Urinary Incontinence: Common, But Definitely Not Normal

Urinary Incontinence: Common, But Definitely Not Normal

Urinary incontinence (UI) affects 1 in 4 of all reproductive-aged women, and 1 in 2 of all post-menopausal women. Incontinence is a significant health problem with considerable social and economic impacts that greatly impairs quality of life and often leads to feelings of shame and depression. And despite its prevalence, fewer than half of the 11 million American women affected by UI seek help. Many women believe there is nothing they can do and that UI is something they simply have do deal with during pregnancy, after childbirth, or as they age. Though the numbers show that UI is certainly common, it’s not normal, and, in many cases, is very treatable.

The types of UI

  • Stress incontinence is characterized by the leakage of urine with physical exertion due to weakened pelvic floor muscles and often responds well to strength and endurance training. It takes place when pressure on the bladder increases and often occurs with strenuous activities such as lifting, or with coughing or sneezing.
  • Urge incontinence is the involuntary leakage of urine usually accompanied by a sudden, urgent desire to void, and is often described as overactive bladder. It typically responds well to behavioral modifications that help reprogram the autonomic nervous system. Patients with urge incontinence often report frequent trips to the bathroom. It’s also common to experience a mixture of both types.

There are many different causes of UI, one of which is weak and damaged pelvic floor tissues.

Certain life events that can compromise the integrity of the pelvic floor include pregnancy, childbirth, and aging.

If weakness is the cause of incontinence, the International Consultation on Incontinence recommends that pelvic floor muscle training – aka: PFMT or Kegels – should be offered as first-line therapy. PFMT addresses strength, endurance, and motor control and is effective when it is offered alongside behavioral modification strategies, such as avoiding bladder irritants, performing urge suppression techniques, and bladder retraining. As for Kegels, women are often instructed to do them, but are never taught how.

The Pelvic Floor & Exercises to Try

If you’re not sure where to find your pelvic floor, you needn’t look far. You’re sitting on it. The pelvic floor plays an important part of bowel, bladder, and sexual function and is made up of a muscular layer that seals off the pelvic cavity from below. Think of it as a hammock that extends side to side from your sit bones, and front to back from your pubic bone to your tail bone. In women, the urethra, vaginal canal, and rectum all pass through the pelvic floor.

Lying down is typically the easiest way to begin practicing pelvic floor muscle training because it’s gravity eliminated. Gently squeeze and lift your pelvic floor as if you’re trying to prevent passing gas or stop the flow of urine. Try not to squeeze your glutes or hold your breath – these are common compensations to avoid. Once you have the movement down, try holding it for several seconds at a time and repeating throughout the day. As you build strength and endurance, you can attempt performing them in more challenging positions and with activities.

Performing these exercises, paired with different components of bladder retraining – such as keeping a bladder diary, practicing urge suppression techniques, and maintaining a fixed voiding schedule – are simple ways to address pelvic floor weakness leading to UI. Your physical therapist can help you understand the best combination to suit your lifestyle and address your particular symptoms.

Coyne KS, Wein A, Nicholson S, Kvasz M, Chen CI, Milsom I. Economic burden of urgency urinary incontinence in the United States: a systematic review. J Manag Car Pharm. 2014:20(2):130-140.
Lamin E, Parrillo LM, Newman DK, Smith AL. Pelvic Floor Muscle Training: Underutilization in the USA. Curr Urol Rep. 2016:17(2):10.
Mayo Clinic. 2018. Available at: https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/symptoms-causes/syc-20352808. Accessed July 12, 2018.
UCSF Women’s Continence Center. 2018. Available at: https://coe.ucsf.edu/wcc/AboutBladderProbs_incont.html. Accessed July 12, 2018.

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