Why Do I Have Urinary Leakage? And How Can Physical Therapy Help?
By: Dr. Lydia Glass, PT, DPT
What is urinary incontinence?
Urinary incontinence (UI) is any accidental loss of urine, or pee. It can vary from a few drops of urine to a full emptying of the bladder. There are several different types of UI. It can happen when you laugh, cough, sneeze, jump, squat, or exercise. It may also happen when you hear running water, put a key in the door, or while on your way to the bathroom. Leakage may occur in addition to sudden urges to go (urinary urgency) and feeling you have to frequently visit the bathroom (urinary frequency), waking up more than once a night to urinate (nocturia), and leaking urine while asleep (nocturnal enuresis).
How common is this and is it normal?
It is very common, but it’s NOT NORMAL! One in every two women suffer from urinary incontinence symptoms.
The good news is that it is treatable and in many cases cured! Pelvic floor physical therapy can help!
Why do I have leakage?
There are many causes of urinary incontinence:
- Poor drinking habits: Different types and amounts of fluid can irritate the bladder and cause incontinence.
- Poor toilet habits: Going to the bathroom “just in case” trains the bladder to store smaller volumes than it should, which can cause incontinence and urgency.
- Medical conditions: Conditions such as Parkinson’s disease, multiple sclerosis, stroke and diabetes can interfere with bladder sensations and emptying.
- Anatomy differences/changes: Anatomical problems can block the urethra. Examples include pressure from constipation, bladder stones, or other growths.
- Medication side effects: Some medications can affect bladder function. For example, diuretics make the bladder produce urine more quickly which can increase urgency, frequency, and make leakage more likely.
- Weakness: Weak pelvic floor muscles can lead to more likely leaking urine. Weak pelvic floor muscles can come from things like constipation, chronic coughing, being overweight, pregnancy, vaginal birth delivery, and high impact activities such as jumping, or heavy lifting.
- Menopause: The reduction in estrogen that occurs during menopause can result in thinning of the urethra. Urine may leak if the urethra does not close as well as it used to.
- Prostate surgery: Many men experience urinary incontinence after prostate surgery.
- Infection: Urinary tract infections sometimes cause urine to leak.
- Tension: Muscle tension in the pelvic floor muscles and abdominals can cause urinary leakage due to poor muscle function.
Abdominal separation: A condition in which the abdominals have a separation (diastasis rectus abdominis) can frequently cause urinary leakage. This condition typically develops after pregnancy.
How can I fix this? How can PT help?
Urinary incontinence can be managed conservatively, with medications, or surgery. Initial treatment should be conservative; this is done with a pelvic health physical therapist. We take a comprehensive and whole body approach to treating and solving urinary incontinence.
Examples of PT conservative treatment:
After considering possible causes of urinary incontinence, we will give you strategies to help manage it. For example, we may discuss lifestyle strategies such as general exercise (what is helpful versus unhelpful), hydration education, or encouragement to see your physician about an ongoing cough. You will learn about good bladder and bowel habits; for example, healthy toilet posture for bowel movements is important for anyone, especially when you have urinary incontinence.
We may teach you urge suppression and control techniques to reduce the sensation of urgency. This will allow you to have more time to get to the bathroom. A bladder diary may be issued to determine if bladder retraining is necessary.
Pelvic Floor Muscle Training
We may need to teach you how to activate your pelvic floor muscles and how to relax your muscles. Many people think they are doing this correctly but have actually been doing it incorrectly for many years! We can help you learn how to properly do this with the use of tactile and verbal cuing, real time ultrasound, positioning, and co-contraction with other core muscles.
After mastering this muscle activation and core engagement, you will receive a pelvic floor muscle training program. The program will be reviewed and progressed during your follow up sessions. As with all muscle training and strengthening, it takes time to alter the pelvic floor muscles and improve their function.
Maintaining your general fitness will help improve your overall muscle tone, blood flow, aid in regular bowel emptying, and will help to improve your mood and mental health. We will help you establish an exercise program that is safe and appropriate for you, taking into account your individual goals and preferred exercise or activities that you enjoy.
Clinical Pilates is an excellent option to strengthen from the inside out, with exercises designed specifically for you. In addition to seeing your PT and/or doing your home program, attending these classes at a minimum of one time per week will help you to build a strong core foundation and progress you to be strong enough to participate in the activities you enjoy.
If you’re interested in becoming a patient or have more questions, please fill out a contact form or give us a call at 864-236-8146.