Urinary Incontinence: Causes, Symptoms, Physical Therapy Treatment

What is Urinary Incontinence?

Urinary incontinence refers to accidental leakage of urine. There are several types of urinary incontinence including stress, urge, mixed and functional incontinence.

What causes urinary incontinence?

Several things can cause urinary incontinence, but the most common cause is weakness and lack of pelvic floor support. The pelvic floor consists of muscles that attach to the pelvic bones in order to support the internal organs, control the bladder and bowel, and assist with sexual function.  These muscles also work closely with the abdominal, back and diaphragm muscles to stabilize the body during motion.  Weakness, tightness or incoordination of these muscles can contribute to urinary incontinence.

Stress incontinence refers to the leakage of urine when there is increased pressure on the bladder during exercise, sneezing, coughing, lifting or other activities requiring exertion.

Individuals with stress incontinence often have “underactive” pelvic floor muscles.  Causes of stress incontinence include:

• Pregnancy and childbirth
• Episiotomy (during childbirth)
• Injury or trauma
• Pelvic or genital surgery
• Lack of exercise
• Excessive coughing or sneezing
• Prolonged heavy lifting

Urge incontinence is often due to weak and “overactive” pelvic floor muscles.  Individuals experience a strong urge to urinate and may have difficulty getting to the bathroom in time.  Causes of urge incontinence include:

• Diabetes
• Medications
• Urinary tract infections
• Caffeine or alcohol
• Incomplete bladder emptying
• Neurological disorders

Mixed incontinence refers to a combination of urge and stress incontinence.  The causes can include any combination of the triggers for stress and urge incontinence.

Functional incontinence is urine leakage that occurs when a person with normal bladder function cannot get to the toilet in time due to physical, cognitive, or environmental barriers.  Causes of functional incontinence include:

• Joint pain or muscle weakness
• Problems with mobility and walking
• Confusion, dementia or delirium
• Environmental barriers (example: the bathroom is too far away, a walker or cane takes time to maneuver, too many obstacles in the way, difficulty removing clothes)
• Poor vision
• Psychological problems such as depression or anger

How can physical therapy help?

Physical therapists can help when a person’s joints and muscles are interfering with the ability to move to the bathroom in time and causing incontinence.  Treatment is geared toward improving joint motion, muscle strength, walking speed and safety.

There are also Pelvic Health Physical Therapists who have specialized training in evaluating and treating a person’s pelvic floor muscles.  Pelvic floor muscles that are weak, tight or not working in a coordinated fashion can cause urinary incontinence.  Pelvic Health (or Pelvic Floor) PTs are ideal providers to teach women and men how to gain control over their bladder symptoms.  Treatments are generally very effective.  They take place in a private setting and are pain-free.

Pelvic Physical Therapy can:

• Give you control over your bladder and your life
• Save you money and embarrassment by requiring less pad protection
• Reduce the need for medications to control incontinence
• Potentially prevent the need for surgery
• Rehabilitate weak pelvic muscles after pelvic surgery

Pelvic Physical Therapy Treatment may include:

• Education on food and drinks that may worsen symptoms
• Advice on how to change behaviors to reduce symptoms
• Techniques to help you learn how to correctly use the pelvic muscles
• Pelvic floor exercises to strengthen the pelvic muscles
• Exercises to stretch and strengthen other important muscles
• Education on strategies to reduce urinary urgency and frequency
• Biofeedback to show you how your muscles are working
• Electrical stimulation to improve awareness and strength of the muscles

Who should be referred to a Pelvic Health Physical Therapist? If you…

• Leak urine during daily activities
• Leak urine when sneezing, coughing, laughing, lifting, or exercising
• Have difficulty or hesitancy starting a urine stream
• Have a strong urge to urinate that may or may not result in urine leakage
• Frequently urinate during the day (more than every 3-4 hours)
• Urinate more than once during sleeping hours
• Have difficulty getting to the bathroom because of balance, weakness, or pain

Looking for a Physical Therapist that specializes in urinary incontinence?

Visit our PT Locator that will allow you to find PTs by zip code and specialty including urinary incontinence.