Urinary incontinence is very common. It affects men and women of many different ages. It tends to affect people as they get older, although it also happens with young people. Studies have shown that women who have never been pregnant report some amount of stress incontinence when they are active or playing sports.
If you have incontinence, it means you are not able to control your bladder and some amount of urine comes out when you don’t want it to. Some physicians call it "leaking out" and ask patients if they have trouble with leaking urine. If they do, there are often treatments that can help.
- What are the different types of incontinence?
The two most common types of incontinence are stress incontinence and urge incontinence. Stress incontinence often happens when patients cough, sneeze, laugh, jump or lift something heavy. Urge incontinence often occurs during bladder spasms, which can occur when people get the urge to urinate and leak urine as they are headed to the bathroom.
- What is the first step of the treatment process?
The first step varies based on patient comfort and the type of incontinence the patient is experiencing - stress incontinence or urge incontinence. A large variety of womens' and mens' incontinence diagnoses are treatable. Some treatments are more invasive than others. Typically doctors try to keep the treatment as uninvasive as possible. Exercises and education are a good place to start. Some women may be able to treat urge incontinence simply by making dietary changes.
- What are treatment options for stress incontinence?
For stress incontinence, the first steps is getting the pelvic floor muscles stronger. If results are not satisfactory, then a trial of a vaginal pessary ring (a little silicone device that fits inside the vagina) can help people with milder types of incontinence - especially if it only occurs during exercise or running. It applies pressure to the opening of the bladder and helps keep it from leaking. Surgery is also an option. There are a large number of surgeries that have been successful for stress incontinence.
In 2018, the most common type of surgery for stress incontinence was a sling, which involves a small piece of mesh that goes under the urethra that helps support the urethra. This helps prevent leakage when a patient coughs or sneezes. There are also medications for urge incontinence. However, there is not a medication that works well for stress incontinence.
- What are treatment options for urge incontinence?
Urge incontinence pelvic floor exercises can help but diet is also important. Caffeine and acidic foods like orange juice, cranberry, pineapple, and tomatoes can be very irritating to the bladder and can cause it to be more spastic. Bladder training is often helpful. Patients are educated about triggers for bladder spasms that can cause urge incontinence. Some patients will say they are unable to control their bladder when they stand up or when they get out of the car or put the key in the front door. This is often a result of the bladder learning an association between a certain activity and going to the bathroom.
For men, urge incontinence is often related to an enlarged prostate. There are good medications to help reduce the size of the prostate or to make the prostate have less tone. These medications can be very helpful in allowing the bladder to empty more easily, which often helps with the urge incontinence.
- What are other types of treatments for incontinence?
Treatment can consist simply of pelvic floor exercises or can be as broad as working on postural muscles. Improving posture, core strengthening and core stabilization are all these things that can affect the pressure on the bladder.
- Does cranberry juice help with incontinence?
Cranberry juice has some limited use for urology problems. If you drink a lot of straight cranberry juice, which tastes terrible, or took cranberry supplements it may help prevent some urinary tract infections. But for the most part cranberry juice is not helpful because it very acidic and can cause more problems than it solves. If people have a recurrent urinary tract infections doctors may encourage patients to take cranberry supplements rather than cranberry juice.
- Are there foods and beverages we should avoid?
Try to avoid foods and beverages with caffeine and increase water intake. Water intake helps to dilute urine so the bladder does not get as irritated. Staying hydrated and increasing water is important. It sounds counterintuitive to people that are having trouble with incontinence. Patients often do not want to drink more when they already leak. But educating them that they are diluting out that urine so it’s not an irritant is very important.
- Is incontinence something to be concerned about?
Incontinence is not typically a precursor to something more concerning, but it is not normal and there are treatments that can help. Women will often talk to their friends and find out that other women have the same problem so they tend to think incontinence is just something that happens as we get older. The job of physicians is to offer options and let patients know treatments are available that are likely to help.
- Is the need for pads or briefs often a turning point for people?
When women wear a pad here and there especially if they have a cold or when the exercise it typically doesn't alarm them, but if they start wearing briefs or diapers that tends to prompt them to ask for help.
- Do men have trouble talking about incontinence?
Men are less likely to talk about incontinence. There is often an event in a man's life when he has an accident when he reaches out for help.
- What typically causes incontinence in men?
In men, urge incontinence can occur following any type of urologic surgery It is also related to having an enlarged prostate.
- Is incontinence a progressive problem? Should you get it taken care of as soon as possible?
Don't wait. It’s not normal not to have full control over your bladder. Incontinence can be an indicator of risk for bladder damage. It is important, particularly for men, to have urinary problems evaluated.
- When should patients start to consider solutions like medication and physical therapy?
The first step is to help your doctor get a good understanding of what you are experiencing - if you have stress incontinence or urge incontinences or a mixture of both. Once that is determined, doctors usually recommend that women consider doing pelvic floor physical therapy or pelvic floor exercises, often called Kegel exercises. This is a natural, less invasive treatments and typically help with both types of leakage.
- What is the anatomy of the pelvic floor?
The kidneys are the organs that filter our blood and send urine down small tubes to the bladder. The bladder stores the urine until you’re ready to go the bathroom. As you are going about your day the bladder is slowly filling up. The pelvic floor muscles, which include sphincter muscles, act like the door that only opens while urinating.
The pelvic floor muscles are like a hammock. There is a sheet of muscles that extend from the pubic bone (the bone in the lower part of your abdomen). They hold your organs in and up and help to close off the bladder and rectum to maintain control over the bowel and bladder.
- How does a physical therapist contribute to a woman’s recovery from incontinence?
Physical therapists often start treatment with biofeedback. This technique is helpful early on because it lets people see what their muscles are doing and and if they are using the right muscles, which is typically the key in recovery.
- What is biofeedback?
Physical therapists use visualization techniques and try to help people relax, especially if they’re feeling tight in their pelvic floor muscles. It also helps with weakness and awareness of when their muscles are contracting or relaxing. A sensory electrode is placed on the skin that connects patients to a computer to monitor their muscles. Therapists also use visual imagery like trucks and flowers to help patients connect what their muscles are doing and what they are seeing on the screen.
- How do physical therapists start to work with women with incontinence problems?
Biofeedback and awareness of the muscles is a good start. Education about Kegel exercises are also helpful. Many women have heard about Kegeal exercises, but may not be educated about the proper way to perform Kegel exercises.
- What are Kegels?
Kegel is another term for a pelvic floor muscle contraction. Therapists teach patients about Kegels and how to use their muscles.
- How does a patient get access to a physical therapist?
A visit with a physical therapist requires a doctor's referral from your primary care doctor or urologist.
- What type of training have Frye Regional's physical therapists received?
The physical therapist that leads Frye Regional's program has a doctoral degree in physical therapy.
- Are there classes that can help?
Core & Beyond is a class available at Frye Regional - a community class designed to educate and make pelvic health a topic that people are more willing to talk about. This exercise class may help with treatment of milder forms of incontinence. It also gives the opportunity to see a physical therapist outside of the clinic and discuss if physical therapy can possibly help you.
For more information, call 828.315.3186.