Let's face it: Nobody wants to talk about incontinence. However, many women have some degree of it. There is no reason why anyone should have to feel embarrassed about or continue to suffer from this problem, but it continues to be a common chronic health condition that diminishes quality of life.
Many women experience urinary incontinence for the first time during or after pregnancy. The physical changes of pregnancy, along with the stresses put on the pelvic floor, can cause urine leakage with exertion, coughing or sneezing. For many women, this problem resolves within several months postpartum. However, without treatment, some women may continue to have a chronic incontinence issues for life.
There are two main types of urinary incontinence, listed below. Some women develop a mix of the two.
Stress Urinary Incontinence
-A weak pelvic floor.
-Urethral sphincter dysfunction.
Women who have stress incontinence experience urine leakage when pressure is put on the bladder during laughing, coughing, sneezing, or with exercise.
Urge Urinary Incontinence
-Pregnancy or pelvic surgery such as C-section.
-Injury to pelvic area.
-Diseases such as diabetes, stroke, MS or other neurological conditions.
This condition is more commonly called ''overactive bladder.'' Urge incontinence occurs when there is nerve dysfunction that causes bladder contractions outside of normal urination. Women with urge incontinence find that they have episodes where they experience an extremely strong and immediate need to urinate. The bladder contractions can make it difficult to make it to a bathroom.
The first line of treatment is to strengthen the pelvic floor to help provide greater support and control. The pelvic floor muscles play an important role throughout a woman's life in maintaining proper alignment of the spine and support and function of the pelvic organs. The muscles of the pelvic floor span from the pubic bone to tailbone, forming a figure eight around the urethra, vagina and anus. Weak pelvic muscles result in sagging and loss of support of the pelvic organs, and can lead to incontinence problems if not corrected.
Pelvic floor exercises (sometimes called "Kegel" exercises) are a great way to strengthen these muscles and are simple to perform, but require that you first identify how to correctly contract the pelvic floor muscles. One method for locating the pelvic floor muscles is to note the area that contracts when you stop urinating. The muscles responsible for stopping urine flow are the pelvic floor muscles. You can use the urine stop-and-start test when initially learning how to locate and isolate the muscle group.
Pelvic Floor Exercises
Two or three times a day, do 5-10 repetitions of each exercise listed below. Build up to two times a day of 25-50 repetitions of each exercise. If your pelvic floor muscles fatigue quickly, do fewer repetitions each time, but increase the frequency throughout the day.
Contract your pelvic floor muscles quickly and release.
Slowly contract your pelvic floor muscles (think of lifting up like an elevator moving up floors), progressively increasing your contraction, and then slowly releasing back down. You can increase the effectiveness of this exercise by holding for five seconds at the top of the contraction.
Your abdomen, buttocks, and thighs should not be tensed when doing these exercises. Lie, sit, or stand with your legs slightly apart so you can isolate the correct area. No one will be able to tell that you are doing these exercises, so you can do them anywhere. It's helpful to give yourself a ''cue'' to do your exercises; for example, try to remind yourself to do them while brushing your teeth or driving to work. You should contract your pelvic floor muscles each time you lift something, laugh, sneeze, or cough to provide support and prevent further weakening.
Increasing pelvic floor strength is helpful for reducing stress incontinence, and the exercises can be part of the treatment for those with ''overactive bladder'' or urge incontinence issues.
In addition, those with urge incontinence can improve the condition with the following bladder-retraining program:
1. When you feel a strong bladder urge, stop and stand (or preferably sit) very still.
2. Squeeze your pelvic floor muscles 5-6 times to prevent leaking.
3. Relax by taking a deep breath and exhaling several times until the urge reduces.
4. Slowly walk to the bathroom. If the urge suddenly becomes strong again, go back through the steps to regain control and retrain your bladder response.
Additional treatments can range from biofeedback and behavior interventions to medications and surgery. The key for effectively treating an incontinence problem is proper diagnosis and follow-up with a healthcare provider who is trained to treat this condition.
A physical therapist that specializes in women's health can be a great resource for treating incontinence issues. A PT can help you prevent the need for surgery or medications through techniques and exercises that help strengthen the pelvic floor and retrain your bladder. You can find a physical therapist in your area by visiting the APTA website and entering your zip code, distance for your search. You can refine your search by clicking on ''women's health.''
Remember, if you suffer from incontinence, you are not alone! It is an easily solvable and common problem that you don't need to feel ashamed of.
For additional information on incontinence, click here.
For a video demonstration on how to do pelvic floor exercises, click here.
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