There are two major types of urinary incontinence that benefit from physical therapy treatment, stress and urge, and you can suffer from more than one.

Stress Incontinence: the sudden involuntary loss of urine when you exercise or move in a certain way. Examples include jumping, coughing, sneezing, or laughing. Urine leakage occurs in these cases due to weak pelvic floor muscles and poor ligament support at the bladder outlet and urethra, or due to a defect in the urethral tube itself.

Urge Incontinence: urine leakage that occurs as soon as you get the urge to go to the bathroom. The sensation is overwhelming, your bladder muscle, the detrusor, contracts (tightens) at the wrong time, and you can’t control it. These inappropriate contractions can stem from reversible causes like a bladder infection, bladder irritability after surgery, or simply poor dietary and bladder habits. Sometimes they are caused by problems with the nervous system.

Knowing you can do something about incontinence, that you don’t have to just learn to live with it, puts you on the path to regaining control over your bladder.

First, and this is the hardest step for many people to take, you must discuss your problem with a health care professional. It is important to find a health care practitioner who is knowledgeable in evaluating and treating incontinence.

Get a thorough examination from your physician to rule out any medical conditions that may be causing your loss of bladder control. The initial screening should include your health history regarding incontinence, a physical examination, including a pelvic exam, analysis of your urine, and a measurement of the amount of urine left in your bladder after you urinate. Then you’ll be ready for the next step, an individualized treatment program that works best for your type of incontinence.

• Education about the bladder, pelvic floor muscles and normal emptying techniques
• Bladder retraining and timed schedules for urinating
• Exercises to strengthen the pelvic floor muscles
• Vaginal weights to strengthen the pelvic floor muscles
• Medication to treat infection, replace hormones, stop abnormal bladder muscle contractions, or tighten sphincter muscles
• Dietary modifications
• Surgery to correct bladder position

Many physical therapists concentrate their practice in women’s health, and incontinence is one of the most common problems they treat. Physical therapists use a variety of methods to help their clients correct pelvic floor weakness. Your physical therapist will teach you how to strengthen your pelvic floor muscles, which may prevent the onset of incontinence or help to reverse the process. She will evaluate the extent of your incontinence, identify treatment goals, and make sure you understand how your treatment works, now and in the future. Physical therapists may also offer some tips on lifestyle changes that will help the bladder be less irritable.

These suggestions include:

• lifting and moving correctly
• bracing the pelvic floor muscles when you cough, laugh, or sneeze
• avoiding common bladder irritants
• keeping a bladder diary to promote normal urinating habits
• exercising correctly and avoiding improper sit-up techniques

Many women learn about their pelvic floor muscles and Kegel exercises during childbirth classes, but what about individuals who don’t have children or athletes who experience incontinence while exercising?

Perhaps the best time for a young woman to learn about the function of her pelvic floor muscle is when she is an adolescent or when she has begun menstruating. At this age, she will be old enough to understand where her pelvic floor muscles are, and she will be developing healthy habits for a lifetime that should include Kegel exercises as part of her regular exercise program for health and fitness.

Exercises to strengthen your pelvic floor muscles can improve your bladder control. But these exercises are not easy to do correctly, unless you follow your physical therapist’s instructions.

First, identify your pelvic floor muscles by trying the following: partially empty your bladder, and then try slowing down the flow of urine. If you can stop or slow the flow, then you are contracting (tightening) the right muscles. Use this technique about once a month, only to identify the right muscles and see if you are improving.

Once you have learned how to contract the pelvic floor muscles, try doing these contractions, called Kegel exercises, throughout the day. Do them with daily activities, such as sitting in a meeting, while stopped in your car at a traffic light, or when talking on the phone. Hold the muscles contracted for about 3 seconds, 12-15 repetitions in a row, making sure to rest for a few seconds between each exercise set. Do this at least three to six times per day.

If your pelvic floor muscles are weak, you may need to lie down while you exercise. As you feel stronger, you can go to a sitting position, and then do these exercises while standing. Your physical therapist will help guide you.

You should also vary these exercises: Contract your pelvic floor muscles and hold for 5 to 10 seconds. Or contract and release quickly. Or clear your throat or cough while holding the muscles contracted. You should do these exercises several times throughout the day. Remember that Kegel exercises are discreet. Nobody will notice that you are doing them.

If you have tried these exercises without success, you may benefit from a referral to physical therapy for a specific pelvic floor examination. Please call our office with any questions and we will be happy to help you.