What Really Causes Urinary Incontinence
Your pelvic floor serves several functions, including control of your bladder. When the collagen in your pelvic walls break down after aging or giving birth, theyre unable to control your bladder like before. Restoring that collagen is key to repairing your pelvic floor.
But restoring your pelvic floor means so much more than reducing the symptoms of urinary incontinence. A weak pelvic floor can cause vaginal dryness, loss of responsiveness, inability of climax and decreased vaginal tone. This may lead to a decline or even an absence of sexual desire, where women lose the ability climax.
Simply put: Restoring your pelvic floor means leaking less and peaking more.
What Is Urinary Incontinence
Urinary incontinence is any undesired leakage of urine. People with the condition may have trouble starting the urine stream or holding urine. Urinary incontinence involves the muscles of the pelvic floor. These muscles attach to the bottom of the pelvic bones and run front to back, forming a hammock structure that lifts to support the internal organs and controls the sphincter muscles. The pelvic-floor muscles also help support the low back, stabilize the pelvic bones, and help with sexual function. Women may be more likely than men to have urinary incontinence however, the condition in men may be underreported.
There are different types of urinary incontinence, including:
- Stress incontinence. This occurs when there is increased intra-abdominal pressure and the pelvic-floor muscles do not have the control to maintain continence. Those with stress incontinence leak urine during a physical activity, such as playing a sport, or simply laughing or sneezing.
- Urge incontinence. People with urge incontinence can experience a sudden, strong need to pass urine, and leak before reaching the bathroom.
- Mixed incontinence. Some people experience both stress and urge incontinence.
- Functional incontinence. Even without an intense urge to urinate, people with functional incontinence may leak urine on the way to the bathroom.
- Urinary frequency. Some people feel the need to empty the bladder frequently throughout the day and more than once during the night.
Design Participants And Settings
This was a pragmatic non-randomized controlled trial that investigated the effectiveness of service and patient oriented physical therapy intervention for community women with UI symptoms delivered at health centers. Intervention program was service and patient oriented regarding to: participant’s preference about the setting to perform the intervention, either at health center or at home pelvic floor muscle contraction capacity evaluated by inspection over the underwear PFMT dose prescribed according to the participant’s PFM endurance bladder training according to the participant’s 24-h micturition diary.
All women who attended two primary care centers, from July 2010 to Oct 2011 were invited by community health agents or by nurses to answer the International Consultation on Incontinence Questionnaire-Short Form and signed the informed consent. In a second moment, women identified in the ICQ-SF as having UI, aged 18 years, and had never received physical therapy intervention for pelvic floor dysfunction were invited to participate in the study. Women who could not contract their PFM, were pregnant, presented symptoms of urinary infection, neurological disorders and/or difficulty understanding the treatment protocols were excluded and referred to the primary care physician for further consultation.
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What Causes Urinary Incontinence
Urinary incontinence occurs when you accidentally lose control of your bladder and leak urine. You can temporarily develop urinary incontinence when you have a urinary tract infection or from some foods, beverages, and medications.
However, when urinary incontinence is persistent, there may be a problem in the nerves that control your bladder or your pelvic floor muscles, which support the bladder and control the flow of urine.
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Pelvic Floor Muscle Training Can Improve Symptoms Of Urinary Incontinence
Two-thirds of women with any type of urinary incontinence who have pelvic floor muscle training see improvement or cure compared with only a third of women who receive no treatment or inactive treatments. It is even more effective for women with stress incontinence, with three-quarters of women reporting improvement or resolution of symptoms, such as episodes of leakage.
This systematic review included 31 trials and 1,817 women with any type of incontinence stress, urgency or mixed urinary incontinence.
Findings support current guidelines to offer pelvic floor exercises as first-line conservative management in women with urinary incontinence. Long-term effectiveness and cost-effectiveness require further evaluation.
