Urinary Incontinence - back to Programs & Services

Incontinence is the loss of bladder or bowel control. A broad range of conditions and disorders can cause incontinence, including birth defects, pelvic surgery, injuries to the pelvic region or to the spinal cord, neurological diseases, multiple sclerosis, poliomyelitis, infection, and degenerative changes associated with aging. Incontinence from surgery is often temporary and may occur after operations such as hysterectomies, Caesarean sections, prostatectomies, lower intestinal surgery, or rectal surgery. Incontinence can also occur as a result of pregnancy or childbirth. The National Association for Incontinence estimates that 13 million Americans are incontinent, with one in four women over the age of 18 having episodes of involuntary urine leakage.

There are four different types of urinary incontinence:

Stress incontinence:
Stress incontinence occurs when pelvic muscles have been damaged or weakened, causing the bladder to leak during exercise, coughing, sneezing, laughing, or any body movement which puts pressure on the bladder. A problem that commonly affects women, stress incontinence may occur after multiple childbirths or menopause. Pelvic fracture, radical prostatectomy, or bladder neck surgery can also damage the sphincter muscle and cause stress incontinence.

Urge Incontinence:
This type of incontinence occurs with the sudden, strong urge to urinate, which may result in the inability to reach the toilet in time. Urge incontinence causes leakage of urine due to bladder muscles that contract inappropriately. Causes are often unknown but can also be due to stroke, dementia, Alzheimer's disease, and Multiple Sclerosis (MS). Urge Incontinence is a major symptom of Overactive Bladder.

Mixed Incontinence:
This variety of incontinence is very common and occurs when symptoms of both stress and urge incontinence are present. Symptoms of one type of incontinence may be more severe than the other. Treatment will depend on which symptoms are more bothersome to the patient.

Overflow Incontinence:
Overflow Incontinence refers to leakage that occurs when the quantity of urine produced exceeds the bladder's holding capacity. Overflow incontinence can be the result of leakage of urine when the prostate gland becomes enlarged in men. With women this type of incontinence may occur when a pelvic organ herniates out of its normal position, inhibiting the normal flow of urine. It can also result from such conditions as diabetes, pelvic trauma, extensive pelvic surgery, injuries to the spinal cord, shingles, MS, or polio.

How Can Physical Therapy Help?
Incontinence can often be effectively treated. If the doctor has determined that muscle weakness is the cause of incontinence, studies have shown biofeedback with pelvic floor exercises (kegal exercises) to be effective in up to 90% of the cases. Unfortunately, research has also shown that more than 50% of people perform kegel exercises incorrectly. Physical Therapy has been shown to be effective in educating the patient in the proper performance of kegals.

At One Step Ahead Physical Therapy, we have specialized training in treating a variety of types of incontinence for both men and women. During the first appointment, a thorough history and evaluation are performed followed by the designing of an individualized treatment plan.

The treatment plan may consist of any or all of the following treatment techniques:

Bladder retraining: This involves regular scheduled toileting times with the length of time between bathroom trips being steadily increased. With this treatment the therapist is attempting to train the bladder to postpone voiding for progressive larger time intervals and has been proven effective in treating urge and mixed incontinence.

Education: Informing people that certain foods and or medications that may be contributing to incontinence is essential. Additionally, teaching proper breathing techniques and body mechanics can improve treatment outcomes.

Exercises: Kegal exercises, abdominal strengthening and postural and flexibility exercises are often prescribed. A home exercise program is provided and updated regularly to ensure maximal effectiveness.

Biofeedback: Biofeedback is a specialized treatment technique that allows an individual to visually see or hear how the muscles are responding to exercise. This technique is most effective in people who have a difficult time with correctly performing kegals or working at a high enough intensity to effectively make strength gains.

Muscle Stimulation: Small doses of electrical stimulation can strengthen pelvic floor muscles in a way similar to exercising the muscles. Electrodes are temporarily placed in the vagina or rectum to stimulate the muscles. This can also be used to calm overactive muscles. Electrical stimulation can be used to reduce both stress incontinence and urge incontinence.

Weighted Vaginal Cones: Special cone-shaped weights are worn in the vagina while performing kegals and activities such as squatting, lifting and walking. These can be included in a treatment program to further strengthen the pelvic floor muscles. The cones vary in weight and a physical therapist can help design an exercise program with vaginal cones.

Incontinence is a sensitive issue with many people; therefore, treatment is always provided in a private and comfortable setting. Patients are often seen for one to two visits per week for six to eight sessions.

For more information or to schedule an appointment, call or email One Step Ahead Physical Therapy.

Additional Resources:
› National Kidney and Urologic Diseases Information Clearinghouse - (800) 891-5390
› National Association For Continence - (800) BLADDER (252-3337)
› Simon Foundation for Continence - (800) 237-4666