Questions and Answers A Physical Therapist Speaks to PT’s Role in Addressing Incontinence

HCN: What exactly is urinary incontinence?

CD: Urinary incontinence means you lose urine when you don’t want to. Along with leakage, there might be other symptoms: urgency, frequency, or nocturia – awakening from sleep because of the urge to urinate. This can vary with age and is not necessarily abnormal unless is occurs more than two to three times a night.

HCN: What types of things can exacerbate urinary incontinence?

CD: Many things can contribute, at all ages, including pregnancy, hormonal changes during menopause, caffeine intake, medications, obesity, chronic illness, or bladder infection.

HCN: How can a physical therapist help?

CD: Physical therapists use a variety of methods to help clients, mainly to help correct pelvic floor weakness. These can help prevent incontinence, or can help to reverse the process.

HCN: The American Physical Therapy Association (APTA) recently reported that urinary incontinence affects 13 million Americans every day, and that the condition can be brought on by a number of changes in the body resulting from age, pregnancy, or even heavy lifting. Are there certain things that physical therapists can do for all women, despite their age or the reason for their incontinence?

CD: Each physical therapy program for incontinence is individualized depending on the woman’s status. Certain core values are relative to all, though, such as making sure a woman is maintaining adequate fluid intake, educating her on the importance of eliminating irritants from her diet such as caffeine, and safer lifting techniques.

HCN: What are some things women can do on their own to lessen issues with incontinence?

CD: Lumbar stabilization – with a pad or brace – can strengthen abdominals and the lower back, to improve posture and pelvic stability. A physical therapist can help facilitate both of these changes.
Pelvic floor muscles can also be worked by doing the Kegel exercise, the voluntary contracting of the pelvic floor muscles. The APTA recommends you first identify your pelvic floor muscles – partially empty your bladder, then try stopping or slowing down the flow of urine. If you can stop the flow, then you’re contracting the right muscles. Then try doing these contractions throughout the day, during daily activities – sitting in a meeting, stopped at a light in your car, or talking on the phone, for instance. Hold the muscles contracted for three seconds 12 to 15 times in a row, three to six times a day.

HCN: How early in life should a woman begin Kegel exercises?

CD: Many women learn about them during pregnancy, but individuals who don’t have children, especially athletes, can experience incontinence too. The best time for a woman to learn about the function of her pelvic floor muscles is when she is an adolescent or has begun menstruation. She will be developing a health habit that will benefit her for a lifetime.

HCN: You work often with women during their pregnancies to alleviate pain and discomfort, as well as to address stress incontinence, which is often brought on by pregnancy and childbirth. But you also work with women in other stages of life. Is it harder for older women to address incontinence issues through physical therapy?

CD: A woman can improve at any age. By treating stress incontinence conservatively through physical therapy, some women may avoid surgery by improving muscle strength and posture. Each individual will determine for herself how the symptoms of incontinence impact her daily routine, and those symptoms can be decreased to a manageable level using physical therapy. If surgery is recommended, PT can also contribute to a more successful outcome.

HCN: You mentioned Kegel exercises and lumbar support as two ways women can address incontinence with the help of a physical therapist. What other interventions are being used by physical therapists to address incontinence?

CD: Biofeedback is effective. It uses visual and auditory feedback as a training tool, to locate and strengthen pelvic floor muscles. This can mean the use of an internal, vaginal sensor, or could use surface electrodes.
Electrical stimulation is the use of an internal sensor, which, through an individualized series of contractions, ‘re-educates’ and facilitates the strengthening of weak pelvic floor muscles.
There are also some manual therapy techniques, which address muscle tone, trigger points, and other variables that can affect pelvic floor function.
Finally, education plays a large part in any incontinence therapy. Dietary influences are examined, and behavioral techniques are suggested.

Catherine D’Agostino can be reached via Johnson Memorial Hospital; (860) 272-2912;catherine.dagostino@jmhosp.org