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Updated February 23, 2023
November 17, 2022

A Guide to Physical Therapy for Urinary Incontinence

Introduction

Urinary incontinence (UI), the involuntary leaking of urine, is a condition that often goes untreated due to embarrassment or the assumption that it is a normal part of postpartum or aging.

UI affects up to 50% of women and up to 10% of men, yet less than half seek treatment.1 With conservative care, UI is often a highly treatable condition. Seeking care from a CityPT clinician can help you feel in control and improve your quality of life.

In this guide, we will discuss all aspects of physical therapy for urinary incontinence, from symptoms and causes to treatment and prevention. If you are looking for an effective way to manage urine leakage, read on.

Table of Contents

Understanding Urinary Incontinence

The bladder is a balloon-like organ that stores urine until it is ready to be eliminated from the body. The pelvic floor muscles and the urethral sphincter muscle work together to keep the bladder closed so that urine does not leak out when it shouldn't.

There are two primary types of UI:2

  • Stress incontinence: Urine leaks when the abdominal pressure increases, such as with coughing, sneezing, laughing, or exercising.
  • Urge incontinence: Urine leaks due to an involuntary contraction of the bladder muscles.
  • A combination: UI can also be caused by a combination of both stress and urge incontinence.

Most people experience some degree of UI at some point in their lives. UI becomes more common as we age, but it is not a normal part of aging. UI can occur in people of all ages and affects both men and women.

Symptoms of Urinary Incontinence

The most common symptom of UI is the involuntary leakage of urine. Other symptoms may include:

  • Frequent urination
  • Urgency (a strong need to urinate that cannot be delayed)
  • Waking up at night to urinate
  • Leakage with physical activity
  • Leakage when coughing, laughing or sneezing
  • A feeling of pressure in the lower abdomen (which could be due to an organ prolapse)

What are the Most Common Causes of Urinary Incontinence?

There are many possible causes of UI, but the most common are:3

  • Weak pelvic floor muscles: The pelvic floor muscles support the bladder and urethra and help to keep them closed. Weak and/or stretched pelvic floor muscles can lead to UI.
  • Nerve damage: Damage to the nerves that control the bladder muscles can cause UI. This can be caused by conditions such as diabetes, stroke, Parkinson’s disease, or multiple sclerosis.
  • Pregnancy and childbirth: The added weight of pregnancy can put pressure on the pelvic floor muscles and cause them to weaken under the strain. Childbirth can also damage the pelvic floor muscles and nerves — particularly if instruments (i.e. forceps or a vacuum) were needed during labor.
  • Menopause: The loss of estrogen during menopause can cause the pelvic floor muscles to weaken.
  • Enlarged prostate: For men, an enlarged prostate can block the urethra and cause UI.
  • Constipation: Hard stool in the rectum can put pressure on the pelvic floor muscles and cause UI. Plus, frequent straining can damage the pelvic floor.
  • Organ prolapse: When the bladder, uterus, or rectum prolapse (falling into areas of the pelvis they are not meant to be) it can affect bladder control and lead to UI.

Risk Factors for UI

There are several risk factors that can increase your chance of developing UI, including:

  • Age: The risk of UI increases with age.
  • Gender: Women are more likely to develop UI than men.
  • Pregnancy and childbirth: As mentioned above, pregnancy and childbirth can weaken the pelvic floor muscles.
  • Obesity: Excess weight can put pressure on the pelvic floor muscles.
  • Smoking: Toxins from smoking and secondary coughing can irritate the bladder and lead to UI complications.
  • Chronic cough: A chronic cough can put pressure on the pelvic floor muscles.
  • Medical conditions: Like diabetes, stroke, and depression.

Diagnosing Bladder Dysfunction

If you are experiencing symptoms of urinary incontinence, it is important to see a medical professional so that the cause can be properly diagnosed and treated. This will likely mean you schedule an appointment with your primary care physician, OB (if postpartum), or CityPT physical therapist.

An in-depth evaluation will be completed, looking at history, symptoms, pelvic floor strength, and other core and hip related factors to help determine the type of incontinence and potential underlying causes. Once complete, a comprehensive treatment plan can be created. This is where physical therapy is your best choice since it will give you actionable steps (as you'll see below).

