Incontinence

Urinary incontinence is any undesired leakage of urine that can occur during the day or night. According to the National Institute of Diabetes and Digestive and Kidney Diseases, more than 13 million people in the United States have urinary incontinence. Physical therapists design specialized treatment programs to help people with urinary incontinence gain control over their symptoms, and reduce the need for medication and possibly surgery.

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.

Stress Incontinence

The pelvic-floor muscles surround the urethra, and help to keep it closed during times when pressure is placed on the bladder. Therefore, stress incontinence can result from a weakness and/or lack of support in the pelvic-floor muscles. It can happen with laughing, sneezing, or coughing, or with exercise or activities such as lifting. Women with stress incontinence often have pelvic-floor muscle dysfunction as a result of:

• Pregnancy and childbirth, which can put stress or pressure on the bladder and possibly cause trauma to the pelvic-floor muscles
• Episiotomy (a surgical procedure sometimes used to ease childbirth)
• Injury or trauma, such as a pelvic fracture
• Inflammation, such as cystitis
• Surgery in the vagina or rectum
• Lack of exercise, or a sedentary lifestyle

Urge Incontinence

A strong and coordinated contraction of the pelvic-floor muscles helps to decrease the urgency to urinate and helps keep the urethra closed. Patients with urge incontinence may lack this control due to pelvic-floor weakness or tightness, or may experience spasms that contribute to uncontrolled bladder contractions. Urge incontinence may also be increased by nervous conditions, such as anxiety.

Urge incontinence can also be a learned behavior. For example, if someone always goes to the bathroom when arriving home from work, they can begin to associate getting home from work with going to the bathroom. After some time, that person can begin to feel the urge to go to the bathroom on the way home. This high-urgency feeling may lead to urinary incontinence.

Foods, such as caffeine and sugar, acidic foods, and smoking can irritate the pelvic floor. The irritation can cause inflammation and/or make the bladder lining contract more, contributing to urge incontinence.

Functional Incontinence

The causes of functional incontinence are not related directly to the bladder or pelvic-floor muscles, and include:

• Joint pain or muscle weakness (ie, low back, core, pelvis, hips) that make movement difficult
• Confusion, dementia, or delirium
• Psychological problems such as depression or anger
• The use of devices such as a walker, which slow movement
• Environmental barriers, such as obstacles (rugs, furniture) that block easy access to a bathroom

Urinary Frequency

A person with an “overactive bladder” feels the need to empty it frequently throughout the day, and has to get up more than once during the night to urinate. Sensitivities to certain foods or beverages can cause urinary frequency.

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 magnetic resonance imaging (MRI) to show any pelvic-floor muscle problems, to ensure an accurate diagnosis.