URINARY INCONTINENCE
Who experiences urinary incontinence?
One of the first important things to understand is that urinary incontinence is prevalent, though it is often a topic that people avoid discussing. For vulva/vagina owners (VO), the prevalence of urinary incontinence ranges from 25 to 45 percent depending on factors like age and pregnancy experiences. The prevalence of urinary incontinence in penis owners (PO) is not as well-documented, but some research suggests that approximately 30-40 percent of POs seeking treatment for other health concerns experience some form of urinary incontinence. The range of impact in non-treatment-seeking PO communities is much broader due to limited reporting and documentation of cases. Urinary incontinence is not uncommon in any population, though that does not necessarily mean it is normal and that you have to live with it. If you experience urinary incontinence you are not alone and we are here to talk about it with you!
What is urinary incontinence?
The Mayo Clinic defines urinary incontinence as the loss of bladder control with symptoms ranging from occasionally leaking urine to having sudden and strong urges to urinate that make it difficult to get to the bathroom in time. The two main types of incontinence are Stress Urinary Incontinence (SUI) and Urge Urinary Incontinence (UUI). Stress urinary incontinence includes urinary incontinence with coughing, laughing, and sneezing as well as urinary incontinence with jumping and running, basically urinary incontinence with effort and/or physical exertion. Urge urinary incontinence includes urinary incontinence associated with a strong urge to get to the bathroom, but not making it to the bathroom before urine leakage occurs. An aspect of these categorizations that is important to PO pelvic care, though relevant to all individuals, is the inclusion of dribbling/post-void urinary incontinence3. Post-void urinary incontinence involves the involuntary release of urine right after an individual has seemingly finished passing urine. Urinary incontinence can be bothersome and embarrassing, the latter of which can prevent individuals from seeking care. Urinary incontinence can also lead to difficult health impacts like anxiety, depression, urinary tract infections (UTIs), and even premature death in elderly populations.
What are some of the symptoms of urinary incontinence?
The primary reported symptom is the involuntary loss of urine. As discussed above, stress urinary incontinence involves the involuntary loss of urine with effort/physical exertion and urge urinary incontinence involves the loss of urine with the urge to go to the bathroom. Below are some other reported symptoms as defined by the American Physical Therapy Association:
Loss of urine with change in position (postural urinary incontinence)
Loss of urine while sleeping (nocturnal urinary incontinence)
Mixed symptoms of stress urinary incontinence and urge urinary incontinence termed “mixed urinary incontinence”
Continuous leakage (continuous urinary incontinence)
Loss of urine without knowledge of how it may have occurred
Leakage during intercourse (coital urinary incontinence)
Urinary incontinence symptoms also include bladder storage symptoms (e.g., increased frequency and urgency), sensory symptoms (i.e., increased, decreased, or absent bladder sensations), and voiding symptoms (e.g., hesitancy, slow stream, straining, dribbling, etc.).
Pelvic floor physical therapists (PFPTs) are knowledgeable on all of these symptoms and others that are not listed here. While pelvic floor PTs can help you once you are symptomatic for urinary incontinence, pelvic floor PTs also serve a preventative role. To do that, we have to understand some of the causes of urinary incontinence.
What are some of the causes of urinary incontinence?
While it may be important to distinguish between stress urinary incontinence and urge urinary incontinence in treatment, the list below does not differentiate between the two types of urinary incontinence because it is not necessarily the case that a particular cause will create a specific symptom in every individual. This list can help you identify some of the reasons you might be experiencing urinary incontinence or help you prepare for events that may instigate urinary incontinence in the future. The list below is not exhaustive, so please do not hesitate to reach out to a pelvic floor PT to discuss other concerns you might have about your pelvic floor’s health and influence on your urination experiences.Below is a list of some of the possible causes of urinary incontinence:
Arthritis
Cancer (e.g., prostate cancer, female reproductive cancers)
Certain medications can impact urinary function
Cognitive deficits
Diabetes
Low back pain, which may impact postural control
Menopause and/or low estrogen
Mobility issues
Obstetric causes including the number of pregnancies and types of delivery
Smoking history
Transition-related UI
What are some common treatments for urinary incontinence?
We always recommend checking with your doctor and/or your pelvic floor practitioner when seeking help for urinary incontinence. We are providing this information so that you know how approachable urinary incontinence treatment can be and to familiarize you with some of the topics your doctor/PT may discuss in developing your treatment plan.
Treating pelvic floor conditions, in general, is not only kegels. This well-known exercise for the pelvic floor can be helpful when your pelvic floor muscles are weak. However, in our daily lives, our pelvic floor is never turning on in isolation. It is always turning on in a complex and beautiful orchestration of motor patterns involving many muscles. The pelvic floor also is not like a light switch. It does not turn on 100% and then off. The pelvic floor has the perfect “tension to task”, meaning it may turn on anywhere on the spectrum from 0 to 100% with movement and depending on how much force is passing through our skeleton (e.g., pushing open a heavy door may activate our pelvic floor muscles more than if we push open a light door).
Strengthening the pelvic floor to treat urinary incontinence with jumping, running, lifting and other exercises can be such a fun challenge! We need a super strong pelvic floor for urinary incontinence. We need power, quickness, and good fast-twitch muscular function as well as reflexive/automatic activation. Because we cannot just kegel the whole time we run, lift, or jump rope we can play around by observing how our breath moves and our core engages during exercise movements.
You can try switching up where you inhale and where you exhale to notice what makes movement feel easier and more fluid. You can also try strategically placing the exhale on moves that are tough, where you need extra core activation. For example, if you normally breathe in (inhale) when you squat and breathe out (exhale) when you stand up from the squat, try exhaling when you squat down and inhaling when you stand up from your squat. People with stress urinary incontinence may need to learn “the knack” (doing a kegel before and during activities that increase intraabdominal pressure), and those with urge urinary incontinence may need to learn urge control techniques.
How can Pelvic Care support urinary wellness?
While we hope this article sheds some light on who experiences urinary continence, how urinary incontinence might present, and how it can be treated, this is just a small part of the urinary incontinence story. Pelvic floor physical therapy involves collaborating with a skilled practitioner capable of helping your unique experience with urinary incontinence, which typically requires more than a one-size-fits-all approach. Pelvic Care Physical Therapy can work with vulva/vagina owners and penis owners of all ages, abilities, and identities to identify underlying issues impacting their urinary wellness and subsequently build a treatment plan specific to you.