In the midst of your morning run, after finding a comfortable pace, it happens— a sudden leak of urine that seems to come from nowhere. Does this sound familiar? Don’t worry— you are not alone. It has been estimated that approximately 26 percent of women between the ages of 30 and 59 have problems with urinary incontinence, an involuntary loss of urine that represents a social or hygienic problem. Urinary incontinence often goes untreated because the woman feels embarrassed to seek treatment or does not know where to go. In recent years, physical therapists trained in the field of pelvic floor rehabilitation have played an important role in helping women conquer the problem of urinary incontinence.
In order to understand urinary incontinence, a brief overview of the anatomy of the pelvis is essential. The bones of the pelvis (Latin for “bowl”) are shaped like a basin that is open at the bottom. To provide dynamic support, the pelvic floor muscles run like a hammock between the front (pubic bone) and back (tailbone) of the pelvis. Openings in this muscular sling permit the passage of the urethra, vagina and anus; and the pelvic floor muscles assist in coordinating their opening and closing. These muscles are working all the time as “postural muscles” to help support the internal organs of the pelvis against the force of gravity and they are important in maintaining continence— when they relax they allow urine and feces to pass out of the body. These muscles also contribute to sexual pleasure. If these muscles of the pelvic floor are weakened or damaged, a woman may begin to experience leakage of urine, decrease in sexual pleasure, and/or sagging of the bladder or uterus into the vagina (known as prolapse).
Stress incontinence is defined as urine leakage at the same time as a physical stress or effort like sneezing, coughing, jogging, lifting and jumping. One of the most common causes of stress incontinence is childbirth. The active mother may find herself using panty liners to protect herself from leakage when going out for her daily run or aerobics class, or even just while sneezing.
The second most common group to experience urinary incontinence is the postmenopausal woman. As estrogen levels decrease, the tissues of the vagina become dry, and the muscles of the pelvic floor become weakened. Other causes of urinary incontinence include chronic constipation, obesity, neurological damage, aging and pelvic floor weakness as a result of other musculoskeletal dysfunctions such as lower back pain.
Childbirth is a common cause of urinary incontinence because during pregnancy, the weight of the uterus and fetus puts significant pressure on the muscles of the pelvic floor causing them to weaken. They may not function as well to support the organs and sphincters of the pelvis, and the risk of this occurring increases with subsequent births. During a vaginal delivery, the pelvic floor muscles must lengthen and stretch to let the baby pass through the vaginal canal— after delivery, the muscles must re-learn how to shorten and provide support again. Fascial connections (support structures like ligaments that hold the pelvic organs in place) may also be disturbed or disrupted as the baby is born. In addition, an episiotomy, which is a cut through the pelvic floor muscle system, can lead to deficiency in pelvic floor strength.
Not all women experience urinary incontinence postpartum; some women will experience mild leakage problems. But others are significantly affected, putting a serious damper on their lifestyle. Conventional wisdom holds that it is normal to leak after having a baby, but this is not true— not for the postpartum woman, nor for any other person with a healthy nervous system.
The good news is that, common as it is, stress incontinence is very treatable, because the pelvic floor muscles, like any other muscles, can be retrained to provide the necessary support at the base of the pelvis. Research supports physical therapy intervention— conservative, nonsurgical treatment— in retraining the pelvic floor muscles and treating stress incontinence.
If a woman is experiencing stress incontinence, her first step is to discuss the problem with her family doctor, gynecologist or urologist. If the doctor agrees that the woman is a good candidate for physical therapy, he or she will make a referral and provide the woman with a prescription for physical therapy. Treatment may vary somewhat from clinic to clinic, but most pelvic floor programs utilize similar evaluation and treatment methods.
After the evaluation, the physical therapist can identify the cause of the problem and determine whether it is from pelvic floor muscle weakness, poor urinary habits or too much tone in the pelvic floor muscles. Upon proper evaluation, the physical therapist will design an individualized home program, which may include stretches, pelvic floor muscle exercises, abdominal stabilization, breath control/coordination, bladder habit retraining and functional retraining. The pelvic floor program is only effective if the female is compliant with the home program.
Most women attend a pelvic floor program from two to eight sessions spaced out over four to eight weeks, depending upon the severity of the problem— many women notice an improvement in symptoms after just one or two sessions. Upon completion of the program, the woman is given further guidelines to follow, promoting a healthy, active life without fear of the embarrassment and restrictions imposed by urinary incontinence.
