Understanding and Managing Incontinence
Pelvic Floor Physical Therapy Can Help!
Understanding and Managing Incontinence
Pelvic Floor Anatomy
Bones and Joints
Pelvis: Consists of Two Ilium
Ilium Connection
Spine Connects to the Pelvis at the Sacroiliac (SI Joint)
Femur meets the Pelvis at the Hip Joint
SI Joint and Pubic Symphysis have minimal movement
Hip and Spine have Significant ROM
Muscles
Pelvic anatomy involves the core muscles that form a “canister” around your abdomen
Three layers of pelvic floor muscles form a sling underneath (bottom)
Pelvic Wall
Abdominals (front), Diaphragm (Top) and Back muscles complete the canister.
Body Functions supported by the pelvic floor
It is critical for pelvic floor health, that all parts of the “canister” are working in sync and with coordinated movement.
To determine coordination,
Start with the breath!
What is Incontinence?
What is incontinence?
The involuntary leakage of urine or stool from the bladder or bowels.
Urinary: This can consist of small leaks during activity strong urges or constant dribbling.
Fecal: Small leaks to complete loss of control. Unable to fully clean self after a bowel movement.
Incontinence is COMMON but not “normal”
It does not have to happen and is not just a normal consequence of aging!
Affects 1 in 3 women and 1 in 9 men.
Causes and Risk Factors
Muscle Damage
Hormonal Changes
Aging and Weakness
Mechanical Pressure
Lifestyle Factors
Quality of Life Impact
Embarrassment and anxiety
Leaving the house less often
Concerns over sexual relationship with partner
More common infections or physical discomfort
Financial cost of incontinence pads and other supplies
Disrupted sleep
Incontinence is common…
Common does
not mean normal!
Different Types of Incontinence
There are 2 main types of urinary incontinence
Stress: Caused by a sudden increase in pressure on the bladder such as coughing, sneezing, laughing or exercise.
Urge: A sudden, strong, and frequent need to urinate. Can also be an inability to make it to the bathroom in time or waking in the middle of the night.
Mixed: You can have a combination of both urge and stress incontinence.
Less common types:
Overflow - when the bladder does not completely empty.
Functional - when physical limitation prohibit you from reaching the bathroom in time.
Stress Incontinence
Stress incontinence occurs when there is increased pressure in the intra abdominal cavity
If the pelvic floor muscles are weak, they may not contract in time to control the flow of urine.
If the diaphragm and pelvic floor muscles are out of sync, the pelvic floor muscles may be in a relaxed state when they should be in a contracted state.
A pelvic floor that can’t relax is not strong!
Common Causes:
Muscle weakness from injury or childbirth
Muscle weakness from overall lack of activity
Pressure on the bladder - constipation is a major cause of this!
Muscle tightness and inability to relax the pelvic muscles.
Urge Incontinence
Common Causes:
Irritants such as coffee or alcohol
Lifestyle
Medications
Physical irritation of the bladder from enlarged prostate or constipation.
Urge incontinence occurs when you feel a sudden, strong urge to urinate.
The bladder muscles contract and spasm unexpectedly.
There is a natural feedback loop where the bladder fills and stretches. The stretch sends a message to the brain. The brain responds with either wait, start looking for a toilet or emergency!
Urge incontinence is a neuromuscular control issue - not a strength issue!
The bladder has a memory and can be trained positively and negatively. Both holding your urine and peeing “just in case” can interrupt the bladders natural feedback loop.
Don’t “practice” by stopping and starting the flow of urine. This confuses the bladder messaging loop.
Stress // Urge // Mixed: what do I have?
Try a forced exhale and focus on what your pelvic floor does!
The pelvic floor should contract up and in with forceful exhalation.
Try a bladder diary for 48 hours to record how often you go to the bathroom.
Every 2-4 hours during the day is normal. More than 8 times per day is considered abnormal.
Pelvic Floor Physical Therapy
Physical Therapy Assessment
On the first visit you can expect:
A lengthy conversation! The interview and information gathering is extensive prior to a pelvic floor examination.
A review of your medical history including medications and any other medical conditions.
A review of your symptoms including how they are impacting your quality of life. We want every last detail!
Outcome measures are completed.
A bladder diary and instructions for completing will be given if indicated.
We may ask questions about lifestyle.
We will ask questions to get more information and connect the dots.
Physical Therapy Examination
Physical Therapy Examination
This gives a lot of valuable information BUT is not a necessary step if the patient is not comfortable.
Physical Therapy Treatment Plan
Bladder Training (Urge Issues)
Muscle Control (Stress Issues)
Lifestyle Habits (All)
Self Management Techniques
Self Management
Practice these healthy habits to regain control of an overactive bladder or a bladder not supported by a strong pelvic floor.
As with all neuromuscular issues, daily, high frequency practice is the key.
Urge Suppression
Leak Prevention
There is treatment for incontinence.
Don’t let embarrassment keep you from seeking an improvement in quality of life!
Thanks!
Want to ask a question in private…
lindsay@wellness360fitness.com