May 27, 2020  | By

By: Dr. Vivian Zhang, PT, DPT, MS.

What is Urinary Incontinence?

Urinary incontinence is a loss of bladder control resulting in involuntary leakage of urine and can affect men and women of all ages. It is a problem that is embarrassing and can significantly impact one’s function and quality of life. Per the U.S. Department of Health and Human Services, approximately 13 million people in the United States suffer from urinary incontinence. Yet few seek help from pelvic floor physical therapists to treat their symptoms. There are three types of urinary incontinence often treated by pelvic floor physical therapists, they include urgency, stress, and mixed incontinence. Stress incontinence occurs when urine leaks when pressure on the bladder and urethra increases suddenly such as while coughing, laughing, sneezing, running, or jumping. Urgency incontinence, also known as overactive bladder, occurs when one experiences a sudden, intense, and unstoppable urge to urinate. Mixed incontinence is when someone experiences both stress and urgency incontinence at the same time, both of which can safely and effectively be treated by your physical therapist simultaneously.

Some Risk Factors for Urinary Incontinence Include:

  • History of pregnancy and childbirth
  • Menopause
  • Hysterectomy and other pelvic/abdominal surgical procedures
  • Age
  • Gender
  • Obesity
  • Smoking
  • Some diseases and conditions such as diabetes, kidney disease, spinal cord injury, and neurologic diseases

Why Should I Seek Treatment from a Pelvic Floor Physical Therapist?

That’s a great question and a very common one! The pelvic floor is made up of muscles that function to help support our organs and help us control our bladder and bowel function. Physical therapists are health care professionals trained to be musculoskeletal experts with some specifically trained to be specialists about the muscles that make up the pelvic floor. Pelvic floor dysfunctions often involve dysfunctions found in the muscles of the pelvic floor and surrounding structures. Thus, seeking help from a pelvic floor physical therapist trained to evaluate and treat such dysfunctions can help address symptoms such as incontinence.

What to Expect at Your Pelvic Floor Initial Evaluation:

Many patients understandably feel nervous and intimated by the thought of someone “evaluating their pelvic floor”, but rest assured that it is your physical therapist’s number one priority to make sure that you feel safe, comfortable, and cared for. Here are some things to be prepared for prior to your pelvic floor initial evaluation:

  • Be ready to have a conversation about your health history and current symptoms. Answering questions such as:
    • How many pregnancy/births have you had?
    • How many bathroom breaks do you take in a day?
    • How much leakage are you experiencing?
    • What triggers your symptoms?
    • How much water do you drink in a day?
    • What types of beverages do you consume?
  • Undergo a fully clothed physical assessment of your strength, range of motion, pelvic alignment, posture, and movement mechanics.
  • An assessment of your abdomen including things such as C-section scar mobility, transverse abdominal contraction, and diastasis recti.
  • Education about the pelvic floor anatomy and why you may be experiencing incontinence. Warning you may feel like a student again!
  • If, and only if it is deemed necessary and the patient feels comfortable and gives informed consent, an external and internal examination of your pelvic floor will take place. During this portion of the exam expect the physical therapist to palpate structures both internally and externally and for you to perform kegel contractions, bear down, and cough when asked.
  • A home program including exercises to strengthen your pelvic floor, core, and lower extremities, stretches, and a bladder diary, etc.

But Can’t I Just Perform Kegels?

It is a common misconception that everyone woman needs to perform “kegel” exercises. However, kegel exercises are only helpful for those who suffer from pelvic floor muscle weakness. It is true that those who suffer from urinary continence often have pelvic floor weakness and would benefit from the performance of kegel exercises. However, not every patient with urinary incontinence needs to perform kegel exercises, at least not right away. Some patients who have urinary incontinence may also suffer from pelvic floor muscle tightness which can lead to muscle weakness. In this case, it is important to first address the integrity of the pelvic floor muscle tissue prior to addressing the strength of the pelvic floor muscles as a strengthening a tight muscle would exacerbate the dysfunction. It is therefore extremely important to consult a pelvic floor physical therapist to evaluate the pelvic floor musculature to determine the best treatment plan custom to your individual pelvic floor needs.

If you’re in the New York City area and looking for a physical therapist that can treat your incontinence or other pelvic floor dysfunctions, contact us by filling out the form below or give us a call and we’ll get in touch with you.


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