Incontinence. It can affect anyone. Men, women, young or old. According to the National Association for Continence, over 25 million adult Americans experience temporary or chronic urinary incontinence. While anyone can experience incontinence, it is most prevalent in women over the age of 50.
While incontinence is very common, very few realize that there are treatment options available to help combat it and improve the symptoms. And based on my knowledge and professional experience, I believe that healing in the postpartum period is crucial to preventing incontinence later in life. Treatment is dependent on the type of incontinence you are experiencing.
Kegels are not a fix all as some people and internet sites seem to claim! Figuring out the true root cause of the incontinence is the key to improving or eliminating symptoms.
To dive deeper, let’s first look at the anatomy and physiology of the urinary system.
The urinary system is made up of the kidneys, ureters, bladder, urethral sphincter, and urethra.
Photo credit: John Hopkins Medicine
There are 2 types of muscle in our bodies, smooth and skeletal. Skeletal muscle is voluntary, meaning we have control over it. Smooth muscle contracts involuntarily and we have no control over it. The bladder is made of smooth muscle. As the kidneys make urine all day by filtering our blood, it slowly fills the bladder with urine. As the bladder fills, it stretches the detrusor muscle. When this muscle gets full to a certain point, it sends a signal to our brain through different nerves telling us it’s time to find a bathroom.
When you finally get to the bathroom and sit down, the pelvic floor muscles relax, the urethral sphincter relaxes, and the detrusor muscle contracts to allow urine to pass into the urethra and out of your body.
When this system goes awry, you can end up with symptoms of incontinence.
Incontinence And All the Different Types
We’ve been talking about incontinence, but we haven’t yet defined it. What exactly does incontinence mean?
Incontinence is what happens when there is a loss of voluntary control of urine. There are 4 different types of incontinence: Stress, Urge, Functional, and Overflow.
Stress Incontinence
Stress incontinence gets its name because it’s the result of stress on the body that leads to the leakage of urine. This can be things like physical exertion, coughing, sneezing, changing positions, or exercise.
Stress incontinence could arguably be the most common type of incontinence pregnant and postpartum women encounter. The stress and trauma of carrying a baby in the womb and birthing can weaken the structures of the urinary system, most notably the pelvic floor muscles, or possibly cause them to be too toned up, impacting function as well.
Leaking urine is a result of an imbalance between how much stress is put on the pelvic floor versus how strong the muscles are to hold in urine.
Urge Incontinence
Urge incontinence happens when you have a strong, instantaneous urge to pee that you can’t control. This can happen suddenly such as when you change positions from sitting to standing.
In urge incontinence, the detrusor muscle becomes un-synchronized with the fullness of your bladder and contracts at the wrong time. Retaining urine on purpose, or holding it is a major cause. This is common in people with jobs who may not have the ability to use the bathroom when needed such as nurses, teachers, or wait staff. This is a major cause of incontinence in kids too! After holding back urine for a period of time, the pelvic floor muscles and the detrusor muscle forget how to relax, contract, and synchronize to release urine and require re-education to work together
Functional Incontinence
Functional incontinence is when a functional limitation keeps you from getting to the bathroom on time. This can be a result of things like:
Arthritis causing painful joints
Injuries
Cognitive impairments that limit the ability to be aware of the sensation or what to do when the sensation is felt.
This type of incontinence can be helped with the use of assistive devices such as a walker or crutches, toileting adaptive equipment such as a bedside commode, and making access to the bathroom easier by moving furniture or other physical barriers.
Overflow Incontinence
Overflow incontinence is the least common type of incontinence and is a result of the bladder not emptying fully after urinating. When this happens the bladder becomes too full and urine leaks out or there is constant dribbling of urine.
Treating Incontinence
As mentioned above, the treatment that is prescribed for incontinence is dependent upon the type of incontinence you have. A trained pelvic floor physical therapist will be able to listen to your story and your symptoms to identify which type of incontinence you have and the best course of treatment.
Common treatment options for incontinence include:
Behavior Changes
Limiting liquids 2-4 hours before bed
Reducing bladder irritants like coffee/caffeine, spicy foods, carbonated drinks, and citrus drinks
Keeping bowel movements regular to reduce pressure on the system
Bladder Training Activities
Trying to delay bladder emptying
Doing deep breathing activities to relax your pelvic floor to allow complete emptying of the bladder
Creating a bathroom schedule to empty your bladder at set time intervals
Pelvic Floor Stretches/Exercises
Strengthening weakened structures
Stretching and relaxing structures that are too tight
Learning how to control and reconnect to your inner piston system to keep pressures equalized
Core strengthening and posture education
While incontinence is prevalent, it isn’t something that you have to live with or just accept as normal because you’re older or had a baby. With the proper evaluation and treatment, you can improve your symptoms and quality of life. Early intervention is of utmost importance. So if you’re experiencing any symptoms of incontinence take action to fix it now to prevent further problems later in life!