What is the #1 Recommended Treatment for Urinary Incontinence?
Hello friends! Did you know that more than 300 million individuals suffer from urinary incontinence? This can be a costly diagnosis with purchasing incontinence products and lead to several other health issues. The good news: pelvic floor therapy is the number one recommended intervention for urinary incontinence. Let’s talk about why!
Understanding the anatomy of the pelvic floor muscles is important to understand why they play such a big role in treating urinary incontinence. The pelvic floor muscles attach to the pubic bone in the front and the tailbone in the back. They have several functions aside from helping with leakage, including working as part of the core, supporting the pelvic organs, and aiding in sexual function.
The pelvic floor is a group of several different muscles, but one of them wraps around the urethra (where pee leaves the body). This muscle should stay closed at rest to keep pee in and relax to let pee out. Another important muscle (that’s not part of the pelvic floor) is called the detrusor muscle. The detrusor is the large muscle that is the bladder. While anatomically complex, the bladder is essentially a hollow ball of muscle.
As the bladder fills, the pelvic floor muscles should stay engage to keep pee in and the detrusor muscle should stay relaxed. When we are ready to pee, the pelvic floor muscles should lengthen and relax and the detrusor muscle squeezes to get urine out of the bladder.
When talking about incontinence, there are three main types: stress, urge, and mixed.
Stress urinary incontinence (SUI) is urine leakage with activity or exercise like coughing, sneezing, laughing, or exercise. The action causes increased pressure or "stress" on the bladder, and depending on the severity of your incontinence, leaking could be brought on by strenuous activities. Poor support of the urethra from the pelvic floor muscles as well as issues with the internal sphincter of the bladder can be the cause of stress incontinence. Risk factors for stress incontinence include multiple births, surgeries, weakening of connective tissue, hormone deficiency, genital mutilation, or removal of reproductive organs (like a hysterectomy).
With urge urinary incontinence—whether it is a small drop or a large amount—leakage is accompanied by a strong, sudden urge to pee. Leakage is caused by involuntary contractions of the detrusor muscle. Triggers for urgency and leakage can include the sound of running water, cold temperature, drinking cold beverages, and more.
Mixed incontinence is a combination of both stress incontinence and urge incontinence symptoms.
Overall, urinary incontinence has a psychological impact and can significantly reduce quality of life and has been associated with low self-esteem, mood deterioration, and feeling of helplessness. Due to fear of accidents and other people finding out, social life is negatively impacted which contributes to decreased activity (over time can lead to decreased mobility), alienation, social isolation, changes in sexual activity, anxiety, and depression. Urinary leakage can also increase the risk of infections and skin breakdown if moisture is not controlled with absorptive pads or frequently changing underwear.
But there is hope! Pelvic floor muscle training improves muscle coordination and contributes to better urethral compression—research has shown it significantly improved quality of life in women with urinary incontinence by reducing symptoms! Training the pelvic floor muscles to be strong, flexible, and coordinated (to relax or contract at the right times) is one of the keys to stopping urinary leakage.
Pelvic floor muscle training can look different for everybody, so it’s best to find a pelvic floor therapist in your area to help guide you. Depending on symptoms, a pelvic floor therapist will guide you through training not only of the pelvic floor, but most times of the back, hips, abdominal muscles, and more! In most cases, pelvic floor muscle training should take at least 6 weeks with exercises performed 3-7 times per week.
A comprehensive treatment approach will also look at certain habits and behaviors to optimize your bladder and pelvic floor health.
Ask your provider for a referral to a pelvic floor therapist near you or find one at www.mypfm.com/find-a-pt. Remember that we are not your physical therapists and it is important to discuss any symptoms you may be having with your providers. This information is not intended to serve as medical advice and is for educational purposes only.
Ready to learn more about your pelvic health? Here are some helpful resources:
Watch Netflix for Your Pelvic Floor at Pelvic Flicks
Watch our YouTube playlist on Bladder Concerns and Your Pelvic Floor
Learn more about the pelvic floor muscles with our book: My Pelvic Floor Muscles The Basics
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The Hip and Urinary Incontinence: A look beyond the pelvic floor at what keeps us dry with Lauren Trosch, PT, DPT, OCS
Surgical Treatments for Stress Urinary Incontinence with Dr. Sarah Boyles, MD, MPH, FACOG, FPMRS
Postpartum Urinary Incontinence with Dr. Lauren Glugale, MD
Treatments for OAB with Dr. Sarah Boyles, MD, MPH, FACOG, FPMRS
Written by Emily Reul, PT, DPT
Garcia-Sanchez E et al. What pelvic floor muscle training load is optimal in minimizing urine loss in women with stress urinary incontinence? A systematic review and meta-analysis. Int J Environ Res Public Health. 2019;16(22):4358.
Ghaderi, F., & Oskouei, A. E. Physiotherapy for women with stress urinary incontinence: a review article. J Phys Ther Sci. 2014;26(9), 1493–1499. doi:10.1589/jpts.26.1493
Radziminska A et al. The impact of pelvic floor muscle training on the quality of life of women with urinary incontinence: a systematic literature review. Clin Interv Aging. 2018;13:957-965.