Did you know there are physical therapists that specialize in women's health, pelvic health, and postpartum care? Plus, you can see them directly (without the need for a referral) to address any concerns with urinary incontinence, constipation, or pelvic pain.

What to Expect from Physical Therapy Treatment for Urinary Incontinence

The goal of physical therapy for urinary incontinence is to improve your symptoms and quality of life by optimizing the function of the pelvic floor. Treatment will be individualized based on your specific needs, but may include:

  • Pelvic floor muscle exercises: These exercises help to strengthen the pelvic floor muscles and improve bladder control. Core and hip exercises will also be prescribed to encourage optimal muscle synergy.
  • Bladder training: This involves gradually increasing the time between bathroom visits to help retrain the bladder muscles.
  • Biofeedback: This is a type of pelvic floor muscle training that uses sensors to help you better understand and control your pelvic floor muscles.
  • Education: You will be taught about UI, how to manage your symptoms, and what you can do to prevent issues in the future.
  • Manual therapy: This may be used to release any tightness in the pelvic floor muscles or connective tissue.
  • Functional training: This involves learning how to do everyday activities, such as lifting and coughing, without triggering UI symptoms.

What If Conservative Treatment Doesn't Work?

Typically, conservative care is the best option for this type of diagnosis. Only in specific and extreme cases, such as prolapse or a nerve injury, will more invasive treatment, such as surgery, be recommended.

Preventing Urinary Incontinence

There are several things you can do to help prevent UI, including:4

  • Kegel exercises: These exercises help to strengthen the pelvic floor muscles.
  • Avoiding constipation: This can help to avoid putting unnecessary pressure on the pelvic floor muscles.
  • Adequate prenatal and postpartum support: A women's health physical therapist can help to ensure that the pelvic floor muscles are properly supported during pregnancy and after childbirth.5
  • Maintaining a healthy weight: This can help to avoid putting unnecessary pressure on the pelvic floor muscles.
  • Making healthy choices: Factors like getting enough sleep, stress management, and a nutritious diet are all important for maximizing the body's overall tissue health.
  • Avoiding smoking: This can help to avoid an inflammatory response that compromises global tissue health.
  • Treating chronic cough: This can help to avoid putting unnecessary pressure on the pelvic floor muscles.
  • Addressing any mental health or trauma experiences with professional help: This can help to reduce the risk of any UI related conditions, like anxiety or depression.

Is It Time to Seek Treatment?

Do you experience any urinary incontinence symptoms? If so, it's time to talk to a CityPT women's health/pelvic health physical therapist. They will be able to help you determine the cause of your UI and create a personalized treatment plan to address your specific needs.

Book an appointment today.

This guide is intended for informational purposes only. We are not providing legal or medical advice and this guide does not create a provider-patient relationship. Do not rely upon this guide (or any guide) for medical information. Always seek the help of a qualified medical professional who has assessed you and understands your condition.

References

Footnotes

  1. Minassian VA, Yan X, Lichtenfeld MJ, Sun H, Stewart WF. The iceberg of health care utilization in women with urinary incontinence. International urogynecology journal. 2012 Aug 1;23(8):1087-93.

  2. Barry MJ, Link CL, McNaughton‐Collins MF, McKinlay JB, Boston Area Community Health (BACH) Investigators. Overlap of different urological symptom complexes in a racially and ethnically diverse, community‐based population of men and women. BJU international. 2008 Jan;101(1):45-51.

  3. Hage‐Fransen MA, Wiezer M, Otto A, Wieffer‐Platvoet MS, Slotman MH, Nijhuis‐van der Sanden MW, Pool‐Goudzwaard AL. Pregnancy‐and obstetric‐related risk factors for urinary incontinence, fecal incontinence, or pelvic organ prolapse later in life: A systematic review and meta‐analysis. Acta Obstetricia et Gynecologica Scandinavica. 2021 Mar;100(3):373-82.

  4. Laycock J. Pelvic muscle exercises: physiotherapy for the pelvic floor. Urologic Nursing 1994;14:136-40.

  5. Woodley SJ, Boyle R, Cody JD, Mørkved S, Hay‐Smith EJ. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews. 2017(12).