Urinary Incontinence Q&A
What is urinary incontinence?
Urinary incontinence is the involuntary leakage of urine. Millions of people of all ages have this common disorder although most do not seek treatment until symptoms become severe. Please know that urinary leakage is nothing to be embarrassed about, and it is highly treatable! Our goal is to empower you to seek help no matter how mild or severe your symptoms. There are effective treatments, including pelvic floor physical therapy, medications, and surgery (last resort).
What are the different types of incontinence?
Stress Urinary Incontinence: This is the involuntary leakage of urine that occurs during coughing, sneezing, laughing, exercise, and lifting. Leakage occurs when the pressure in your abdomen is more than the pressure holding your urethra closed. This problem often occurs when pelvic floor muscles are not strong enough or have become weakened after childbirth or with hormonal fluctuations (e.g., lactation, luteal phase of the menstrual cycle, menopause). Chronic low back pain, pelvic pain, or repetitive stress on the pelvic floor may contribute to stress incontinence by weakening the pelvic floor muscles and preventing them from contracting as effectively as they normally would.
Urge Urinary Incontinence: This is the involuntary leakage of urine associated with a strong urge to urinate. Those with this condition will leak urine on the way to the bathroom or in response to a trigger, such as the sound of running water.
Mixed Urinary Incontinence: This is a combination of both stress and urge urinary incontinence. Those with mixed incontinence leak during coughing, sneezing, laughing, exercising, and while experiencing a strong urge to urinate.
Functional Incontinence: This is the result of weakness or a medical condition that does not allow you to move well or walk normally. The problem with functional incontinence is difficulty in getting yourself to the bathroom. An example of functional incontinence is the person with severe arthritis who cannot easily stand from a chair and who may struggle with buttons and zippers once in the bathroom. Another example of functional incontinence is a child who doesn't connect the urge to urinate with the need to get themselves to the bathroom in time.
How can I improve my pelvic floor tone to reduce incontinence?
While there are many things that can be done to help heal a weakened pelvic floor, even better is to keep it strong from the start and prevent any damage, to begin with.
AVOID BECOMING CONSTIPATED
Constipation is often a symptom of a pelvic floor disorder since some people with pelvic floor problems are unable to relax and coordinate their pelvic floor enough to have a bowel movement. In addition to being a symptom, constipation can also be a cause of pelvic floor disorder: If you experience chronic constipation, there's a chance that you may also be adversely impacting your pelvic floor muscles.
Sitting too long on the toilet or straining to have a bowel movement can put a lot of pressure on your pelvic floor, and this may lead to muscle dysfunction, weakness, or even a pelvic organ prolapse, especially if your condition is ongoing.
Avoid becoming constipated by drinking plenty of water (at least 64oz daily), exercise regularly, and eat a balanced diet with lots of fruits and vegetables - making sure to get at least 20 grams of fiber in your daily nutritional intake. Use stool softeners or magnesium supplements at night to soften your stool if needed. Avoid laxatives as these can cause dehydration and reliance on the medication.
Yes - there is a right and a wrong way to lift objects to protect your pelvic floor! Lifting things that are too heavy can place added stress on your core and pelvic floor muscles. First, make sure the load is manageable for you. Then, be sure to bring the item close to your body to avoid lifting things from too far away. Before you lift, remember to activate your pelvic floor muscles and bend from the hips in a squat-like position versus bending forward from your back. This is so important when lifting bulky items like children, and car seats!
Lifting and carrying from waist to shoulder level heights is safer on your back and your pelvic floor than lifting something off the floor. This may mean making some adjustments in your life in order to lift wisely, such as using a wheeled suitcase, packing smaller bags of groceries, using a wheeled cart as your laundry basket, etc.
EXERCISE YOUR PELVIC FLOOR MUSCLES AND YOUR CORE
As with any muscle, you can't neglect your pelvic floor muscles if you want them to remain strong. Learning how to properly do a kegel and also how to relax your pelvic floor is important. Your training doesn't stop there - because the pelvic floor is connected with many muscles as part of the pelvis and torso, it's important to work them along with your core, hips, and back muscles too.
If you already suffer from a pelvic floor disorder, these exercises may look different than what you're used to. When your muscles are already compromised, you may need to be careful with the motions you make initially, as many common exercises that work the abdomen can place a lot of pressure on your pelvic floor muscles, causing further stress or strain. A pelvic floor physical therapist can help you develop a routine that may include exercises like modified planks, wall pushups, or single leg extensions. At Quantum Women's Health, we work in conjunction with the best pelvic health specialists in the Treasure Valley and will be happy to send a referral to the clinic of your choosing.
Learn to Relax Your Pelvic Floor
It's just as important to learn to relax your pelvic floor as it is to strengthen it. When your muscles are in a continuously contracted state, they're unable to work as they should. This can lead to problems with bladder pain, incontinence, constipation, and even pain during sex. The pelvic floor muscles need to be able to fully contract at will (which helps when you are trying to hold urine or brace your pelvic floor when lifting something heavy) and fully relax to be able to properly do their jobs like passing stool and urine.
This may seem hard to master at first, but with some practice, it will become second nature.
Practice Good Posture
It might seem easy to fix your posture, but it can actually be harder than you realize! How you carry yourself plays a big part in the health of your pelvic floor. Your pelvic floor muscles work in conjunction with other core muscle groups including your spinal cord, diaphragm, and abdominals. When your body is unbalanced, some of those groups may end up carrying more or less of the load. This can lead to an imbalance in the pelvic floor too, which can create problems.
Pay attention to your posture, both when you're sitting as well as standing. Aim for a neutral spine, which follows the natural curve of your body and puts the least amount of stress on your muscles and bones. A neutral spine is when your lower abs are flat, with just a slight curve of the spine off the floor. Avoid positions that exaggerate tilting too far out (like Donald Duck) or too far in (like the Pink Panther).
Protect Your Pelvic Floor When You Work Out - Modify Exercises if You Have a Pelvic Floor Issue
Good posture is important for anyone who's doing a workout, but that's particularly true for those with a pelvic floor disorder. Without good posture, lifting could cause injury or even bladder leaks. Always make sure to maintain your posture and activate your pelvic floor muscles before lifting weights (remember to relax them when you're done!).
If you do have a pelvic floor issue, that doesn't mean you can't, or shouldn't work out. You just need to make some modifications until your pelvic floor muscles (PFMs) are stronger or capable of providing the support needed to do the activity. Avoid exercises that place repeated pressure on your pelvic floor, like fast running or jumping. Lift weights with caution. Be cautious with certain abdominal exercises when you're not able to maintain good posture.
If you need help modifying your routine or developing a new one, see a physical therapist for suggestions.
What treatments are available for post-menopausal women for incontinence?
The vagina and urethra are very sensitive to the loss of hormones, like estrogen and testosterone, that occur with menopause. The loss of hormones in the vagina and urinary tract causes a condition called Genitourinary Syndrome of Menopause, or vaginal atrophy. For post-menopausal women with vaginal atrophy, low-dose vaginal estrogen therapy is associated with tremendous urinary tract benefits, including a reduction in the incidence of urinary tract infections and overactive bladder symptoms. Adequate estrogen therapy also leads to restoration of the normal vaginal acidic pH and microflora, thickening of the epithelium, increased vaginal secretions, and decreased vaginal dryness and resultant dyspareunia.
These medications can improve incontinence symptoms by improving the condition of the vagina and urethral lining after menopause:
- Estrace® (estrogen)
- Estring® (estrodiol vaginal ring)
- Vagifem® (estrodiol vaginal tablets)
For more education and support about incontinence, visit the National Association for Continence https://www.nafc.org