Incontinence, also known as bladder or bowel control problems, is described as unintentional urine or fecal leakage that occurs during the day or at night. Affecting upward of 13 million people in America, the two main types of incontinence are Stress Urinary Incontinence and Urge Incontinence.
While many come to rely on medication, absorbent products, or surgery to ease bladder control problems, physical therapy for incontinence has proven highly successful at minimizing leaks and providing long-lasting results.
Read on to learn more about physical therapy for incontinence, what it entails, how soon you can expect to feel the results and helpful aids that can be used in conjunction with physical therapy to treat incontinence.
Incontinence Vs Frequent Urge to Pee: The Difference
Even though incontinence and a frequent urge to pee might seem to be the same thing, they are not. Incontinence is considered an unintended leak of urine whereas a frequent urge might have you running to the bathroom more, but it does not necessarily result in leakage.
While incontinence is typically associated with weak pelvic floor muscles failing to support the bladder or an overactive bladder (OAB), a frequent urge to pee is more likely to be a symptom of drinking too much caffeine, alcohol, or an underlying infection like a urinary tract infection, vaginismus, or interstitial cystitis. It can also be a learned behavior that requires re-training.
If you are not sure what is causing your frequent trips to the bathroom, it’s always better to speak with a professional for the correct diagnosis.
Are There Different Types of Incontinence?
Yes. The term incontinence applies to urine leakages and fecal leakages, both of which commonly stem from weak or un-coordinated pelvic floor muscles that are unable to support the pelvic organs. In addition, urine leakages are broken down into the following five categories, with stress incontinence and urge incontinence being the most common.
It's described as urine leaks that occur due to an extra exertion of pressure on the bladder. This is typically caused by pregnancy, childbirth, lifting heavy objects, sneezing, laughing, coughing, exercising, or jumping, but the underlying reason is normally down to weakened pelvic floor muscles.
When a sudden need to pee leads to an unintentional leak of urine. Those suffering from urge incontinence often need to urinate frequently, even during the night. This usual stems from an overactive bladder or pelvic floor muscles that are poorly coordinated or sometimes too tight. This type of incontinence can also be caused by a bladder infection, diabetes, or a neurological disorder that results in a miscommunication between the brain and the bladder.
This is caused by a bladder that fails to completely empty when you urinate and results in a continuous dribble of urine throughout the day and night.
It happens when a psychological or physical ailment prevents you from being able to empty your bladder on time. For example, those suffering from multiple sclerosis, arthritis, or Parkinson's disease might find it difficult to physically get to the bathroom or unbutton their pants on time.
It is when more than one type of incontinence is experienced, typically a combination of urge incontinence and stress incontinence.
Admittedly, all types of incontinence are embarrassing, however, the good news is, it’s treatable.
Why Do Pelvic Floor Muscles Weaken?
Attached to the pelvic bone and around the rectum, the pelvic floor muscles reach from the pubic bone to the tailbone and from sit bone to sit bone, essentially acting as a hammock that supports the pelvic organs like the bladder, rectum, and uterus.
These muscles can weaken due to pregnancy, childbirth, weight gain, bad posture, pelvic trauma, weak abdominals or glutes, hormonal changes, as well as ongoing constipation.
What Is Pelvic Floor Physical Therapy?
The pelvic floor muscles are essential for supporting the bladder, rectum, and uterus, and a weakening of these muscles is what typically leads to incontinence. Therefore, physical therapy for incontinence is typically performed by a pelvic health physical therapist who specializes in the pelvic floor and core muscles.
Trained to understand the connection between the body’s muscles and movement, physical therapists are experts in the field of body motion. They use this expertise to improve muscle strength, mobility, and quality of life through hands-on care, controlled movements, educating their patients about their condition and prescribing exercises that can be practiced at home.
In addition to incontinence, pelvic floor physical therapy is commonly used to treat symptoms of endometriosis, pelvic trauma, constipation, pelvic organ prolapse, pelvic pain, or pain during intercourse.
How Does Physical Therapy Help Incontinence?
The first session of physical therapy for incontinence typically begins with a pelvic floor physical therapist examining and evaluating your pelvic floor muscles. Based on their findings, they then guide you through exercises that help to identify, engage & strengthen the necessary pelvic muscles.
Regular practice of these exercises can improve bladder control, lessen the frequent urge to pee, and prevent embarrassing urine leakage.
These exercises might include:
Pelvic floor strengthening exercises (Kegel exercises) - To engage and strengthen the pelvic muscles that regulate the flow of urine.
