JUNE 12, 2017
It is 6:30 p.m. You are speeding home from work. It has taken you longer than normal because of a terrible wreck on the interstate. You rush to your door, dancing along the way, and as soon as you put your key in the door….it is too late. You couldn’t hold your urine any longer. It is now running down your leg as you finally get the door unlocked.
Or what about that new workout routine? The one that has you doing burpees, jumping jacks, or high kicks? Where any time you do a certain movement you leak a little? How many of us has this happened to? I mean it’s totally normal, right?! NO! We may be too embarrassed or in denial to admit that we have a problem. What is this problem you may ask? The involuntary loss of urine is called urinary incontinence. It doesn’t matter what your age is, your activity level, or gender (for all you men who are reading this) urinary incontinence can affect anyone and everyone.
There are three main types of urinary incontinence. The most common type, stress incontinence, is defined as the involuntary loss of urine that occurs with physical exertion. My patients often complain of incidents with coughing, sneezing, laughing, or with exercise. An experience as the, "lock in key syndrome" mentioned initially is known as urge incontinence. It is leakage associated with a strong urge to void. Many patients mention that when they have the urge to urinate they have to void immediately or else it will be "bad news." Experiencing a combination of stress and urge incontinence is known as mixed incontinence.
Urinary continence is maintained by a network of muscles, fascia, and nerves. These systems are synchronized to "kink" the urethra and prevent urine flow. This coordination is pertinent during activity and to allow you to make it to the bathroom in time. If one of these systems is not working correctly it leads to urinary incontinence. A simple analogy is to think of this system as a garden hose that has been laid across a trampoline. The urethra (garden hose) carries urine (water). The trampoline acts as your pelvic floor muscles and supporting fascia. If you were to step on the hose the hose will bend but not completely; "kink off." The trampoline is flexible; therefore, water is still able to "leak" out. If the trampoline was ridged (by contracting the pelvic floor) stepping on the hose would "kink" off the water. This would allow you to remain continent with the firm back drop of the pelvic floor muscles and the increased pressure from the outside.
Treatment for incontinence is most commonly associated with performing kegels. "Just do your kegels and you will be fine!" So optimistic! However, it is not always that simple. Research has indicated a significant reduction in urinary incontinence with "coaching" during kegels. In other words, performing kegels on your own is not enough. A pelvic health physical therapist can offer many treatment options specialized to your care.
Kegels are not the end all be all. By going to a pelvic health specialist, treatment will be tailored to your needs. Common treatment interventions range from pelvic floor strengthening, biofeedback, electrical stimulation, abdominal dyssynergia, and weighted vaginal cones. Not everyone will require all of these interventions. Treatment will be based on your deficits or what is causing your incontinence. Is it a weak pelvic floor? Are you able to correctly perform a kegel and hold it for the appropriate amount of time? Is there a dyssynergy between the pelvic floor and abdominal muscles? We answer these questions daily and have successful outcomes.
As mentioned above, research indicates better outcomes for individuals who go to a pelvic physical therapist versus those who self-treat, but most importantly, YOU ARE NOT ALONE! Urinary incontinence can be treated. Do not let urinary incontinence prevent you from living the life you want and deserve.
Lee, D. (2010). The Pelvic Girdle: An Integration of Clinical Expertise and Research (4th ed.). Churchill Livingstone
Ward KA, Das G, Berry JL, et al. Vitamin D status and muscle function in postmenarchal adolescent girls. J Clin Endocrinol Metab. 2009;94:559-63
Wei JT, DeLancey JO. Functional anatomy of the pelvic floor and lower urinary tract. Clin Obstet Gynecol. 2004;47(1):3-17