Urinary Incontinence: What to do about it.

UI is more common than you think.

Urinary incontinence (UI) affects a staggering amount of people worldwide, with prevalence in men estimated to be 13.9%, rising to 51.1% in women. It’s easy to write off these statistics as reserved for the elderly or women postpartum, but research and clinical knowledge are starting to paint a different picture.


Reports are drawing attention to high school students, college athletes and nulliparous women experiencing UI, with an estimated 42 percent of female athletes without a history of pregnancy experiencing these symptoms. Although leakage is incredibly common, those affected sometimes feel shame and embarrassment, leading to social withdrawal and anxiety. Fortunately, through education, exercise and habit modification, these symptoms are often successfully treated with pelvic floor physical therapy.


UI is defined as the involuntary loss of bladder control and can be further broken down into stress and urge incontinence. Stress incontinence occurs when an activity that results in increased intraabdominal pressure, like coughing, sneezing or jumping, causes someone to leak urine. Urge incontinence occurs when someone is filled with a strong, sudden urge to urinate that cannot be held until making it to the bathroom. What I see most often clinically is ‘mixed incontinence,’ which as you can imagine, is a combination of the two.


When I talk to people about UI, I’m often asked the same question: “Can you give me exercises to address this?” In reality, because there are multiple causes of leakage, there are multiple methods of addressing it and they may not all be appropriate for each person. Before exercise and treatment, we need to establish the cause of your UI specifically.


On the most basic level, incontinence can be caused by weakness or tension. This can involve the pelvic floor muscles, but also the abdomen, adductors, abductors and even diaphragm. Your pelvic floor does not function in isolation, but rather works alongside the other muscles previously listed. If these muscles are weak, they make it difficult to hold back urine against the increase in intra abdominal pressure that comes with certain activities. However, if these muscles are tight and spasmed, you may not be able to hold your bladder long after that initial signal to go, resulting in loss of control.


It’s difficult to know which category, weakness or tension, someone falls into without assessing the pelvic floor itself. A pelvic floor assessment is an internal exam by a licensed healthcare professional that tests strength and assesses muscular tone of the pelvic floor. Without a proper assessment of the pelvic floor it’s hard to suggest specific strengthening or stretching to individuals.


Fortunately, there is an entire field devoted to helping people struggling with these symptoms. Pelvic floor physical therapists are equipped to help determine what your strength is like, as well as whether tension is a contributing factor. While many of us are familiar with kegels for strengthening the pelvic floor, it’s often difficult to determine whether we’re doing kegels correctly, or if kegels are even the correct exercise for us.


Other exercises that may be appropriate for someone with weakness target the glutes, transverse abdominis, even hip flexor strengthening. Exercises like clamshells, squats and pelvic bracing. On the other hand, for those with tension, we want to focus on relaxation. Relaxation and stretching for the pelvic floor focuses on optimal breathing patterns, and simple stretches like child’s pose and happy baby.


On average, it takes women 6.5 years to find help for pelvic floor symptoms, while it takes men 4.5 years. The more we know, the faster we can find the help we need.

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