Move Forward Guide
Physical Therapist's Guide to
According to the National Institute of Diabetes and Digestive and Kidney Diseases, more than 13 million US citizens have incontinence.
What Is Urinary Incontinence?
Urinary incontinence is the leakage of urine at inappropriate times. With incontinence, you may have trouble starting the urine stream or holding urine when you feel a strong urge to go.
Urinary incontinence involves the muscles of the pelvic floor. These muscles attach to the bottom of the pelvic bones and run front to back, forming a bowl-like structure that lifts to support the internal organs and controls the sphincter muscles. The pelvic-floor muscles also help support the low back, stabilize the pelvic bones, and help with sexual function. Women are more likely than men to have urinary incontinence, but men can have it, too.
There are different types of incontinence:
- Stress incontinence – small amounts of urine leak when there is increased pressure on the bladder.
- Urge incontinence – your bladder muscle goes into spasm, and, if the spasm is severe enough, medium to large amounts of urine may leak; this might happen only occasionally or as often as every 15 to 20 minutes.
- Mixed incontinence – you have both stress and urge incontinence.
- Functional incontinence – urine leaks when you can’t get to the bathroom in time.
Stress incontinence usually results from weakness and lack of support in the pelvic-floor muscles. It can happen with laughing, sneezing, or coughing or with exercise or activities such as lifting. Women with stress incontinence often have "underactive" pelvic floor muscles as a result of:
- Pregnancy and childbirth, which can put stress or pressure on the bladder and possibly cause trauma to the pelvic-floor muscles
- Other injury or trauma
- Surgery in the vagina or rectum
- Episiotomy (an incision in the tissues between the vaginal opening and anus during childbirth)
- Lack of exercise and lack of use
After delivery, women also can have fecal incontinence (leakage of stool) if there was tearing of the vaginal opening that extends to the anal sphincter.
With urge incontinence, you may or may not have pelvic-floor muscle weakness or pelvic muscle tension or spasm.
In functional incontinence, the cause isn't related directly to the bladder or pelvic-floor muscles:
- Joint pain or muscle weakness that cause you to move with difficulty
- Confusion, dementia, or delirium
- Environmental barriers, such as the bathroom being too far away, the use of a walker that slows you down, or too many obstacles that you have to walk around to get to the bathroom
- Psychological problems such as depression or anger
You can also have an "overactive bladder" where your bladder empties frequently throughout the day (more than every 3 or 4 hours during the day) or makes you get up more than once to urinate at night. There is a variety of causes, such as sensitivities to certain foods or beverages.
How Is It Diagnosed?
Your physical therapist will perform an examination to identify the causes of your urinary incontinence. Your therapist also will determine whether you should be referred to a physician for additional tests.
How Can a Physical Therapist Help?
Based on the evaluation results, your physical therapist will individualize treatments to strengthen your pelvic-floor muscles and improve their function. Your physical therapist can help you:
- Gain control over your symptoms.
- Reduce the need for pads and special undergarments, incontinence medications, and possibly surgery.
Strengthen Your Muscles and Make Them Work Better for You
Your physical therapist will show you how to "find" the right muscles and use them correctly. Using pelvic-floor exercises, the therapist will help you strength those muscles so that you can better control your bladder.
Your physical therapist will:
- Show you how to "find" the right muscles and use them correctly.
- Use pelvic-floor exercises to help you strengthen your muscles so that you can better control your bladder. Pelvic-floor exercises include "kegels," in which you gently squeeze the sphincter muscles and squeeze the buttocks, thighs, and stomach muscles.
- Instruct you in exercises to stretch and strengthen other important muscles, so that they can support proper bladder function.
Depending on your symptoms and level of discomfort, your physical therapist may decide to use biofeedback to make you aware of how your pelvic-floor muscles work and how you can control them better. Electrodes attached vaginally or rectally will provide measurements of muscle activity and display them on a monitor, and the therapist will work with you to help you understand and change those readings. The therapist also may use electrical stimulation to improve your awareness of your muscles and increase muscle strength.
Remember: Knowledge Is Power
Your physical therapist can provide information about:
- Diet and nutrition to avoid food and drinks that may irritate the bladder.
- Changing behaviors that make symptoms worse.
- Ways to decrease urinary urge and frequency.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat a variety of conditions or injuries. You may want to consider:
- A physical therapist who is experienced in treating people with urinary incontinence or women's health problems.
- A physical therapist who completed a residency or fellowship in women's health physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people with urinary incontinence.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.
The following articles provide some of the best scientific evidence about treatment of urinary incontinence. The articles report recent research and give an overview of the standards of practice for treatment both in the United States and internationally. The article titles are linked either to a PubMed abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Borello-France D, Burgio KL, Goode PS, et al. Adherence to behavioral interventions for urge incontinence when combined with drug therapy adherence rates, barriers, and predictors. Phys Ther. 2010;90:1493–1505. Free Article
Borello-France DF, Downey PA, Zyczynski HM, Rause CR. Continence and quality-of-life outcomes 6 months following an intensive pelvic-floor muscle exercise program for female stress urinary incontinence: a randomized trial comparing low-and high-frequency maintenance exercise. Phys Ther. 2008;88:1545–1553. Free Article
Burgio KL, Goode PS, Urban DA, et al. Preoperative biofeedback assisted behavioral training to decrease post-prostatectomy incontinence: a randomized, controlled trial. J Urol. 2006;175:196–201. Article Summary on PubMed
Quartly E, Hallam T, Kilbreath S, Refshauge K. Strength and endurance of the pelvic floor muscles in continent women: an observational study. Physiotherapy. 2010;96:311–316. Article Summary on PubMed