PT Tip of the Month

Urinary Incontinence

Urinary incontinence, an impairment of bladder control, is a common problem for many individuals. While its severity can vary, the most frequently reported symptom is urinary leaking with coughing or sneezing. Others complain of a sudden and urgent sensation to urinate and that they do not have time to get to the bathroom. Urinary incontinence can affect both men and women, although it is twice as common in women with one in three over the age of 60 estimated to have bladder control problems. Studies suggest that, globally, up to 35% of the entire population over 60 years of age is estimated to be incontinent. While many might find this problem to be embarrassing, it is a manageable condition that can be treated with the assistance of a medical doctor and physical therapy.

Symptoms and Causes

There are a variety of types of urinary incontinence:

Stress Incontinence: This results in urine leaking when pressure builds up in the abdomen exerting pressure on the bladder. This may occur during coughing, sneezing, exercising, or when lifting heavy items. This form of incontinence results most commonly due to weakness in the pelvic floor. Causes of pelvic floor weakness include pregnancy, child birth, and menopause.

Urge Incontinence: This is an intense and sudden need to urinate followed by an involuntary release of urine. This may occur in the middle of the night and result in frequent trips to the bathroom in the middle of the day. This is a result of an inappropriate involuntary contraction of the detrusor muscle, the muscle that lines the bladder. Causes include neurologic impairment or local infection, inflammation, or irritation to the bladder.

Overflow Incontinence: Characterized by frequent dribbling of urine as the bladder does not completely empty when using the restroom or when the bladder is overly full. This can occur from a blockage of the bladder outlet or weakness in the muscle lining the bladder. Some medications can also cause overflow incontinence. Neurologic disorders can also prevent the bladder from fully voiding during urination.

Functional Incontinence: A physical or mental impairment that limits your ability to get to the bathroom on time. For example, dementia or poor mobility may limit how well or quickly an individual is able to get to or use the rest room.

Mixed Incontinence: A combination of the above forms of incontinence. Additional factors include foods or drinks that act as bladder irritants or diuretics. These include alcohol, caffeine, carbonated beverages, artificial sweeteners, and citric fruits. Medications such as heart and blood pressure medications, muscle relaxants and sedatives can also affect bladder control.

Risk Factors

Gender: While incontinence does not only affect women, it is more common in women due to pregnancy, childbirth, and menopause which all affect the musculature of the pelvic floor.

Age: Like many muscles throughout our body, the pelvic floor can weaken with age. This can decrease the amount of fluid the bladder can hold and increase the likelihood of involuntary release of urine. Changes in hormones during menopause also can affect urine retention.

Lifestyle: Weight and cigarette smoking can also play a role in incontinence. Those with obesity have increased pressure on their bladder, which can result in stress incontinence. Additionally, studies have shown that women who smoke are three times more likely to have urge incontinence than non-smokers.

Health Conditions: Many neurological conditions such as multiple sclerosis and spinal cord injuries can affect the ability to void the bladder. Diabetes has also been linked to increased risk of incontinence.

Treatment

It is important to see your doctor for treatment, especially if you find that problems with incontinence are affecting your quality of life. This could mean that you restrict your social activities or hobbies due to fear of not being able to make it to the bathroom. Older adults might find they have an increase in the number of falls as they are rushing to the restroom. Additionally, it is important to discuss this with your doctor as an underlying cause such as infection may be present.

The treatment for incontinence can vary based on the type. In some cases medications may be used to improve your bladder function or your doctor might change a medication you are taking that may be causing the incontinence.

Finally, your doctor may refer you to a physical therapist that specializes in the pelvic floor. Recent research has shown the effectiveness of treating incontinence, especially urge incontinence, with pelvic floor training and bladder training. A trained physical therapist will teach you how to "find" the right muscles needed for bladder control. By doing so, these muscles can become stronger and decrease the occurrence of incontinence. Your physical therapist may also recommend the use of biofeedback, which is a tool that provides measurements of how effectively your muscles are working and displays this activity as a chart on a monitor. Education is also an important tool to incontinence management. A physical therapist can teach you dietary changes that will help you to avoid foods or drinks that are bladder irritants, lifestyle and behaviors that may be contributing factors, and ways to decrease overflow and urge.

If you are a woman and think you are experiencing the signs and symptoms of urinary incontinence, please call 617-232-PAIN (7246) for our Brookline office to schedule a physical therapy evaluation with Caitlin DiBiasie, our Women's Health Specialist, who is trained in treating all types of urinary incontinence.

References:

  1. Urinary Incontinence. May Clinic. Available at: http://www.mayoclinic.org/diseases-conditions/urinary-incontinence/basics/definition/con-20037883. Accessed February 23, 2015.
  2. Borello-France DF, Downey PA, Zyczynski HM, Rause CR. Continence and quality-of-life outcomes 6 months following an intensive pelvic-floor muscle exercise program for female stress urinary incontinence: a randomized trial comparing low-and high-frequency maintenance exercise. Phys Ther. 2008;88:1545-1553.
  3. DuBeau CE. Approach to women with urinary incontinence. http://www.uptodate.com/home.
  4. DuBeau CE. Epidemiology, risk factors, and pathogenesis of urinary incontinence. Available at: http://www.uptodate.com/contents/epidemiology-risk-factors-and-pathogenesis-of-urinary-incontinence-in-women.
  5. Resnick NM, Yalla SV, Laurino E. The pathophysiology of urinary incontinence among institutionalized elderly persons. N Engl J Med 1989; 320:1.

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