What do Whoopi, Kris Jenner, and 33% of women have in common? A love for Sister Act? A penchant for Jimmy Choo? Fearlessness in the face of controversy? No! Urinary incontinence. Well…maybe the shoe bit too.
Over 20 million men and women in North America suffer from incontinence. Most people are too embarrassed to talk about it, or think that it is “normal” and just deal with it. Men don’t escape the statistics, at a prevalence of up to 11%.
There are different types of incontinence. Stress incontinence is defined as urinary leaking with increased intra-abdominal pressure, from such events as coughing, sneezing, laughing, or any physical exertion. This is a result of the pelvic floor muscles (the muscles that connect from the pubic bone to the tailbone which support the abdominal organs and assist in bowel, bladder and sexual function) being too weak and/or shortened. After vaginal delivery, the pelvic floor muscles may lengthen and weaken, and many women are unaware of how to strengthen the muscles. Both cases can result in urinary or bowel leakage.
Another type of incontinence is urge incontinence, also known as key-in-lock syndrome. A woman states that as soon as she puts the key in the door, she gets this sudden and strong urge to urinate, but is unable to control it and leaks urine. This could be the result of shortened and weak pelvic floor muscles or from an increase in the normal tone of the muscles.
One can also have a combination of stress and urge incontinence, called mixed incontinence. A woman will complain of leakage with coughing, sneezing and lifting a heavy object and also state that she gets strong urges to urinate that subsequently results in small or large amounts of urinary or fecal incontinence.
So, can these problems be fixed? YES! Medication and/or surgery are not always the answer, and sometimes can worsen patients’ symptoms. If you suffer from stress incontinence and/or decreased sexual stimulation, you need to strengthen the pelvic floor muscles. Strengthening of the muscles are called kegels, named after Dr. Arnold Kegel, the gynecologist, in 1950’s. Medications and surgery are not capable of this. There are two different types of muscle fibers in the pelvic floor, therefore, you need to do two different types of kegels: endurance holds (holding for 10 seconds) and quick holds (holding for 2 seconds) and repeating each exercise 10 times. The two exercises need to be done three to four times a day. Biofeedback, directed by a trained healthcare provider (physical therapist, nurse practitioner), can assist in understanding where these muscles are and how to do the exercises properly. They can also help develop an exercise program specific to your needs. Physical therapists also address the entire musculoskeletal system, taking into account hip strength, core stability, and pelvic alignment. With specific exercises, the leakage should stop and the orgasms will improve. Keep in mind that everyone responds differently. One person may achieve their goals within 2 months, and for another person, it may take 6 months.
Urge incontinence usually requires a more “hands-on” approach by a physical therapist that is trained in the treatment of pelvic floor dysfunction. Urge incontinence is typically the result of shortened or hypertonic pelvic floor muscles and these muscles need to be lengthened through myofascial trigger point release and connective tissue mobilization. Once these muscles are lengthened and functioning at full capacity, then you can strengthen them by performing the kegel exercises and core stabilization exercises. If one strengthens the pelvic floor muscles prior to lengthening them, then they will remain in the shortened position and the problem will persist.
A prolapse (a descent) of the bladder, colon or uterus may or may not contribute to the leakage. A prolapse is typically from weak and/or lengthened muscles and fascial tissue. A prolapse can also be helped through strengthening of the pelvic floor muscles (kegels).
What caused these problems in the first place? Sometimes this is easily answered: a fall on your tailbone, a labored vaginal delivery, or chronic straining from constipation. But, usually the answer is not easily understood. The less obvious causes of incontinence may be from poor posture, a horseback riding injury 20 years ago, multiple urinary tract infections or yeast infections. Luckily, physical therapists trained in pelvic floor dysfunction have the skill set to treat these musculoskeletal dysfunctions of the pelvic floor.
We are grateful to Whoopi and Kris for bringing light to this hot topic. Urinary incontinence is much more common than we realize. Tell your friends that they don’t have to suffer in silence.
Take time to enjoy the view without taking your pad along for the ride. See a pelvic floor physical therapist today!