Why Does it Happen and How Pelvic Floor Physical Therapy Can Help
What is Urinary and Fecal Incontinence?
Urinary and fecal incontinence is the involuntary loss of urine or stool. There are several different types of incontinence, which we will discuss later. Incontinence is very common – over 25 million adult Americans have incontinence, and 70-80% are women. This seems like a high number, but imagine the last time you walked down the personal care aisle in a store. There is a whole aisle dedicated to incontinence products from pads, adult diapers, wipes, over-the-counter supplements etc.; it is a money-making niche industry! However, common does not mean normal.
Incontinence in women in more prevalent due to pregnancy, childbirth and hormonal changes, like menopause. Ladies, just because you have been pregnant/delivered a child, does not mean you should have incontinence afterwards. On average, it takes 4-6 years for someone to seek treatment and receive an accurate diagnosis. It does not need to be this way! There is conservative treatment available that is very successful and the sooner you start, the easier it is to address.
Different Types of Incontinence
Stress Urinary Incontinence (SUI)
This is when there is a loss of urine with increased intra-abdominal pressure such as laughing, coughing, sneezing, jumping, lifting, running, etc. Any activity where your pelvic floor needs to engage further to help keep you dry. SUI usually stems from a weak pelvic floor. When you do an activity that increases the pressure in your abdomen, the pelvic floor needs to contract to close the urethra and prevent urine from coming out. If your pelvic floor is too weak, or has lost the ability to contract at the right time, you will leak.
Urge Urinary Incontinence (UUI)
This is when you feel the urge to urinate and that urge is so overwhelming, you cannot control it. Usually there are triggers that create this sensation such as walking up to the front door, putting the key in the door, standing in the bathroom starting to pull your pants down, etc. For some reason, your brain sends the signal to your bladder to contract, and you cannot stop it. People with UUI usually do not have urinary incontinence in other aspects of their life – they can exercise, lift, laugh, etc without leaking, it’s just a problem with certain tasks.
Mixed Urinary Incontinence
This is when you have a combination of the SUI and UUI. This is not uncommon, so do not get worried if you have symptoms of both. It can still be treated!
Fecal Incontinence
This is the involuntary loss of stool. As a physical therapist, the first question I usually ask is what is the stool like when you are incontinent. Often, the stool that comes out is loose. While this is not something you want to happen, it is not unusual. Our bodies are not designed to hold loose or watery stools. If you are having looser stools, you only have about 45 to 60 seconds to get to the bathroom before it comes out. The bigger question is why are your stools loose in the first place. If you are losing stool, and it is not loose, this could also be a sign of weak pelvic floor muscles. Just like SUI, the pelvic floor needs to contract to prevent stool from coming out and it is not strong enough, you will have incontinence.
Treatment
As you have probably guessed by now, there is probably going to be some pelvic floor strengthening involved in the treatment of urinary and fecal incontinence. First, you and your physical therapist will talk about your symptoms, when it started, when it happens, etc. Then, a full evaluation will be performed to figure out how your system functions, identify dysfunction and how this may contribute to your symptoms. If you are comfortable, a pelvic floor exam will be performed as well. Click here to read more about what to expect with a physical therapy pelvic floor exam.
Once you and your physical therapist have a better understanding of the tone, tension, strength and coordination of your pelvic floor, you will develop a treatment plan. Often times, the pelvic floor muscles are tight and weak. Treatment will focus on reducing the tension of the pelvic floor prior to addressing strength. This is sometimes counter-intuitive. Think about the last time you had a muscle cramp, or the last time a Charlie horse woke you up in the middle of the night. What are you going to do? Would you jump out of bed and do heel raises? Probably not! You would more likely stretch your calf, massage it etc. Same thing with the pelvic floor – if it is tight, similar to a muscle cramp, you are not going to perform kegels or strengthening exercises as this would only make the muscle tighter and more painful. You want to stretch and relax the pelvic floor then begin to strengthen the muscles from this more normalized tension/tone.
With UUI and mixed urinary incontinence, where there is usually a trigger for urgency, we will try different strategies to reduce that urge. Some may include, quick pelvic floor contractions, deep breathing and only focusing on your breath, start talking to someone near you, etc. The point of this is to distract you from the trigger and the urgency so that you can get to the bathroom, calmly, not frantically and without leaking.
For FI, if the stool is loose or watery, we will discuss diet, increasing fiber, avoiding irritating foods, etc to increase the solidity of the stool. If your stool is loose or watery, you will not be continent until we bulk up the stool. Involving a nutritionist/dietitian/functional medicine MD may be necessary.
Final Thoughts
Incontinence is very common, but that does not make it normal. If you are experiencing any of these symptoms, talk to your medical provider and contact a pelvic floor physical therapist to get evaluated and start treatment! This is not something you need to or should have to live with. It is never too late to start treatment, even if you have had these symptoms for decades! Sadly, this is more of the norm for patients that finally seek treatment. Seeing a pelvic floor therapist is important because each person’s treatment is going to be different and there are so many factors that may be contributing to your symptoms. It is important to see someone who treats this regularly to develop an individualized, specific plan to reach your goals effectively and efficiently.
