Insights from a Pelvic Floor Physical Therapist - Part 1: Incontinence

Pelvic floor dysfunction refers to a variety of symptoms and anatomical changes related to abnormal functioning of the pelvic floor muscles. This can include increased activity of the pelvic floor, decreased activity of the pelvic floor, loss of pelvic support, or a mixture. It is not usually one thing that causes pelvic floor dysfunction, but rather multiple factors that play a role.

As a pelvic floor physical therapist, I frequently encounter patients dealing with a variety of symptoms.

As a reminder, the pelvic floor is a group of muscles that supports the organs in the lower abdomen, including the bladder, uterus or prostate, and rectum. When these muscles lose strength, have increased tension, or suffer injury, it can lead to a range of conditions that significantly impact quality of life.

Image from www.ic-network.com/pelvic-painconditions/pelvicfloordysfunction/the-pelvic-floor-muscles/

Throughout a series of posts, I’ll discuss a variety of kinds of pelvic floor dysfunction, their symptoms, and provide insight into how physical therapy can help manage these issues.

One of the most common types of pelvic floor dysfunction I treat is urinary incontinence, which is divided into 4 types:

Stress Incontinence

This is leaking urine with sneezing, coughing, lifting, running, jumping, and anything else that causes extra pressure in your abdomen and on your bladder. This is the most common type of incontinence and often occurs after pregnancy, childbirth, and menopause.

Urge Incontinence

Leaking that is preceded by a strong, sudden urge to urinate is classified as urge incontinence. This can happen when you hear running water, unlock your front door, or wake up in the middle of the night. Neurological conditions, such as Parkinson's disease and strokes, can also result in urge incontinence.

Functional Incontinence

This leaking occurs because a person has trouble thinking, moving, or speaking and may not make it to the bathroom in time. An example would be someone with ALS (Lou Gehrig’s Disease) who has a hard time coordinating movement to get to the bathroom.

Overflow Incontinence

This type of incontinence is leaking that occurs as a result of incomplete emptying of the bladder. Leaking can also occur because of an underactive bladder, resulting in an overfull and distended bladder that eventually pulls the urethra open. This type is less common in women, and can occur due to nerve damage related to shingles and MS.

Mixed Incontinence

Mixed Incontinence is any combination of two or more types of incontinence. Stress and urge incontinence are the most common. The pelvic floor muscles can be involved in both of these types of incontinence while the connection between the brain and bladder plays a larger role in urge incontinence.

This is why I often deter patients from peeing “just in case.” If you get in the habit of urinating in certain situations, your brain will start to signal you need to urinate in similar situations, even if your bladder isn’t full.

Women, especially those who have been pregnant or given birth (vaginally or via Caesarean), are more likely to experience urinary incontinence, though it can affect men, especially those who have undergone prostate surgery (Bø et al., 2013).

Fortunately, pelvic floor physical therapy can help you to strengthen and relax these muscles and reteach your brain when it is appropriate to urinate, improving bladder control and reducing or eliminating incontinence.

This way your bladder doesn’t run your life!

Written by Aly Freitag PT, DPT

References:

Bø, K., Kvarstein, B., & Hagen, R. (2013). Pelvic floor muscle training for stress urinary incontinence. Cochrane Database of Systematic Reviews, 2013(10).

Haylen, B. T., de Ridder, D., Freeman, R. M., Swift, S. E. Berghmans, B., Lee, J., . . . Schaer, G. N. (2010). An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. International Urogynecology Journal, 21(1), 5-26.

Office on Women’s Health in the U.S. Department of Health and Human Service. (2021). Q+A Urinary Incontinence. Womenshealth.gov.

Patel, U. J. MD; Godecker, A. L. PhD; Giles, D. L. MD, MS, MBA; Brown, H. W. MD, MAS. (2022). Updated prevalence of urinary incontinence in women: 2015–2018 national population-based survey data. Female Pelvic Medicine & Reconstructive Surgery, 28(4), 181-187.