Help for Urinary Incontinence
By Berkeley Physical Therapist Esther Dolowich of Alta Bates Program for Urinary IncontinenceOpens new window
For the 17 million American women who suffer from urinary incontinence, feelings of shame, embarrassment and isolation often compel them to suffer in silence. But the good news is that 75 percent of women successfully respond to physical therapy treatment for this condition and are able to return to their desired quality of life.
Urinary incontinence has a wide range of symptoms – from minor leaking while laughing to the uncontrollable complete emptying of the bladder. Anyone can have this condition – it is not a respecter of health, physical fitness or gender. It is not an automatic part of aging, which is a persistent and common myth.
Treating Urinary Incontinence
There are three common types of urinary incontinence, which are not the result of a brain/central nervous system illness or injury: Stress Urinary Incontinence, Urge Urinary Incontinence and Mixed Urinary Incontinence. Determining which type you have is important to finding the right treatment.
- Stress Urinary Incontinence (SUI) is defined as involuntary or accidental loss of urine during activities that increase intra-abdominal pressure, such as coughing, sneezing, laughing, exercise, or lifting. SUI is usually caused by a weakness of the pelvic floor muscles – the muscular hammock that sits between the pubic bone and the tail bone. The pelvic floor muscles have four functions: sphincter closure, pelvic organ support (bladder, uterus, rectum), sexual appreciation (increases sensitivity and responsiveness), and core body stabilization.
Physical therapy treatment methods include patient education about the pelvic floor muscles, teaching patients how to find and contract the muscles correctly, working on strengthening the muscles by regularly practicing Kegels – pelvic floor muscle contractions – and integrating the muscles by doing Kegels with a sneeze or cough or while lifting heavy items. Often the patient will attend a class and then receive an individual physical therapy evaluation to assess muscle function. Biofeedback can also give the therapist and patient helpful insights.
- Urge Urinary Incontinence (UUI) is a sudden, strong feeling of urgency caused by overactive and uncontrolled contractions of the bladder. Involuntary leaking of urine is often accompanied by the urge to urinate. UUI can range from leaking a small amount to the complete emptying of the bladder. Urges can be triggered by hearing running water; being cold; putting the key in the front door; walking by a bathroom; consuming a lot of bladder irritants, such as caffeinated drinks or citrus juices; or hormonal changes.
Physical therapy treatment for UUI focuses on the pelvic floor musculature, education about dietary contributions, increasing hydration with water to help dilute the concentration of urine, and bladder retraining. UUI can cause increased frequency of urinating from a normal of 6-8 times to 15-20 times in a 24-hour period. Physical therapy can help with bladder retraining by training the bladder to hold larger amounts of urine for longer periods of time. Learning how to calm the nervous system to reduce anxiety and stress can also be very helpful for UUI.
- Mixed Urinary Incontinence is having symptoms of both stress and urge urinary incontinence and usually requires a combination of the physical therapy methods mentioned to address the problem.
The first step in treating urinary incontinence is to visit your doctor and explain your symptoms. Unfortunately, due to the stigma of this problem, many women wait years before seeking medical attention. But as common as urinary incontinence is, anyone with symptoms can find help right away through medical treatment and physical therapy. Your physician will most likely seek out signs of a variety of medical conditions that cause incontinence and perform tests to measure bladder capacity and residual urine to look for evidence of malfunctioning bladder muscles. After your physician has ruled out diseases, talk with your doctor about your options for physical therapy. A physician prescription for evaluation and treatment will be required prior to scheduling an appointment.
Urinary Incontinence Programs and Doctors in the Sutter Health network:
Berkeley, Lafayette -- Alta Bates Summit Physical Therapy Program for Urinary Incontinence & Pelvic Pain Opens new window
San Francisco – Pelvic Medicine and Continence CenterOpens new window
Sutter Health UrogynecologistsOpens new window