Understanding Urinary Incontinence

More than 25 million adult Americans experience temporary or chronic urinary incontinence, or accidental loss of urine. Incontinence can occur due to changes in body functioning, such as weak or tight musculature, or as a result of disease, use of medications and/or the onset of illness. It is not an inevitable result of aging, but it is common in older people, especially women, after experiencing hormonal changes due to menopause. However, all ages and all genders may experience urinary incontinence.

If you are experiencing leakage of urine, or the strong urge to use the restroom, consult with your doctor for a potential referral to Pelvic Floor Physical Therapy.

Types of Urinary Incontinence

Stress Incontinence (SUI): Leakage of urine during exercise, coughing, sneezing, laughing, lifting heavy objects or performing body movements that put pressure on the bladder. Often occurs due to the pelvic floor muscles being weakened leading to the inability to hold urine.

Urge Incontinence (UUI):  Inability to hold urine long enough to reach a restroom, often associated with a very strong, sudden urge to urinate. Normal frequency of voiding (urination) is 4-8 times a day, or every 2-4 hours; voiding more than this can be a sign of urinary urgency. Many with UUI have anxiety when, or even avoid, traveling longer distances or being away from a restroom for longer periods of time.  Also known as Overactive Bladder.

Mixed Urinary Incontinence (MUI): Combination of both SUI and UUI.

Overflow Incontinence (OI): Occurs when something blocks urine from flowing normally out of the bladder. If your bladder never completely empties, you might experience urine leakage, with or without feeling like you need to go. Often occurs when the quantity of urine produced exceeds the bladder’s capacity to hold it. It can occur in both genders when the bladder muscle becomes underactive or in males with prostate enlargement.

Functional Incontinence: Urine leakage due to a difficulty reaching a restroom in time due to physical conditions or disabilities, such as dementia, that cause you to be unaware, or unconcerned, with the need to urinate.

Bladder habits that can lead to dysfunction

Urinary incontinence can be due to a multitude of factors, but the following habits can lead to long-term bladder dysfunction:

• Delaying toileting too long can overstretch the bladder
• Hovering over the toilet, such as when using a public restroom, does not allow for adequate relaxation of the pelvic floor muscles
• Bearing down to initiate stream or complete urination
• Not allowing time for full bladder emptying
• Urinating just in case, or preventative urination (such as before leaving the home when going to the grocery store)

How to Treat Urinary Incontinence?

Physical therapy offers a conservative treatment to UI for those that do not want, or would like to avoid, surgical procedures. Some treatment strategies include:

• Pelvic muscle strengthening to improve pelvic floor muscle performance
• Relaxation/stretching techniques to decrease muscle tightness
• Behavioral management to increase the length of time between voids
• Education in diet management to decrease ingestion of bladder irritants such as caffeine, carbonation and acids

If you are concerned about urinary incontinence, talk to your primary care doctor.

Marley Smith, PT, DPT, Excela Health Outpatient Rehabilitation