Incontinence, involuntary loss of bladder control…“accidents.”

These words describe a physical condition that affects an estimated 13 million Americans every day. Both men and women, young and old, can experience some form of urinary incontinence that can make them feel ashamed and isolated.

Worse yet is the feeling of not having control over your own body, the feeling that somehow you can no longer depend on it functioning the way it did before. For some people it seems just too embarrassing to confide in someone about your “problem,” even a health care provider.

The truth is there’s no need to feel this way. Physical therapists can help. With the right kind of treatment, you can get your bladder control problem back under control. This brochure will help you understand what incontinence is and the different kinds of physical therapy options available to manage this condition, or, in many cases, regain complete continence.

What Exactly Is Urinary Incontinence?

Urinary incontinence means you lose urine when you don’t want to. Along with leak-age, there may be other symptoms:

Urgency: A strong desire to urinate, even when the bladder is not full. This is sometimes accompanied by pelvic discomfort or pressure.

Frequency: Urinating more than six to eight times a day or more than once every two hours (with normal fluid intake).

Nocturia: Awakening from sleep because of the urge to urinate. This can vary with age and is not necessarily abnormal unless it occurs regularly more than two or three times a night. Many things can contribute to urinary incontinence:

• bladder infection

• obesity

• pregnancy and childbirth

• weak pelvic floor muscles

• chronic illness/cough

• constipation

• medications

• urinary tract abnormalities

• neuromuscular disorders

• stress

• cigarette smoking

• caffeine intake

• hormonal changes of menopause

Although incontinence is not necessarily a natural part of aging, it can be the result of many years of changes in your body, especially in women. Childbirth, improper lifting of heavy objects at work and at home, chronic constipation, or post-menopause—all these factors over time contribute to a weakening of the pelvic floor muscles (muscles that surround the openings of the urethra, vagina, and anus), leading to poor bladder control.

How Bladder Control Works

The bladder’s job is to store and empty urine. When the bladder becomes full, nerves signal the brain, giving you the urge to urinate.

When you urinate, your sphincter relaxes and the detrusor muscle (bladder muscle) contracts to squeeze urine out of the bladder. The urine leaves your body through a tube called the urethra. Strong sphincter and pelvic floor muscles help keep the urethra closed until you’re ready to urinate.

Treating Urinary Incontinence

Knowing that you can do something about incontinence—that you don’t have to just learn to live with it—puts you on the path to regaining control over your bladder.

First—and this is the hardest step for many people to take—you must discuss your problem with a health care professional. It is important to find a health care practitioner who is knowledgeable in evaluating and treating incontinence.

Get a thorough examination from your physician to rule out any medical conditions that may be causing your loss of bladder control. The initial screening should include your health history regarding incontinence, a physical examination, including a pelvic exam, analysis of your urine, and a measurement of the amount of urine left in your bladder after you urinate. Then you’ll be ready for the next step—an individualized treatment program that works best for your type of incontinence.

Types of Urinary Incontinence

There are two major types of urinary incontinence that benefit from physical therapy treatment—stress and urge—and you can suffer from more than one.

Stress incontinence—the sudden involuntary loss of urine when you exercise or move in a certain way (for example, jumping, coughing, sneezing, or laughing). Urine leakage occurs in this case due to weak pelvic floor muscles and poor ligament support at the bladder outlet and urethra or due to a defect in the urethral tube itself.

Urge incontinence—urine leakage that occurs as soon as you get the urge to go to the bathroom. The sensation is over-whelming—your bladder muscle, the detrusor, contracts (tightens) at the wrong time, and you can’t control it. These inappropriate contractions can stem from reversible causes like a bladder infection, bladder irritability after surgery, or simply poor dietary and bladder habits. Sometimes they are caused by problems with the nervous system.