Over 20 million people suffer with urinary incontinence. The majority of these are women and most of these women don’t even mention it to a health care provider for seven years. A recent study in the Annuals of Internal Medicine (May 2006) stated that a three question test could help clinicians diagnose two most common types of urinary incontinence. The questions are: 1) Have you leaked urine in the last 3 months, 2} When do you leak urine, and 3) When do you leak urine to most? Having a simple process that has proven to be highly sensitive to the correct diagnosis should enable women to be connected to the resources that are in the community to assist with the treatment of urinary incontinence.
Since treatment options are available, why do women take so long to seek help with this problem? Many women think that incontinence is an inevitable consequence to having children. This has recently been challenged by research findings that show the correlation between urinary incontinence and vaginal births is not a clear link (Obstetric and Gynecology 2005). This study looked at the prevalence of urinary incontinence in post-menapausal sisters, one who did have children and one who did not. The study found no significant difference in severity or type of urinary incontinence. It did show a familial predisposition or genetic correlation. But one thing is clear, if you leak urine something is not working right. If you want to control the problem you need to look at what is the cause of the problem and then take appropriate action. That is why it is important for women to have a better understanding of how their body works so they can be active participants in the decisions about treatment.
There are several types of urinary incontinence. The type that has you racing to the bathroom to “beat your bladder” is called urge incontinence. Another common name for this symptom is overactive bladder. If you leak urine when you cough, sneeze or exercise that is called stress incontinence. If you suffer from both then you have what is called mixed incontinence. Functional incontinence is when a person is unable to get to the bathroom in time because of weakness or pain that impairs the ability to move.
Your bladder is a muscular organ that holds urine. During urination, muscles in the bladder contract or tighten. This forces urine out of the bladder and into a tube called the urethra that carries the urine out of the body. When the bladder contracts, the muscles surrounding the urethra relax and let the urine pass through. Spinal nerves control how these muscles move and how your bladder contracts. The muscles that are under voluntary control are called the pelvic floor muscles (used in kegal exercises) and are controlled by nerves coming from the sacral segments of your spinal cord. Your bladder is controlled by nerves in the thoracic and lumbar region of your spine. When everything is working properly, your body senses when the bladder is full and you decide if it is a convenient time to empty your bladder. If you are hydrating properly you should need to empty your bladder at regular intervals but you should be able to wait for about 3 hours between voids. Your degree of urgency (the message that you need to void) should match the volume in the bladder. In other words, if it is a mild urge then you should not have an overly full bladder and likewise, if your urge is very strong you should not just have a small amount of urine. You should feel like your bladder is empty after urination and you should not have to push or have to wait for your urine to start to flow once you sit on the toilet.
When you have trouble of urinary incontinence the problems could come from a variety of sources. It could be related to the presence of an infection, certain types of medical conditions or diseases (i.e., spinal stenosis, multiple sclerosis, or diabetes), hormonal changes (atrophic vaginitis), organ prolapse or a lack of strength and coordination of the pelvic floor muscles. Leakage associated with exercise and cough/sneeze occurs when the pressure exerted on the bladder overcomes the sphincter’s ability to prevent urine escaping. It could be related to the weakness or incoordination of the sphincter muscles. Inappropriate urge or urge incontinence can be in part due to bad habits but the other possibility is that the nerves that control the action of the bladder or the sphincter muscles are not working properly.
Today there are more treatment options for urinary incontinence. Surgeries have been performed for many years. Recently in the news a new approach that implants your own adult stem cells into the urethra has shown good results in the experimental phase. It is however a very costly procedure and currently not available in the United States. And although new techniques are intriguing as a general rule, the simplest and safest treatments should be tried first.
In physical therapy approach to treatment of urinary incontinence, the evaluation is aimed and identifying the nerve and muscle issues associated with urinary incontinence. If the nerves in your back are impaired due to chronic inflammation, it stands to reason that the muscles and organs that they supply would not function optimally. Only by treating the source of the inflammation ( limited spinal and hip motion, poor body mechanics and postural problems) can you set the stage for the muscles to be retrained or strengthened properly. The muscles in your pelvic floor are not the only weak muscles that contribute to this problem. Your abdominals are a key player and most people do not effectively engage the deepest layer of abdominal muscles, the transverse abdominus. In addition to needed proper spinal mobility, strong and coordinated core muscles, proper voiding habits also play a role in a healthy urinary system. By addressing all of the problems simultaneously, you are more likely to get the lasting results you seek.
Taking care of your body requires information and assistance from those trained to help you idenfity and rectify the contributors to the problem. Help is available and it is your option if you want to try a simple and effective approach to urinary incontinence.
Kathy Elston, PT