Incontinence at any age: What you should know

March 3, 2016 Providence Health Team

Incontinence is a difficult word to say out loud. Even in the privacy of a provider’s office, discussing urinary incontinence can be uncomfortable. Yet millions of people suffer from the condition, and many of them are young women.

Until recently, urinary incontinence has been considered an affliction of aging or a bothersome side-effect of pregnancy. However, new studies show that incontinence affects women of all ages and levels of fitness more than previously thought.

As many as 30 percent of women between the ages of 25 and 44 experience stress incontinence or some form of leaking without warning – and those numbers only account for patients being treated. Unfortunately many women suffer without seeking help because they consider the topic too embarrassing to address or they believe incontinence is untreatable.

Pelvic floor disorders

There are two main types of incontinence:

  • Stress incontinence is caused by abdominal pressure on the bladder during activities such as running, jumping, sneezing or coughing. Stress incontinence is more common in younger women. A recent study confirmed a prevalence of incontinence in young, elite female athletes engaged in high-impact sports, such as running.
  • Urge incontinence, or overactive bladder, is an increasing urge to urinate with the inability to control the bladder. Postmenopausal women typically suffer from urge incontinence.

Many women suffer from a combination of urge and stress incontinence. This is known as mixed incontinence.

“Awareness and education around incontinence are the keys [to getting help],” says Katie Carr, physical therapist at Providence Scholls Rehabilitation. “Crossing your legs doesn’t help your bladder.”

Carr specializes in pelvic floor health and incontinence in women. There isn’t a one-size-fits-all solution for every person, but there is a solution, Carr says.

Pelvic floor muscles

The pelvic floor muscles hang in the pelvic girdle like a sling, indirectly helping to control the contractions of the bladder and urethra. These muscles relax to allow urination and tighten to stop the urine stream. Contraction of the pelvic floor muscles closes the lower urethra, squeezing any remaining urine back up into the bladder.

Pelvic floor muscles can be weakened by:

  • Pregnancy
  • Childbirth
  • Aging
  • Repetitive high-impact exercise, such as running 
  • Pressure of obesity
  • Straining of constant constipation

For many, the solution to incontinence is strengthening the pelvic floor muscles with exercise. 

Strengthening the correct muscles

Carr helps her patients restore and maintain strong pelvic floor muscles and good muscle function by teaching them how to do Kegel exercises. The exercises are named for Dr. Arnold Kegel who used them in research in the 1940s and 1950s. Contracting and releasing the muscles under the uterus, bladder and bowel (large intestine) several times a day will strengthen the muscles. The timeline for strengthening differs for everyone, Carr explains. Typically she sees patients over several months; it can take that long to build the muscle strength needed to fully control the bladder.

“It takes time, patience and effort to build these muscles,” she says. Motivation is the key to how fast  patients make progress. She also recommends adding squats to the exercise routine. “Why not do both?” says Carr.

Kegel exercise quick tips

  • Know which muscles. If you can stop your urination flow mid-stream, you have identified your pelvic floor muscles.  However, holding the flow of urine while on the toilet is only a test. Do not do Kegel exercises while sitting on the toilet.
  • To start, lie on your back with your knees bent. Progress to sitting or standing to do your Kegel exercises after building some pelvic floor muscle strength. 
  •  Be careful not to flex the muscles in your abdomen, thighs or buttocks.
  • Build up to your routine. Performing with an empty bladder, your first goal should be to tighten your pelvic floor muscles for 5 seconds. Then relax them for 5 seconds. Try to do 5 reps on your first day. As you gain confidence in your new routine, aim for 10 seconds at a time, relaxing for 10 seconds between contractions.
  • Don’t hold your breath. Breathe freely during the exercises to avoid stressing the rest of your body.
  • Repeat three times a day. Aim for at least three sets of 10 repetitions per day.
  • Give yourself encouragement. These exercises will feel foreign in the beginning. The longer you stay with this, the better your bladder health will become.

3 common incontinence myths

  • Incontinence is a normal part of aging. False: You are not destined to have urine leakage once you reach a certain age. Your pelvic floor muscles can be strengthened just like your biceps or quadriceps.
  • Childbirth caused irreversible problems that ensure incontinence. False:  It’s not uncommon for women to experience a loss of bladder control after pregnancy, but it’s usually temporary and can be resolved by doing Kegel exercises.
  • You just have to live with it. False: In most cases, urinary incontinence can be greatly reduced or eliminated. In addition to Kegel exercises, there are other treatments. Ask your primary care physician for more information.

If you’re experiencing incontinence or have questions, contact your primary care provider or ask to be referred to a physical therapist who specializes in pelvic floor muscle health.

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