By Emily Bessemer, DPT, CLT-LANA
Imagine suddenly feeling like you have to urinate at a crowded event, or urinating every time you cough or sneeze. For many women and men, this is a frequent concern that seriously impacts the quality of their lives.
Whether caused by a medical issue, childbirth or age, urinary incontinence can be uncomfortable and embarrassing, but the good news is it’s usually treatable. Physical therapy can help patients of all ages, from infants with constipation and children with bedwetting issues, to women after childbirth and those suffering with pelvic floor pain due to endometriosis, and men after a prostatectomy to seniors with age-related loss of control.
The Causes and Types of Incontinence
Urinary incontinence involves the muscles of the pelvic floor. This group of muscles connects to the bottom of the pelvic bones and runs forward, forming a sling that supports internal organs and controls the sphincter muscles. Pelvic floor muscles also help support the lower back, stabilize pelvic bones, and help with sexual function.
Some of the most common causes of incontinence include:
- Bladder and pelvic muscle weakness
- Pregnancy and childbirth
- Hormonal changes
- Prostate problems
- Chronic cough
- Effects of medicine
- Repetitive lifting
- Diseases such as multiple sclerosis, muscular dystrophy and diabetes
There are several types on incontinence, including:
- Urge Incontinence is caused by an overactive bladder that empties without your permission. This type of incontinence usually occurs when you feel a sudden, strong urge to urinate but can’t make it to the bathroom without leaking. You also may urinate frequently and lose moderate to large amounts of urine when you leak.
- Stress Incontinence is usually caused by weak pelvic floor muscles, often the result of childbirth. This type of incontinence usually occurs when you leak urine during coughing, sneezing, exercising, or other movements.
- Overflow Incontinence occurs when the bladder fails to empty completely. This type of incontinence usually occurs when you lose small amounts of urine throughout the day and night, or when you get up often during the night to urinate. You also may feel like you have to empty your bladder but can’t, or you may spend a long time in the bathroom but produce only a weak, dribbling stream of urine.
Fighting the Urge with Physical Therapy
Patients can be referred to the program, which is typically covered by insurance, by their primary care physician, OBGYN, urologist, radiation oncologist, pediatrician or another medical provider. We will conduct an initial evaluation to learn more about each patient’s individual symptoms and probable causes, then meet with him or her for one-on-one sessions for an hour, once a week, for six- to- eight weeks.
While therapy is individualized for each patient’s specific issues, it usually includes performing pelvic floor contraction exercises, sometimes called Kegel exercises, to activate and strengthen the muscles of pelvic floor. Exercises to strengthen the abdominal muscles and lumbar spine may be combined with yoga-based movements to increase strength and body awareness. To further improve awareness, we may use biofeedback, which helps patients see which muscles they are contracting to focus on the correct ones. To do this, patients will wear a surface electromyography (EMG) device to visualize their muscle activity.
Treating Women during the 4th Trimester
During pregnancy and childbirth, women’s bodies can shift and change. Additionally, a woman may have an episiotomy during childbirth or suffer back pain and strain.
The three months after childbirth – the fourth trimester – is a time for self-care for mom, not just baby. This is an important time for women to regain their muscle strength, as pushing during childbirth often results in stress incontinence.
We work with women to help strengthen those strained and weakened muscles. In addition to traditional pelvic floor therapy, we may also use real-time ultrasound to loosen or soften any scarring that women may have. Other aspects of therapy include learning how to decrease bladder irritability, maintaining a diary to help “retrain” your bladder, and relaxation and breathing techniques.
Our program has enabled men, women and children of all ages to find relief and get back to their active lifestyles – without embarrassment. For example, I recently worked with a patient who had given birth two months before. She had pain with intercourse, difficulty with urge control and issues with abdominal bloating and discomfort. After six sessions together, she no longer had pain, her abdominal bloating was reduced to nearly none and she was able to control urges well enough to complete errands without worrying about where the bathroom was.
Pelvic floor physical therapy is offered at The OceanFirst Rehabilitation Center at CentraState Medical Center in Freehold and at our satellite offices in Jackson, Marlboro, Monroe and East Windsor. For more information, call 866-CENTRA7 or visit centrastate.com/pelvicfloor.
Emily Bessemer, DPT, CLT-LANA, is a physical therapist on staff at CentraState Medical Center. She holds a doctorate degree in physical therapy and is certified in lymphedema therapy.