Author: Denise Amsrud PT, DPT
“Sure I have some problems with a little urine leakage, but I have had two kids, so this is normal.”
“Doesn’t everyone have issues with incontinence as they get older?”
“I have issues with my prostate so this is a normal part of aging.”
These are common statements that are often heard from patients in our clinic or from the audience at our community lectures about incontinence. While the occurrence of urinary incontinence is common among seniors, it must not be regarded as a normal aging side effect. It is a problem that can be successfully addressed and treated.
According to the National Association for Continence 25 million Americans have issues with incontinence. Only 1 in 12 people will seek medical advice about it; perhaps because it is an uncomfortable issue to talk about, or possibly because of the belief or acceptance that it is a normal part of growing older.
The fact is urinary incontinence is costly: economically, psychologically and physically.
- Incontinence is the second most common reason for nursing home admissions
- Isolation and withdrawal can occur due to the shame and fear of accidents
- Incontinence products are a billion dollar industry and patient cost can be anywhere from $50.00 to $1000 a year¹
- Urinary incontinence is strongly associated with fall risk in the elderly²
Causes of Incontinence
The causes of incontinence can vary from an urinary tract infection to something more complex associated with a chronic medical condition.
- Dehydration (concentrated urine can be a bladder irritant)
- Intake of bladder irritants (caffeine, acidic foods, carbonated beverages)
- The hormonal changes during menopause can result in a weakening of the urethral and vaginal tissues
- The nerves to the bladder can be affected by diseases such as Parkinson’s Disease, Multiple Sclerosis, Stroke or Diabetes
- An enlarged prostate can cause urinary urgency, hesitancy and incontinence
- Post- prostatectomy is one of the most common causes of incontinence in males
- Pelvic floor and core muscle weakness (including the lower back and hips)
- Decreased mobility (the ability to make it physically to the toilet in time)
Types of Urinary Incontinence
Stress Urinary Incontinence
This type of incontinence occurs secondary to weakness of the core muscles and fascial connections around the bladder. The pressure on the bladder causes leakage during coughing, sneezing, laughing, and during exercise. It can also occur when lifting or bending over.
This type of incontinence is associated with urgency and an overactive bladder (OAB). There is a strong, sudden urge to urinate. The bladder contracts and an involuntary loss of urine occurs.
This type of incontinence occurs due to an overflow of urine in the bladder. This can be due to a blockage at the urethra such as an enlarged prostate, poor sensation of the bladder, or the nerves to the bladder are affecting the ability of the bladder to empty completely.
A person may have normal bladder control, however physically cannot make it to the restroom in time.
Regardless of which type of incontinence a person may have, nonsurgical management, such as physical therapy, is the first line of treatment. (Practice Guidelines by the American College of Physicians³). First a thorough evaluation of the patient is necessary to determine an individualized plan of care.
Physical Therapy for Incontinence
Bladder retraining involves different aspects depending on the issues/needs of the patient
- Bladder diary
- Assesses the degree of urinary frequency and void intervals
- Assesses appropriate urge sensation
- Determines if there are dietary factors that may play a role in bladder dysfunction
- Identifies adequate fluid intake
- Urge suppression techniques
- Strategies to calm down or suppress inappropriate bladder urge
- Timed Voiding Schedule
- Determining specific schedule to retrain the bladder
Pelvic Floor Muscle and Core Training
The coordination of the pelvic floor and abdominal muscles is very important to continence. It is not just about doing kegels, but coordinating the entire core and postural system.
- Body mechanics
- Learning correct bending and lifting techniques are important to decrease the intra-abdominal pressure on the bladder.
- Proper toileting posture is also important for effective bladder emptying.
- Biofeedback uses special sensors that help the patient to learn how to increase the awareness of the pelvic floor function. It can be a tool to help strengthen or help relax these muscles.
- Electrical Stimulation
- Electrical stimulation can also be used to help patients with stress incontinence as well as an overactive bladder.
- Functional training
- Specific pelvic floor training to strengthen or to relax the muscles.
- Making sure the functional unit of the diaphragm, the back, the abdominal muscles and pelvic floor work together in a coordinated and safe manner (avoiding adverse intra-abdominal pressure)
There are many studies that show physical therapy is successful treating urinary incontinence.
N2 Physical Therapy was created especially for pelvic floor health rehabilitation. Our professionals can provide patients evidenced based treatment with a combination of experience, skills, and passion. They can also help patients understand that incontinence is NOT a normal part of aging and can be successfully treated.
Denise Amsrud PT, DPT
1: Subak et al “The Cost of Urinary Incontinence for Women” Obstet Gyncecol 2006 Apr;107(4): 908-916
2: Soliman et al “Falls in the Elderly Secondary to Urinary Symptoms” Rev Urol 2016: 18(1): 28-32
- Annals of Internal Medicine: Clinical Guidelines September 2014: “Nonsurgical Management of Urinary Incontinence in Women: A Clinical Practice Guideline From the American College of Physicians”.