Physical therapy for urinary incontinence

Laugh and you leak? Unlock your door and you leak? Rush to the bathroom and you leak? Urinary incontinence can be embarrassing, but the good news is there are many treatment options.

What is urinary incontinence?

As women get older, the muscles, ligaments and nerves in the pelvis often weaken, in some cases causing urinary incontinence. But urinary incontinence is not a normal part of aging.

Urinary incontinence is the involuntary leakage of urine. There are two primary types of incontinence in women: stress incontinence and urge incontinence.

Stress incontinence. Stress incontinence is leakage associated with abdominal pressure:

  • Cough or sneeze
  • Lifting
  • Exercise

Urge incontinence. Urge incontinence occurs when your bladder contracts involuntarily, often at the sign of a trigger, and releases a larger volume of urine.

Possible contributors to urge incontinence include:

  • Diabetes
  • Many neurological problems
    • Spinal cord injury
    • Stroke
    • Multiple sclerosis
    • Spinal stenosis
    • Spine surgery
  • Chronic constipation

Pelvic floor physical therapy

Stress and urge incontinence don’t have to be permanent conditions. There are several nonsurgical, highly effective approaches to treating incontinence in women.

Pelvic floor physical therapy can help you gain better bladder control, reducing the frequency of involuntary leakage. There are two goals to pelvic floor physical therapy:

  • Strengthen the muscles of your pelvic floor
  • Retrain the nerves that go from your brain to your bladder so that your brain controls your bladder rather than your bladder controlling your brain

Pelvic floor physical therapy is a combination of:

  • Pelvic floor exercises
  • Electrical stimulation
  • Biofeedback

Pelvic floor exercises, often called Kegel exercises, help with stress incontinence by strengthening your urethral sphincter so that it can better control your urine floor.

Electrical stimulation, biofeedback and a drill called quick-flicks help you identify and isolate which muscle group you’re using. They also help with reprogramming the nerves from the brain to the bladder, Dr. Larsen says.

Success rate

Stress incontinence. Depending on the patient, pelvic floor physical therapy can be very successful. Studies show that women who do pelvic floor physical therapy for stress incontinence can delay or eliminate the need for surgery.

There’s a catch, however.

You have to continue doing the exercises. Your therapist will train you how to do the muscle-strengthening and nerve retraining exercises during your therapy sessions, but you have to continue them month after month, year after year, or your body will go back to its old ways.

Urge incontinence. Women with mild to moderate urge incontinence can also see significant improvement with pelvic floor physical therapy as you learn how to better control your responses to certain stimuli.

If your urge incontinence is advanced, physical therapy may not be helpful. Your physician may recommend medication or surgery.

Seek treatment at first signs

Call for an evaluation if you’re:

  • Having difficulty making it to the bathroom
  • Waking up and going to the bathroom multiple times during the night
  • Going to the bathroom more frequently than normal and it’s become bothersome
  • Not able to fully empty your bladder
  • Leaking urine with cough, sneeze or exercise

For pelvic floor physical therapy, you’ll need a referral from your gynecologist or urogynecologist.

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Physical therapy for urinary incontinence