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& Health Medical M C What is bladder leakage? Bladder leakage (urinary incontinence) is the involuntary leakage of urine. When do women leak? Women leak during and after pregnancy, menopause, post radiation for breast or uterine cancer, when performing athletics and during intercourse. Some other medical conditions like painful bladder syndrome, neurological conditions such as multiple sclerosis and vulvodynia, can also cause incontinence. Are there different types of incontinence? Yes. Stress Incontinence- leaking with laughing, coughing and sneezing. Stress incontinence is a storage problem due to weakened pelvic support when pressure in the bladder is greater than the urethra. Urge Incontinence is a strong desire to urinate even when the bladder is not full, increased frequency greater than 6-8 times per day or nocturia (awakening from sleep) because of urge to urinate. Urge incontinence is a filling problem due to uninhibited, involuntary bladder contraction. Mixed Incontinence is a combination of urge and stress incontinence. What causes bladder leakage? Loss of bladder control or poor strength, endurance and coordination of pelvic floor muscles. Pelvic floor muscles contract to support and lift the bladder in good position and close the urethra. Isn’t leaking a normal part of aging? 40 million women between the ages of 18-45 live with incontinence. Incontinence should be treated as soon as it begins. Leaking is not normal. By Cora T. Huitt PT, DPT, BCB-PMD Cora has been practicing physical therapy for forty one years. She earned her Bachelors of Science at Ohio State University, Masters in College Teaching at University of North Carolina and her Doctor of Physical Therapy at Alabama State University. Cora has been a clinical instructor and adjunct professor at several universities. She is a certified women’s specialist in pelvic muscle dysfunction. The clinic she started, Women’s Health Physical Therapy is one of six credentialed by the American Physical Therapy Association in the United States. Cora is an affiliate member of the American College of Obstetrics and Gynecology, International Continence Society, National Vulvodynia Association and International Society for the Study of Women’s Sexual Health. Why Didn’t I Know That 1 In 4 Women Leak? However, women over 80 years old suffer due to aging muscles, decreased estrogen and slowed nerve transmission. How can a woman tell if she is doing her pelvic floor exercises correctly? Education about anatomy/ physiology and specialized equipment like ultrasoundography, a squeeze pressure gauge or an educator can display correct muscle contraction. Exercises done correctly contribute to 70% improvement in symptoms of stress incontinence. Improvement has been seen across all age groups with a supervised exercise program by specialized physical therapists or continence nurses versus leaflets or unsupervised exercise. Do I have to put up with incontinence? No, whether you are a teen or a mature woman, specific muscle training from a Women’s Health Physical Therapist can be most effective. The Agency on Healthcare Research and Quality endorses such behavioral therapy. As an athlete, girls have been told its ok if they leak. Performing impact sports such as running or gymnastics can fatigue the pelvic floor muscles that hold the pelvis together and support the pelvic organs. Pelvic floor muscles must be strengthened and work together with the abdominals and deep back muscles. Can holding your breath contribute to leaking? Yes, increasing intra-abdominal pressure will compress the bladder. Why do women leak more frequently than men? Women have a much shorter urethra than men. The urethra must be compressed quickly like 6 kinking a garden hose to close off the tube so urine is not leaked. How long should pelvic exercises be practiced? Pelvic floor exercises are most effective when done for three months. Exercises should be continued throughout life as activities of daily living are performed. Why does bladder leakage need to be treated? Female incontinence is embarrassing and can cause emotional distress, which can result in decreased physical activity and social function. The cost of pads is expensive. Women can develop irritation in the region and urinary tract infections. Is it correct to think that the first step to reducing leaking is to cut back on liquids? No, decreasing liquids is not a good idea because a woman can become dehydrated, with an increase in uric acid which can contribute to infection. Is a side effect of having a baby incontinence? Possibly, pelvic floor muscles are often strained during pregnancy and vaginal birth. Decreased estrogen levels can also reduce the connective tissue thickness reducing the compressive forces on the urethra and the lift of the bladder. What types of exercises do physical therapists do? Exercises include: 1. Training the transverse abdominals, training deep back extensors beside the spine, and pelvic floor muscles to work together when performing daily life tasks. 2. Coordinated breathing. 3. Bladder retraining to expand the bladder’s capacity to hold urine. 4. Urge suppression to reduce leaks. Depending on the individualized exercise program tailored for each woman, the sessions are typically 8 visits of 45 minutes over a 6-8 week period. 5. Timed voids, which is slowly increasing time intervals between going to the bathroom. What other treatments are available? • Electrical stimulation • Surgical procedures • Medications (even though the medication action can be helpful, sometimes side effects like dry mouth can be bothersome) How can electrical stimulation work? The InToneTM device is an electrical muscle stimulator that encourages the pelvic floor muscles to work more effectively. Patients are instructed how to insert the probe vaginally to ensure good contact with the pelvic floor muscles. Stimulation is set to aide muscle contraction. A twelve minute therapeutic session is done with visual biofeedback, audio encouragement and instruction. Regular sessions, 6x/week for 14 weeks for stress and 26 weeks usage for urge or mixed incontinence is recommended. The company that manufactures the InTone offers a money back guarantee if the patient complies with the suggested treatment and does not achieve positive results. Why do women feel a strong urge to urinate or even leak when she sees a toilet, or walks into the door of her home? A person can develop a conditioned response associating the toilet with the need to urinate.
Common questions women are hesitant to ask & Health Medical M C When a woman sees a bulge in her vaginal area, is that contributing to incontinence? Prolapse, descent and change of anatomical position of the bladder can contribute to leaking. Inappropriate leakage of urine is falsely perceived by many as not serious. If you or a family member or friend are experiencing leaking, consider seeking care. Many women do not seek advice and care for seven or more years. The National Institute of Health and the Agency for Health Care Policy and Research recommends as a general rule that the least invasive procedure should be the first choice of medical care if appropriate to your needs. Please give us a call at Womens Health Physical Therapy if you have any questions or comments. “Most women who have incontinence use pads and do not seek care for seven or more years. Research documented twenty-five years ago that leaflet instructions are not effective in teaching women how to strengthen and improve the endurance and coordination of the pelvic floor muscles. As a pelvic health specialized physical therapist, I have witnessed many women struggling to use the superficial and deep pelvic floor multiplanar muscles correctly. My patients that have used the InTone electrical stimulator feedback system have found it most helpful. The InTone device is easy to use and gives auditory and visual feedback. Computer generated graphics in follow up sessions show the patient her progress to strength goals. After years of withdrawal, most find they can be more socially and physically active due to decreased or eliminated incontinence”. - Dr. Cora T. Huitt, PT, BCB-PMD Testimonials “My use of the Intone Device has been to reduce incontinence. As a 55 year old, I did not want to stop my social activities like going to craft classes due to leakage of urine. Whenever I sneezed, coughed, or laughed I had a problem. My gynecologist recommended pelvic floor physical therapy. As a result, I have been under the care of an excellent women’s health physical therapist who suggested electrical stimulation as part of comprehensive pelvic health therapy. I like working with the InTone device because of the audio supervision. To my delight I have noticed good results. After twelve treatments I have tripled my initial pelvic floor muscle squeeze pressure. I was able to go to a local chocolate festival and enjoy myself with my husband and make it to the bathroom without leaking. Thank you for the high level of medical care to reduce my leaking by isolating pelvic muscle strength and endurance.” - Patient of Cora T. Huitt, DPT, PT, MA, BCIA-PMDB 7
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