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Pelvic Floor Muscle Exercises
Many physicians recommend Pelvic Floor Exercises as a first line treatment for Stress and Urge bladder leakage. The goal of pelvic floor muscle training is to strengthen weak urinary sphincter and pelvic floor muscles the muscles that control urination and defecation.
Pelvic floor muscle exercises are often referred to as Kegel exercises named after the physician, Dr. Arnold Kegel, who popularized this technique.
Can Physical Therapy Help Incontinence
Pelvic floor physical therapy can help you strengthen the muscles that govern when you go.
However, the problem may not be just weak pelvic floor muscles. These potential problems should be properly assessed by a pelvic floor physical therapist.
Even if the problem is caused by weak pelvic floor muscles, doing exercises, such as kegels, without the help of a physical therapist can do more harm than good. Many do these exercises incorrectly, which may cause more problems than they solve.
PRO~PT provides pelvic floor physical therapy for incontinence that can help train your body and improve your condition.
Getting a physical therapy evaluation for urinary incontinence or fecal incontinence will help your physical therapist learn more about your specific situation. Everyone is unique, and getting a professional opinion will point you in the right direction to begin healing.
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Clinically Relevant Anatomy: Pelvic Floor
The pelvic floor is made up of the muscles, ligaments, and fascial structures that act together to support the pelvic organs and to provide compressive forces to the urethra during increased intra-abdominal pressure.
The pelvic floor muscles refer to the muscular layer of the pelvic floor. It includes the levator ani, striated urogenital sphincter, external anal sphincter, ischiocavernosus, and bulbospongiosus.
The urethra, vagina, and rectum pass through the pelvic floor and are surrounded by the pelvic floor muscles. During increased intra-abdominal pressure, the pelvic floor muscles must contract to provide support. When the pelvic floor muscles contract the urethra, anus, and vagina close. The contraction is important in preventing involuntary loss of urine or rectal contents. The pelvic floor muscles must also relax in order to void.
What Is Pelvic Floor Physical Therapy
Pelvic floor physical therapy is a form of physical therapy that helps you to properly engage the pelvic floor muscles that regulate the release of urine and feces. If you have OAB, pelvic floor physical therapy may help you to control sudden or frequent urges to urinate.
A specially trained physical therapist will first assess your pelvic floor. Theyll help you to identify and utilize the proper muscles, then guide you through a set of pelvic floor exercises based on your individual needs.
Some of these exercises may include:
- Kegel exercises, which focus on tightening and holding the muscles that control urine flow
- abdominal exercises
- exercises that target the glutes, such as glute bridges and squats
- exercises to help strengthen your posture
If you have trouble identifying your pelvic floor muscles, biofeedback can help. A pelvic floor physical therapist will apply special sensors to the pelvic floor that capture electronic activity. A monitor displays a chart that changes or lights up when the right muscle is tightened.
A pelvic floor physical therapist may also teach you other behavioral strategies that can help control a sudden, frequent, or uncontrollable urge to urinate. These may include:
- bladder training and urge suppression strategies
- lifestyle measures, such as diet
- programmed urination
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What Do They Do In Physical Therapy For Incontinence
The pelvic floor refers to a hammock-shaped group of muscles that make up the floor of the pelvis. In many cases, these muscles can be conditioned to function better on demand.
These muscles have important functions that include:
- Support for the bladder inside the pelvis
- Telling the bladder to hold until you can reach the bathroom
- Helping to control urgency by communicating with both the brain and bladder
- Contributing to bladder control by holding the sphincter closed
- Assisting with emptying the bladder by releasing the sphincter
A physical therapist can help those with incontinence by doing a few key things:
- Education on pelvic floor anatomy
- Teaching you exercises to strengthen the pelvic floor muscles
- Dietary coaching to help reduce foods that may contribute to incontinence
- Instruction on using your pelvic floor muscles during common activities
What Is Pelvic Floor Muscle Therapy
Pelvic floor therapy is a type of physical therapy or exercise program that focuses on the pelvic floor, including the muscles and connective tissues that help hold the pelvic organs in place. PFMT, is a painless treatment option which comes with a 70-80 % success rate of significantly improving symptoms and has no side effects.
