Leaks, drops, dribbles, incontinence, no matter what you call it, bladder leaks and incontinence can be embarrassing. But you should know that you are not alone. Millions of Americans suffer from one of several different types of incontinence.
What is Incontinence?
Incontinence is the involuntary, that is the uncontrolled, release of bowel or bladder. Even someone who has partial control over when they use the restroom can be considered at times to be incontinent. The controlled release of your bowel or bladder is based on your pelvic floor muscles’ ability to prevent urine or feces from leaving the body. And there are a variety of life events that can impact the health and strength of your pelvic floor, these changes (or dysfunctions) of the pelvic floor do not have to be permanent, they can be cured, but understanding the type of incontinence and the underlying challenge is necessary to getting the most out of treatment.
Types of Incontinence
Incontinence can be broken down into several different types. But the first difference in incontinence types is whether you are having bowel or bladder incontinence. Leakage through the urethra (and ultimately the vagina or penis) is different than leakage from the rectum. Bowel incontinence is less common, and there are several subtypes of bladder incontinence, so we are going to focus our attention on bladder incontinence and urine leaks.
4 Main Types of Urinary Incontinence
Stress Incontinence
Stress incontinence is also known as exercise induced incontinence because it occurs when there is stress or strain placed on the muscles of the pelvic floor as occurs during coughing, sneezing, laughing, and exercise. Generally speaking, stress incontinence can be managed using incontinence products or pelvic floor physical therapy pretty easily and it is not going to require you to run to restroom right away. However, stress incontinence is an indicator that your pelvic floor is not as strong as it should be.
What Causes Stress Incontinence?
Remember that stress incontinence is due to stress and strain places on the muscles of the pelvic floor. This stress can come from a variety of causes but there are two that are very common. During and following pregnancy stress incontinence is common. During pregnancy the pressure from the added weight of an additional human, your baby, puts a ton of strain on the pelvic floor muscles. Additionally, following the birth of your child your pelvic floor will have stretched, these muscles should return to their previous tension, but sometimes they need some help. The second common cause of stress incontinence is high impact exercise. Frequently those who run (marathoners) or jump (including dancers) put consistent pressure on their pelvic floor. This leaves these muscles at risk of weakening and yielding to stress incontinence.
 |
|
Bouncing on a trampoline, dancing, running, none of these should leave you worried about peeing your pants. But if they do, you might be suffering from stress urinary incontinence. An all too common condition, affecting mostly women, that can be cured quickly and for good. |
Urge Incontinence
Urge incontinence is also known as overactive bladder because it occurs when you are not expecting it, often at inconvenient times without a bathroom in close proximity. The feeling, or urge, to use the restroom comes on strongly and suddenly, and it is often followed closely by an involuntary loss of urine from the bladder (hence an “overactive bladder”). Urge incontinence is not as easy to deal with on your own because of its immediate nature. If you have to plan your trips to the grocery store based on the closest rest stops or bathrooms, you are likely experiencing some urge incontinence. Urge incontinence is another indicator that your pelvic floor is not as strong as it should be, treatment may look similar in that pelvic floor muscle exercises will be involved, but the goal in the case of urge incontinence is to reduce the feeling of needing to go and to be able to wait until a bathroom is available.
 |
|
If you worry about making it to the bathroom on time, if you have to plan your day around bathroom stops, you might be suffering from urge urinary incontinence. Just one type of urinary incontinence that affects both men and women, but it can be treated. |
Mixed Incontinence
Mixed incontinence is fairly straight forward once you understand stress and urge incontinence. It is known as mixed because you have symptoms of both stress and urge incontinence at the same time. However, achieving a healthy pelvic floor for someone currently facing mixed incontinence is no different than for stress or urge incontinence alone. A physical therapist can walk you through the steps necessary to help you Love Your Life!
Overflow Incontinence
If you have a persistent dribble of urine, it is likely that you are suffering from overflow incontinence. This type of incontinence is characterized by a lack of bladder emptying that leads to this persistent flow of urine. The symptoms mimic those of stress incontinence, but one common differentiator is that overflow incontinence is more common in men.
3 Special Types of Urinary Incontinence
Functional Incontinence
Functional incontinence is related to the co-occurrence of an underlying neurologic or physical condition (such as Alzheimer’s or arthritis) that prevents you from making it to the bathroom on time. Functional incontinence is not related to your ability to retain urine, so if you were to make it to the bathroom in a timely manner you could control the release. If you are suffering from functional incontinence it is because you cannot make it to the bathroom to be considered continent.
Reflex Incontinence
Reflex incontinence refers to the involuntary contraction of the bladder muscles when it is full, commonly resulting in the release of a large volume of urine. Because the contraction is involuntary it cannot be controlled; the lack of control with reflex incontinence generally occurs following an injury to the spinal cord, which interrupts the signal to the brain that warns that the bladder is filling.
