Caitlin Ruggiero DPT, PT
In the past, urinary incontinence has been considered as a “normal” part of aging when in fact it is not. Furthermore, urinary incontinence affects individuals of both sexes throughout the life span. While an embarrassing topic to talk about urinary incontinence is not an issue that one needs to secretly live with.
There are several types of urinary incontinence. Stress urinary incontinence is the loss of urine with cough, laugh, and sneeze due to the sudden downward force of the abdominopelvic organs from the increased abdominal pressure. This form of incontinence is very common in women after child birth due to mechanical stretching of the muscles and ligaments. Stress urinary incontinence is also common in men and women following surgery to pelvic/ abdominal area, chronic coughing or sneezing and someone suffering chronic constipation.
Urge urinary incontinence is when there is a sudden, strong urge to urinate and not enough time to get to the restroom. There are several common triggers for the urge including: running water, seeing a bathroom, putting one’s key in the door and cold air. When the trigger occurs, the bladder contracts and the urinary sphincter relax causing urinary leakage. This form of incontinence quickly isolates individuals due to the fear of having to go to the bathroom when in a social setting. Many people with this form of incontinence know all the locations of pubic bathrooms in their area and tend to go to the bathroom “just in case.”
There are several other types of less common urinary leakage. Mixed incontinence is when an individual has a combination of both urge and stress incontinence. Functional incontinence is due to the physical inability to make it to the restroom on time which is more common in the elderly population due to orthopedic problems, environmental factors and cognitive issues.
In all forms of urinary incontinence there is often a common factor of pelvic floor muscle weakness. The pelvic floor is a muscular hammock along the bottom of the pelvis which the urethra, vaginal canal and rectum pass through. The pelvic floor is made up of three layers of pelvic floor muscles and when the muscles contract they close the openings and close the rectal and urethral sphincter. In addition the contraction of the pelvic floor causes the muscles to shorten and lift helping to support the pelvic organs. The pelvic floor is comprised of both slow-twitch and fast-twitch muscle fibers which collectively help maintain continence. The slow twitch fibers are constantly contracting to maintain sphincter closure when not urinating. The fast twitch fibers function when quick contraction of the pelvic floor is required at times such as suppressing the urge to void.
There are several ways to treat urinary incontinence but first the medical provider needs to determine where the problem is stemming from. There are several factors such as posture and hormonal change and lumbar spine dysfunction that can cause pelvic floor dysfunction. Through a musculoskeletal assessment of the pelvis, lumbar spine and LE strength weaknesses will be assessed. In addition, a breathing assessment will be performed to ensure the pelvic floor muscles are coordinated. Pelvic muscle recruitment will be assessed through surface EMG biofeedback. Pelvic floor muscle strength can also be assessed through an internal pelvic exam where the evaluating therapist checks muscle tone, strength and endurance. Based on the physical and subjective assessment a specific program will be created which may include: kegels, core stabilization, stretches functional mobility activities and patient education on lifestyle modifications.
If you feel you may have urinary incontinence or any other forms of pelvic floor dysfunction please contact your nearest Aquacare Physical Therapy and set up an appointment or a free screening to talk with one of our pelvic floor specialists. Come join me on September 14 at the Aquacare twenty year anniversary celebration at our Milford street location to learn the bottom line of kegels!
Caitlin Ruggiero DPT, PT leads our specialty women’s health center in Salisbury, MD as a pelvic floor therapist with over 7 years of experience.