Pelvic floor therapy begins with a health assessment and an examination to determine the existing strength of the pelvic floor muscles and to decide which exercises will be most beneficial in achieving results. Patients are taught how to identify and focus on their pelvic floor muscles so exercises are more effective. Pelvic floor stimulation is then performed in our office with a vaginal and/or rectal sensor. A mild electrical stimulus is used to stimulate pelvic muscles and causes a comfortable, timed contraction of the pelvic floor muscles. This will feel like a gentle tapping sensation and you will feel the muscle contract.
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Is Pelvic Floor Dysfunction A Disability
Pelvic floor dysfunction isnt currently listed as a social security disability. However, depending on your symptoms you may be able to claim disability under the Disability Evaluation Under Social Security Section 6.00, Genitourinary Disorders. For more information, check with your provider and social security contact.
Pelvic Floor Exercises And Stress Incontinence
Reviewed byDr Hannah Gronow
Pelvic floor exercises, also known as Kegel exercises, have numerous benefits and may help cure stress incontinence. Pelvic floor exercises are also useful to prevent incontinence for women who have had children. In addition, some people feel that having strong pelvic floor muscles heightens the pleasure when having sex.
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Types Of Urinary Incontinence
Urge incontinence is caused by a muscle spasm or some other dysfunction in your bladder. That spasm causes a strong urge to urinate right now. Before youre able to reach the toilet, you may leak some urine.
If you have urge incontinence, physical therapy can help control the muscle spasms or other dysfunctions that cause the strong urge to urinate.
Stress incontinence is any leakage of urine that begins with increased pressure on your abdomen. This pressure could be a cough or sneeze. You may leak when you laugh or jump, or from any physical activity.
Physical therapy for stress incontinence will help strengthen the pelvic floor muscles to prevent leakage during physical activity.
Mixed incontinence is when you leak from both stressors and urges.
This could mean you have an involuntary loss of urine thats associated with the urgency to urinate, or due to physical activities, or from coughing or sneezing.
How Is It Diagnosed
Your physical therapist will perform a thorough examination to identify the causes of your urinary incontinence, and will ask you to describe your symptoms and your daily experiences. They may assess the muscles of your pelvis, hip, and low back, as well as the coordination, strength, and flexibility of the muscles of your pelvic floor.
Your physical therapist also may refer you to a physician for additional tests, such as urodynamic testing, diagnostic ultrasound, or MRI to show any pelvic-floor muscle problems, to ensure an accurate diagnosis.
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Where To Receive Physical Therapy Treatment For The Pelvic Floor
If a patient needs to be seen by a physical therapist, the providers at CU Urogynecology work with her to find the closest location to receive treatment. We have 12 locations all over the Denver metro area for easy access, no matter what part of town a woman lives in.
We also offer physical therapy services in our Anschutz office. This can be a great option for before or after appointments with our providers.
Contact us to request an appointment with one of our urogynecologists to learn if this nonsurgical therapy is an option to treat a pelvic floor disorder.
If youre struggling with a pelvic floor disorder, we want to help. Contact us today to learn about our services and treatment options.
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How Can Pelvic Floor Physical Therapy Help
Your pelvic floor muscles work to support your abdominal contents , allow for urination and defecation, prevent leakage of urine or stool when not desired. These muscles also help to stabilize the pelvis, working with your abdominal muscles, back muscles, and diaphragm. When these muscles are too weak or too tight, urinary incontinence can be the result, and you may need pelvic floor rehabilitation.
When you arrive at our office, your physical therapist will evaluate your medical history and ask you a series of questions regarding urinary frequency. He or she will perform a physical evaluation that includes watching you walk, squat, bend over, and breathe, all to observe for any mobility deficits, muscle imbalances, or postural dysfunction. Strength, endurance, flexibility, and motor control of the pelvic floor muscles will also be evaluated to help in determining the best route for your treatment plan.
