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Urinary Incontinence….the what, the why, the how the heck do I fix this?

Ashley Dougvillo 
January 16, 2022

What exactly is urinary incontinence and why has it become such a “norm” in social circles?  It is not uncommon for women to commiserate about how they all pee a bit when they sneeze, when they cough, or when they jump.  However, that is usually where the conversation ends, and women continue to struggle with this daily.

First let’s shine some light on the different types of urinary incontinence and today we are going to break it into 3 groups:  stress, urge, mixed.  Stress incontinence occurs due to pressure down on the bladder (coughing, sneezing, laughing, jumping, running, etc).  Urge incontinence is when you have a sudden intense urge to urinate followed by a loss of control of the bladder (incontinence).  Mixed incontinence can be a combination of the two.

It is important to identify the type of incontinence because the next step is to discover the cause behind it.  The best way to do this is to schedule an appointment with a pelvic floor physical therapist who is educated and trained on both internal and external assessments.  What a session will entail is learning about your history (how long has this problem been going on, do you have a history of childbirth, what is your typical menstrual cycle like, are you peri/menopausal, etc).  There is discussion on diet/hydration, bowel and bladder trends, as well as any past interventions.  We then perform an objective exam to assess overall mobility and strength and if deemed necessary, we do suggest an internal vaginal (and in some cases rectal) assessment to check for pelvic floor muscle strength and tone.  From there a good picture is gathered on what may be contributing to the dysfunction and an individualized plan is then set for you, the patient, to work toward your goals.

So what could be contributing to the dysfunction then?  Many things could be at play.  Is there an active infection (UTI, yeast infection) that is causing an acute flare up?  What is diet/hydration like? There are certain foods and drinks that can cause irritation and increase incontinence such as caffeine, chocolate, alcohol, citrus foods, etc.    Is there weakness throughout the pelvic floor muscles, core and gluts?  Is there abnormal tone and tightness that is contributing?  All of these questions are answered by undergoing an exam like the one listed above.

Another question I field quite a bit is….. “well, why can’t I just do kegels?”  Kegels are not always appropriate to perform.  For example, if an individual is very tight throughout their pelvic floor muscles, further tightening or strengthening of those same muscles are only going to exacerbate their symptoms further (tightness= weakness as the muscle fibers are not able to move like they should).  This may be seen more often in a stress incontinence case (ex- only have leakage when they jump during an exercise class).  Being examined by a pelvic floor therapist allows us to see what is going on and set an appropriate plan.  Hands on manual intervention may be needed to relax glut, hip and pelvic floor muscles.  A focus on proper breathing, pressure management, and coordination of pelvic floor activation may be needed.  Additional strengthening to address areas of weakness may be a focus.  If somebody is an athlete (crossfit, endurance runner, etc) we may look at their form during their activities to assess landing pattern and pressure management.

Ultimately it is worth getting the incontinence checked out and the sooner,  the better.  As females we undergo many hormonal fluctuations throughout life, the main change occurring during peri/menopause.  As estrogen (a huge stabilizing force for muscles and bones) dips throughout this period, further exacerbation of symptoms or a sudden onset of symptoms may occur.  Help does exist and a pelvic floor Physical Therapist is a good first stop for treatment.  In some cases further intervention is needed in regards to medications, surgical interventions, etc however a conservative approach is always a great way to get the ball rolling on health, happiness, and urine free pants!

Meet the Author
Ashley Dougvillo joined Smith Physical Therapy and Running Academy in 2019. She graduated from Marquette University in Milwaukee, WI in 2008, receiving her Bachelor of Science degree with a concentration in Biomedical Sciences. She then went on to attend Northwestern University in Chicago, IL to complete her Doctorate of Physical Therapy in 2010. She is a Certified Manual Therapist and has additionally obtained specialty certifications in the Pose Method of running, kinesiotaping, FMS/SFMA, ASTYM, and Women's Health.