Abdominal exercises – The pelvic muscles are directly connected to the group of muscles we call ‘the core’, therefore, engaging and strengthening the abdominals is also helpful to prevent incontinence.
Glute exercises – The glute muscles, located in the buttocks, serve as a counterbalance to the pelvic floor muscles and help separate the sacrum from the pubic bone. If the glutes are too weak to balance the pelvic floor then the pelvic floor muscles become tight and shorten, resulting in a lack of support for pelvic organs, such as the bladder.
Posture exercises – When the body is standing tall with good posture, each set of core muscles - the pelvic floor muscles, abdominals, diaphragm, and spinal muscles - are engaged to support the body. However, poor posture can weaken any of these sets of muscles and thereby put more stress on the pelvic floor, which can inevitably lead to incontinence. When treating incontinence, physical therapists will often address your posture too.
Home Remedies for Incontinence
Along with regular physical therapy sessions, research has shown that using Kegel weights for home practice can significantly improve the strength of pelvic floor muscles and help women recover from incontinence.
For best results, women’s health experts recommend purchasing a set of ascending Kegel weights and sizes, and only advancing to the next size once the smaller weight is comfortably held in place for up to fifteen minutes per day.
How Many Sessions of Physical Therapy Are Needed To Treat Incontinence?
Even though the amount of physical therapy needed for bladder control can vary from person to person, research and feedback from physical therapists recommend regular sessions for 2-12 weeks, however some cases require a few more months to improve incontinence. During this timeframe patients are also encouraged to practice strengthening exercises at home.
Added Benefits of Physical Therapy for Incontinence
Although the best form of treatment for urine leakages will depend on the individual and the severity of their symptoms, pelvic floor physical therapy is considered one of the best incontinence treatment methods for many reasons.
It Helps to Avoid Medication & Surgery
All medication comes with some side effects and surgery can also be taxing on the body, not to mention possible complications. By treating incontinence with regular physical therapy, most people can avoid medication and/or surgery.
It Fixes the Actual Problem & Stops Incontinence from Worsening
The pelvic floor muscles naturally weaken as you age, however, this can be counteracted with regular physical therapy sessions and using Kegel weights at home.
Improves Your General Health
Weakened pelvic floor muscles not only affect the pelvic muscles like the bladder, bowel, and uterus, side effects can eventually spread into the lower back muscles, hips and spine too.
It’s Cost Effective
For many people, physical therapy sessions are covered by their insurance. But even if it’s not covered, the cost of medication, absorbent products, and potential surgery could far outweigh the price of some physical therapy sessions and the purchase of kegel weights for home use.
It Makes You Feel Powerful
Pelvic physical therapy not only ensures bladder control, but it also helps you to sit, stand, and walk with better posture. In addition, taking control of incontinence gives people a sense of empowerment by taking charge of their health and reducing the feelings of embarrassment and frustration that go hand in hand with bladder leaks.
If you notice frequent bladder leaks are affecting your quality of life, stopping you from doing the activities you enjoy, or causing you to cancel social engagements out of embarrassment, it’s time to speak with a doctor about treatment options for incontinence or an overactive bladder.
Although absorbent products, medication, and surgery are often recommended to treat a lack of bladder control, pelvic floor physical therapy is proving to be one of the most successful treatment options.
Mayo Clinic – Urinary Incontinence - https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/symptoms-causes/syc-20352808
National Association For Continence - What Is An Overactive Bladder - https://nafc.org/overactive-bladder/
Physiotherapy Journal – Is Pelvic Floor Muscle Training Effective for Symptoms of Overactive Bladder Symptoms in Women - https://www.physiotherapyjournal.com/article/S0031-9406(18)30289-X/fulltext
Physiopedia – Urinary Incontinence - https://www.physio-pedia.com/Urinary_Incontinence
National Association For Continence - Surgery For Overactive Bladder - https://nafc.org/bhealth-blog/surgery-for-overactive-bladder/
Intimate Rose – Pelvic Floor Exercises - https://www.intimaterose.com/blogs/kegel-exercise/pelvic-floor-exercises
Pelvic Floor First – Is Posture Important for Incontinence? https://www.pelvicfloorfirst.org.au/news/647/is-posture-important-for-continence/
Continence Foundation of Australia - https://www.continence.org.au/resource/pelvic-floor-and-core-exercises?v=7330
National Library of Medicine - The effect of EMG biofeedback-assisted pelvic floor muscle therapy on symptoms of the overactive bladder syndrome in women - https://pubmed.ncbi.nlm.nih.gov/27869312/