Last week I explained how the bladder works and correctly interacts with the pelvic floor. If you missed it, go check it out here. This week I’m talking about urinary leakage: who, what, when, where, and why.
Anyone can have urinary leakage or incontinence (UI). As many as 57% of middle-aged and postmenopausal women, 25% of young women, and 75% of women in nursing homes experience leaking.
The likelihood of leaking increases with successive vaginal births with a lower correlation following c-section. One study found that 28% of elite female athletes who had never had children experienced leakage, with 40% of those noting that the leakage started in high school.
Incontinence is any urine leaking at an undesired time.
The four types of urinary incontinence are stress incontinence, urge incontinence, mixed incontinence, and overflow incontinence. All of these result in urine leaking at undesirable times. This could be anything from a few drops to emptying the full bladder. Stress incontinence occurs with jumping, running, sneezing, and coughing. Urge incontinence is when leaking occurs with an urge to pee. The urge often has triggers such as running water, walking in the house, or being cold, but it does not have to be associated with these activities. Mixed incontinence is a combination of stress and urge incontinence. Overflow incontinence occurs when the bladder stores well but has difficulty emptying. The bladder will continue to store urine until it is so full that it can not expand any more and leaks. Picture this as a cup overflowing.
Urinary incontinence typically starts with body changes such as pregnancy and birth, menopause, weight gain, constipation, or for men prostate enlargement or cancer. Medical procedures such as surgery or radiation can cause changes that increase incontinence. One example for women is hysterectomy. Medications can affect the way the bladder and muscles function leading to leaking. Diuretics, antidepressants and antihistamines are only a few examples. Neurological changes due to Parkinson’s Disease, spinal cord or brain injuries, multiple sclerosis or diabetes will lead to urinary and bowel changes and often leaking if not proactively managed.
Down there, in your underwear. (Okay, "where" just went with the theme so I left the section in.)
The short answer… it depends on you. Why your leaking started could be something as simple a new medication with not so fun side effects! It could be that you had a vaginal birth and your body just hasn’t made a full recovery yet. A good provider will help you get to the answer to your "why" and get started with treatment.
Treatment options can include everything from activity and nutrition modification, exercise, medication changes and surgery. A pelvic health PT will discuss your medical history, current diet and exercise. They will ask you about bladder habits - how often do you leak, how much, when, how often do you go to the bathroom, and other questions. They will examine and assess your pelvic floor, abdominal and hip strength, coordination and functional activation. All of this information will be taken into account to determine the best plan of action for you! Treatment may consist of increasing water and pelvic floor coordination or it may be a handful of exercises focused on proper muscle coordination.
There is no "one size fits all" approach to urinary incontinence, and seeking out a good provider who looks at all the possible factors and you as a person can make the difference in your successful outcome.
To summarize: pelvic health physical therapy can help you recover quickly so you can get back to living your best life!
Next week: Tips to reduce pain with urination