Urinary incontinence, among both men and women, is a common occurrence.
Just because it is “common,” however, does not mean that it is normal, unavoidable, or untreatable. Many cases of urinary incontinence can be resolved or well-managed with treatment, which a qualified pelvic floor physical therapist can provide.
Ashley Williams, a pelvic floor therapist at KCP, has helped many patients improve their lives through treatment for their leaky bladders. In a recent interview, she shared more about the types of urinary incontinence and effective treatment strategies for each.
Below are Ashley’s answers to some frequently asked questions on the subject.
What is Urinary Incontinence?
Any type of bladder leakage is considered urinary incontinence. But there are many types of incontinence, and it’s not helpful to lump all of them together as just one diagnosis. Different types require different approaches, so it’s important to understand which type someone is experiencing.
The two most common types that we can talk about today are stress incontinence and urge incontinence.
What is Stress Incontinence?
Stress incontinence is leaking that occurs when you cough, sneeze, or laugh too hard. Or, it could be that you’re running or lifting something heavy, which causes you to leak a little.
It can happen when you’re doing something that puts stress on the pelvic floor, and the pelvic floor cannot provide strong enough support to prevent the leak.
Stress incontinence can occur as a result of pelvic floor muscle dysfunction that can result from many common life experiences, like pregnancy and childbirth, pelvic injuries, inflammation, surgeries in the pelvic area, sedentary lifestyles, and even pelvic floor tension.
What is Urge Incontinence?
Urge incontinence is when your leakage is accompanied or preceded by a strong sense of urgency to void. It’s the constant feeling of needing to go or feeling like you must do what I call a “Just in Case Pee.” You might be leaving our office, for example, and your home is only 15 minutes away, but you go anyway because you’re afraid you might pee yourself before you get home. Sometimes you’re rushing to the bathroom, but you can’t quite get there in time before you leak a little -or a lot.
Sometimes urge incontinence goes along with a stimulus, like water. For example, when people wash the dishes or hear running water, they feel the urge. Maybe they traditionally pee in the shower, and so anytime they get into a body of water or touch water, they pee themselves a little. That’s urge incontinence.
Usually, urge incontinence is habitual, being related to habits that put the bladder in a position where it has altered.
How Can Physical Therapy Help?
Thankfully, pelvic floor therapy can help with both types of incontinence.
Stress Incontinence: With stress incontinence, we usually work on strengthening and load management. The pelvic floor may be really tight and not strong enough to contract. In other cases, it could be very fatigued or atrophied.
We typically start with an internal exam to determine if we’re dealing with tightness/tension or weakness from atrophy. Once we determine that, we know where to start with a treatment strategy.
During treatment, we’ll not only work on exercises that will strengthen the pelvic floor but also discuss healthy bladder habits. We might talk about how to empty the bladder completely, positioning on the toilet, avoiding bladder irritants, and breathing mechanics. All these techniques help to ensure that incontinence does not become a continuous issue.
Urge Incontinence: With urge incontinence, we emphasize correcting bladder habits. Maybe you’ll have to stop peeing in the shower or drinking too much coffee or diet coke. We’ll work on positioning on the toilet, avoiding bladder irritants, and bladder scheduling. The bladder can be like a toddler- it requires consistent scheduling. When we ignore signals from the bladder, it can cause the bladder to stop sending us alerts. The contrary is also true- if we always use the bathroom when our bladder tells us to, then we will get alerts when our bladder is hardly full.
A healthy bladder requires using the bathroom every two hours. A healthy bladder volume is indicated by an 8-10 second stream. Sometimes we work on prolonging the amount of time in between using the bathroom; other times, we make sure to schedule bathroom breaks for people, like teachers, who may be used to going hours without using the restroom.
Overall, it’s a mix of different treatment approaches. It’s dependent on what the individual presents with; sometimes people need both approaches at the same time. Everybody is different. The biggest thing to remember is that even though incontinence is common, it’s not normal, and it’s quite treatable. And it’s nothing to be ashamed of!
Incontinence in any form (urinary or fecal, which we can also treat) can have an impact on people’s quality of life. Helping people to manage or move beyond their issues can be extremely satisfying for this reason!
The earlier we can address the issues, the better, so I urge people not to wait until it gets worse. We can help at any stage, but if you’re starting to experience little leaks, you don’t have to wait until it’s a bigger problem to seek treatment.