Nocturia
Nocturia is characterized by night-time incontinence only. While several types of incontinence can occur while a person is sleeping, nocturia only occurs at night while the individual is sleeping. Usually nocturia occurs only in children under the age of 5, but if it is persisting beyond that age, medical attention should be sought.
Can Incontinence be Cured?
No one would choose incontinence; unfortunately, many people choose to live with it because they don’t know there is a cure for incontinence. Incontinence can be a really isolating condition, one that can feel like there is no solution, but treatment for incontinence exists. And the time to consider treatment for incontinence is now because taking a wait and see approach, or ignoring your bladder symptoms altogether, is only putting you at risk for greater problems down the road.
We see a lot of patients who drink as little as they possibly can so they don’t have to go. It seems like a logical cure for incontinence. “If I don’t drink anything, I won’t have to go.” The reality is you get fluids from the foods you eat, and by not drinking enough you can create even more problems for yourself (think incontinence is rough, consider trying to pass a kidney stone).
In order to best treat your symptoms and challenges it is helpful for your pelvic floor physical therapist to understand what you are going through. Just like no one knows your pain like you do, no one understands your incontinence like you do. But you may not even know what type of incontinence you are suffering from.
So here are 4 questions to help you get the most out of your urine incontinence treatment:
1. How many times per day do you have to go?
2. What are you doing when you have to go?
3. Are you able to empty your bladder?
4. Do you get up more than once per night to go to the bathroom?
What if I don't get Treatment for My Incontinence?
You have no obligation to get treatment for your incontinence. In fact many people try to manage it with pads or incontinence prodcuts. This seems to be a solution, but you should consider the underlying issues a little more. If you just manage the symptoms of incontinence, you are not going to solve the problem. Managing the symptoms of incontinence is not a cure or treatment for incontinence.
Beyond the inconvenience of managing your incontinence with pads or frequent trips to the bathroom, there are 3 additional considerations:
1) Additional pelvic floor dysfunction. Incontinence is just one sign of an unhealthy pelvic floor, people with an unhealthy pelvic floor can also suffer from sexual dysfunction (like erectile dysfunction or pelvic pain) and pelvic organ prolapse. Generally speaking, the main types of urinary incontinence are least problemtatic pelvic floor dysfunction. Sexual dysfunction and prolapse are more challenging and may require additional intervention, including surgery.
2) Low Back Pain. Low back pain is a common symptom of pelvic floor dysfunction. In fact, up to 95% of women with low back pain suffer from underlying pelvic floor dysfunction and a large portion of these women go undiagnosed because their providers are not prepared to ask the right questions.
3) Falls. Remember that your pelvic floor muscles are just that, muscles! Just like your arms, legs, or back they can grow stronger with use and they can become weaker with inactivity. Physical therapists are experts in your musculoskeletal system and how your body moves. A women’s health physical therapist or a physical therapist with training in pelvic floor physical therapy has advanced training in the pelvic floor muscles and associated structures. They can assess why your dysfunction is occurring, identify what needs to be done to correct it, and provide you with the support and feedback to teach you how to get it done. Because a physical therapist is a movement expert they are going to treat this underlying issue of pelvic floor dysfunction, which will immediately reduce your risk of falling, but they can follow-up with a thorough falls risk prevention program tailoring a balance rehabilitation plan to your needs. Not all types of incontinence increase the risk of falling equally, but all three types do increase your risk of falling and should be treated with pelvic floor physical therapy. Unfortunately, your increased risk of falling is nearly twice (1.92 times) as high when you have mixed incontinence as when you have no urinary incontinence at all. Given that the symptoms of stress incontinence and urge incontinence are not the same, but that they both indicate a pelvic floor that could be healthier than it is, the increased risk of falling that comes from mixed incontinence seems obvious.
Why should I Strengthen My Pelvic Floor (and Stop Incontinence)?
When it comes to your overall muscle health, your pelvic floor is vital in nearly every activity you do on a daily basis including toileting, breathing, and especially standing and walking. Your pelvic floor is the base of your core muscles which supports your spine, stops your internal organs from falling out, and helps your hips properly mobilize allowing you to walk. Without a healthy pelvic floor back pain, pelvic organ prolapse, and difficulty walking are all common. No matter the type of urinary incontinence, if you are suffering from bladder leaks, you are suffering from an unhealthy pelvic floor. Overall, your pelvic health is a good indicator of your overall physical well-being. Pelvic health is your physical health and left untreated, you can suffer from a variety of more complex issues. Talk to a Pelvic Floor Physical Therapist Today.