal dysfunction that can be contributing to the condition.  Some typical musculoskeletal problems can include:

  • Pelvic floor muscle weakness (these muscles help “close the door” of the urethra (where the urine comes out) – when they work properly, they help you stay dry
  • Overactive pelvic floor muscles -muscles are too tense and therefore cannot function properly
  • Poor posture – increased arch in low back, locked (hyperextended) knees – this posture can produce tight hip flexors which are located in the front of your pelvis, pulling your pelvis more forward, placing increased stress on your bladder (this can lead to urgency and frequency)
  •  Weak lower abdominals (your deepest layer of abdominals in the lower abdomen – the transverse abdominus– works with your pelvic floor, taking strain off the bladder, when it is functioning properly)
  • Abnormal muscle imbalance throughout the pelvis and abdominal region (a common presentation is a female presenting with too much tension and overuse of the upper abdominals and not enough resting tone/support in the lowers, which can result with leakage of urine with cough or sneeze)
  • Abdominal or gynecological surgeries can produce scar tissue – without getting the scar tissue massaged/stretched, this can lead to abnormal pulling on the muscles and lead to muscle imbalance (scar massage should not be attempted without skilled guidance from your pelvic floor physical therapist)
  • Abdominal or gynecological surgery can also lead to muscle disuse and weakness, or abnormal resting tone -muscles that are too active or not active enough
  • Obesity can place increased stress on the bladder
  • Poor breathing pattern  – yes, ladies – I am talking about your breathing quality.  If we are stressed out, we tend to breathe more from our upper chest and accessory breathing muscles in the neck.  This does not help us use our main breathing muscle – the diaphragm.  If we continue to breathe more from our chest and not our lower abdomen and lower thoracic region, we can develop abnormal resting tone of the pelvic floor – which can eventually lead to bladder control problems.

Other things to consider that can lead to urinary incontinence include:

  • Prolapse (a drop of the pelvic organs – uterus, bladder, or rectum commonly into the vaginal wall) may or may not cause incontinence symptoms, but should be addressed with strength and posture training in order to prevent further dropping.  Mild to moderate prolapses tend to do very well with pelvic floor and core strengthening.  It should be noted that prolapses that are moderate to severe should be evaluated for a pessary (an item that is placed to push the organ back up) versus a surgical consult.
  • Toileting habits – Your position matters when you sit on the toilet.  Learning proper posture techniques can enable you to void urine and bowels better without straining the organs. Also, rushing could lead to not fully emptying bladder or even lead to constipation.  (It be should noted that straining hard to have bowel movements can make prolapses worse.)
  • Dietary Bladder Irritants – Some individuals may find that their bladder is better when they avoid certain foods.  Most common ones include citrus, spicy, caffeine, carbonation, and artificial sweeteners.  Dairy has also been included on some lists and has been noted clinically.
  • People with chronic pain – may have problems with the bladder and/or bowel – due to prolonged abnormal muscle activity
  • People with conditions such as Parkinson’s, lung disease, or that have jobs with heavy lifting. (Parkinson’s – many of the medications folks take for Parkinson’s have side effects of bladder urgency incontinence; however with basic breathing/relaxation techniques this can greatly improve their symptoms while they, of course, stay on their needed medications)

Ladies, you owe it to yourself to seek out physical therapy for the pelvic floor if you are indeed having any incontinence symptoms.  Physical therapy may not be right for everyone, but it may be helpful if you do have some of these conditions listed above.  It is important that you know there are more options for treatment than medications, and you may be able to prevent surgery if you catch a prolapse soon enough.  If you do in fact need to have a surgery, getting to know the pelvic floor muscles and training them first, may help you have a better surgical outcome.  Pelvic floor therapists work closely with your doctor to help you achieve the goals that are right for you.