Typical treatments for those dealing with urinary incontinence typically include:
- Participating in functional activities.
- Participating in a home exercise program and instruction
- Ultrasound therapy
- Increasing endurance of the core, strength, and stability in hip muscles and pelvic floor
- The use of biofeedback for pelvic floor training
- Performing strengthening exercises
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Who Needs Pelvic Floor Physical Therapy
Pelvic floor physical therapy is recommended as first-line remedy for many disorders of the pelvic region. Both men and women with weakness in pelvic floor muscles can perform exercises to strengthen the floor and enhance bladder and bowel control. Specifically, a physician will refer a patient for the therapy if pelvic floor dysfunction is suspected to have a neuromuscular cause. The dysfunction may result from aging, illness, childbirth, surgery or other conditions and may coexist with other genitourinary problems, such as urinary incontinence, fecal incontinence, bladder-emptying problems, and constipation.
Patients are referred for pelvic floor therapy when they have incontinence, chronic pelvic pain, painful intercourse, and difficulty with bowel movements or urination. Women may see pelvic floor therapists for treatment of endometriosis or vaginismus while men may be treated for premature ejaculation and painful ejaculation. Pelvic floor exercises are beneficial for women with a lower risk of vaginal prolapse, bowel and bladder issues, and those recovering after childbirth. The treatment also helps men who have undergone prostate surgery to have speedy recovery, reduced risk of rectal prolapse and improved bladder and bowel control.
Pelvic Floor Exercise Tips
If you are not used to doing pelvic floor exercises then perhaps do the exercises as often as described above for the first three months or so. This will strengthen up the pelvic floor muscles. Thereafter, a five-minute spell of pelvic floor exercises once or twice a day should keep the muscles strong and toned up which may help to prevent incontinence from developing in later life.
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What The Research Says
Research suggests that pelvic floor physical therapy can reduce OAB symptoms of frequency, urgency, and leakage. It may also help ease pelvic pain and improve quality of life.
One small study found that pelvic floor muscle training significantly improved a variety of symptoms in women with OAB, including urinary leakage, nocturia , and the extent of discomfort caused by urinary symptoms.
A 2016 study found that pelvic floor muscle training paired with biofeedback significantly reduced symptoms and complaints of OAB and increased quality of life for the study participants after 9 weeks of treatment.
A meta-analysis of several studies also found that pelvic floor muscle training significantly reduced OAB symptoms, including urinary frequency and urgency urinary incontinence, across at least five studies. However, the authors believe that more studies are needed with higher quality methods to draw better conclusions.
How Can A Physical Therapist Help
Based on the evaluation results, your physical therapist will create an individualized treatment program to improve your pelvic-floor muscle function. Your physical therapist can help you:
- Gain control over your symptoms.
- Reduce the need for pads and special undergarments, incontinence medications, and possibly surgery.
Treatments to Improve Pelvic-Floor Muscle Function
Your physical therapist will teach you how to “find” your pelvic-floor muscles by tensing and releasing them. The physical therapist will design an exercise program based on your condition to help you improve your pelvic-floor muscle function so you can better control your bladder.
Your treatments may include:
- Kegel exercises. The Kegel exercise is performed by squeezing the sphincter muscles or imagining that you are trying to stop the flow of urine.
- Biofeedback. Depending on your symptoms and level of comfort, your physical therapist may gently employ electrodes to measure your pelvic-floor muscle activity. The biofeedback obtained can help make you more aware of the correct way to use your pelvic-floor muscles.
- Muscle strengthening exercises. Your physical therapist will teach you specific exercises to stretch and strengthen other important muscles that help support proper bladder function.
- Electrical stimulation. Your physical therapist may apply gentle electrical stimulation to help improve your awareness of your muscle function.
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