By Falguni Vashi
The expression “I laughed so hard I peed my pants” is often said jokingly. But there is nothing funny about it. Urinary incontinence (involuntary leakage of urine) is common but not normal.
Who is affected by Incontinence?
The World Health Organization considers urinary incontinence as a public health problem. Urinary incontinence affects more than 13 million Americans. Both men and women, young and old, may experience some form of incontinence that can make them feel ashamed and isolated. For many people, the fear of public embarrassment, prevents them from enjoying many activities with family and friends.
Urinary incontinence with exercising, dancing, running and any other high impact activity is very common but not normal. Urine loss can also occur during sexual activity and cause tremendous emotional distress. 1 in 4 women, over the age of 18, experience episodes of incontinence. Urinary incontinence is not part of normal ageing process, menopause or pregnancy or prostate problems (for men) and when addressed properly can be reduced or eliminated.
What are the different types of urinary incontinence?
There are different types of incontinence:
1. Stress incontinence – Stress urinary incontinence is leakage of urine that occurs when there is increased pressure on the bladder. This can happen with activities such as coughing, sneezing, laughing, exercise or lifting. Stress incontinence is common post pregnancy. Stress incontinence can be caused by obesity, surgery, medications and lower hormonal levels also cause it. Physical therapy is the first line of treatment for stress incontinence. Stress incontinence may also be treated with medications, pessary and surgery.
2. Urge Incontinence- Urge urinary incontinence is loss of urine with a sudden and strong feeling of urgency/desire to urinate. Urge incontinence usually has triggers (cold, running water, key in the door). The common complaint is “I am unable to make it to the bathroom”. Urge incontinence is caused by overactive and uncontrolled bladder contractions, followed by involuntary leakage of urine. Urge incontinence is common in diabetes and in some of the neurological conditions. Urge incontinence is treated with physical therapy, medications and surgery.
3. Mixed Incontinence- Mixed urinary incontinence is a combination of both urge and stress incontinence.
When should you see your doctor?
See your health care provider if you are experiencing frequent urination, urgency, urine leakage, blood in the urine or pain with urination. You should also see your doctor if you have the habit of going to the bathroom, “just in case”, because either you are going out or have a long meeting or a long ride. We all have heard mothers tell their children, “go to the bathroom because we are going out”. Children should be encouraged to go to the bathroom only when they need to. When talking to the doctor, bring up your concerns about your bladder/urinary incontinence. More often than not, health care providers are very happy to discuss the issue and direct you in the right direction.
What are the healthy bladder habits?
• Urinate every 2-5 hours.
• Urinate 0-2 times at night.
• Avoid going to the bathroom “just in case”, so your bladder can hold more urine.
• Drink 6-8 glasses of clear fluids, two-thirds of your fluid intake should be water.
• Avoid constipation
• Avoid bladder irritants
• Do not drink fluids 2 hours before bedtime
• Avoid: caffeine, alcohol and nicotine
What is the role of Pelvic Floor Physical Therapist?
Research has shown that pelvic floor muscle training be included as the first line of conservative management programs for stress, urge or mixed urinary incontinence. Pelvic floor PT results in significant reductions in both the urinary incontinence which in turn results in ability to carry on with daily activities withut having to worry about incontinence and getting back to exercising and enjoying other recreational activities. symptom-related distress and symptom impact (change the wording to simple wording)
Behavioral treatments for UI
Behavioral treatments are effective for stress and urge UI and overactive bladder. These include Bladder re-training, treating constipation, and medication review.
Bladder re-training
• Bladder Diary- First you need to fill out a bladder diary, which has information about amount and time of intake of fluids/kind of fluids, time of urination, amount of urine, amount of urinary leakage and activities that cause urinary leakage. This will give you a general idea about your bladder habits. Based on the bladder diary, your physical therapist will be able to devise an individualized plan of care.
• Urge Deference –Instead of rushing to the bathroom as soon as you have the urge, it is important to learn to “hold on”. Ideally you should be able to hold onto 3-4 hours between bathroom visits. People with urge incontinence / overactive bladder, tend to go to the bathroom more often than they need to, to avoid accidents. Unfortunately, rather than helping this makes it worse as the bladder becomes used to holding less urine. So DO not go to the bathroom just in case. At times, decreased fluid intake and dehydration will make your bladder irritated, which in turn will increase urinary urgency and urinary frequency. Your physical therapist can teach you urge deference techniques that will help you gradually decrease the frequent bathroom visits, but patience is needed as it may take weeks or months before you notice improvement. Again keeping a bladder diary will help you monitor your progress
• Change your fluid intake- There are a number of fluids that may affect/irritate the bladder. Some of the common bladder irritants are : caffeinated drinks like tea and coffee, carbonated fizzy drinks, green tea, hot chocolate and alcohol. Some of the common fluids that do not irritate your bladder are: water, caffeine free tea and coffee, herbal teas, all types of diluted juices and milk. Many people with bladder problems reduce the amount of fluid that they drink. DO NOT reduce the fluid intake, as this can make the problem worse as the bladder never gets full and loses the ability to stretch. In addition, the urine becomes concentrated (due to dehydration) which irritates the bladder more. The goal should be to drink 1.5 to 2 liters of fluids a day.
Pelvic floor muscle exercise with or without biofeedback
A pelvic health physical therapist assesses your pelvic floor muscles, both externally and internally (vaginally or rectally). The therapist will also assess your core strength and hip muscle strength. Based on the assessment the physical therapist will prescribe exercises for your pelvic floor muscles and your core/hips as indicated/needed. Sometimes, the pelvic floor muscles are too tight and have tenderness/trigger points. The tight muscles have to be relaxed first, before any strengthening or kegel exercises are prescribed. The therapist can work on these muscles internally and help reduce/release the tightness and tenderness/trigger points. Often times, they will use biofeedback, to help the patient understand and relax the pelvic floor muscles. The biofeedback provides visual and auditory cues to the patient to understand what a pelvic floor contraction/relaxation feels like.
(This is just some basic information about urinary incontinence for informational purposes. For any such issues, please contact your physician. If you have any question regarding the information provided here, please email your questions to Falguni Vashi at pelvicrehabpt@gmail.com.)
