Urinary Incontinence

What is Urinary Incontinence?

It is simply the involuntary loss of urine. Stress, urge, or a mix of the two are the most common types of incontinence.

Stress Incontinence

The latest estimates are that 15-25 million Americans experience some form of incontinence. The Occurrence is much higher for women than men. Incontinence affects an estimated 26% of women between the ages of 30 and 59.

Related Anatomy - Pelvic Floor and Pelvic Organs

The Pelvic Floor organs consist of the bladder, urethra, uterus and vagina in women, and the rectum. The Pelvic Floor muscles support the pelvic floor organs by acting like a hammock. These muscles can be contracted to cause the hammock to become more taut, thus giving more support. This is especially important when doing physical activities or while coughing.

Related Anatomy - Bladder and Sphincters

The bladder is lined with smooth muscles. These muscles cannot be controlled voluntarily. They are controlled by the autonomic nervous system, which is similar to how our heart muscles are controlled.

When a person feels the urge to urinate, it is because the bladder muscles are contracting. The pelvic floor muscles, including the deeper sphincter muscles, can be contracted to prevent urine leakage during the strong urges and to turn the bladder contractions off indirectly through the nervous system. The person can then urinate at the appropriate time by relaxing the pelvic floor muscles.

Causes of Incontinence

There are many causes of incontinence. The following are some causes for stress and urge incontinence:

• Dropping of the Uterus, Bladder or other organs
• Weakness or Looseness of the Pelvic Floor
• Nerve and/or Muscle Damage from Surgeries,
• Trauma, or Childbirth
• Scar Tissue
• Connective Tissue Disorders
• Tight Abdominal and Pelvic Floor Muscles
• Chronic Constipation
• Neurological Conditions such as Stroke, MS,
• Spinal Cord Injuries and Diabetes
• Vaginitis, Cystitis or Uethritis Medications
• Structural Obstructions (enlarged prostate in men)
• Urinating Habits

Treatment

The treatment plan is individualized based the physical therapists evaluation and assessment of each patient, and it can be modified according to each patients preferences and comfort level. Great emphasis is placed on teaching patients the correct way to do a pelvic floor contraction (Kegel). Many times patients have already tried Kegel exercises on their own without improvement. The reason usually being because they were done incorrectly. Treatment may include the following:

• Bladder Diaries
• Diet and Fluid Intake Modifications
• Correction of Voiding Habits
• Exercise to Strengthen/Relax the Pelvic Floor
• Biofeedback
• General Relaxation Exercises
• Internal and External Soft Tissue Mobilization

Success Rates

Physical Therapy has an 80-90% success rate of an 80-90% reduction of symptoms for those with Stress Incontinence. That is a higher percentage than surgery! There is a 60-80% success rate of a 60-90% reduction of symptoms for Urge Incontinence. However, success is dependent on the patient following through with the treatment plan. Typically, the course of treatment is once a week for 6-12 weeks. The latest estimates are that 15-25 million Americans experience some form of incontinence. The occurrence is much higher for women than men. Many of them are not elderly. Incontinence affects an estimated 26% of women between the ages of 30 and 59. Please report your problem to a doctor and seek help! There are treatment options out there.