The Common Health Issue That No One Wants to Talk About

As a topic of conversation, urinary incontinence is not a favorite.

But since it is so common among people of all ages, we need to talk about it.

“There is a lack of public knowledge about urinary leakage. It is not normal; it’s not something that just happens in older women,” says Andrea Wood, a pelvic health physical therapist at the University of Miami Health System. When a video of Cross Fitters making light of “leaking during double unders” went viral, Ms. Wood and her colleagues decided to speak up about this embarrassing, yet common complaint.

What’s happening down there? We separate the facts from fiction:

Only older women experience incontinence.
False.
Urinary leakage is more common among women who have experienced childbirth and post-partum depression. However, studies show an alarmingly high rate of stress urinary incontinence among female high school and college athletes who compete at a high level. Leaking urine during heavy lifting or exertion is not normal.

Other than being a nuisance, there are no long-term risks associated with incontinence.
False.
It can lead to low back or pelvic pain and pelvic organ prolapse, a condition where the pelvic organs droop. These organs include the bladder, vagina, uterus, small bowel, and rectum.

A strong pelvic floor is the key to controlling incontinence.
True.
In men and women, the pelvic floor consists of three layers of muscles. These muscles do more than control urinary flow. They are responsible for sexual function, helping the lymph system, supporting the hips and back and keeping the bladder in place. The pelvic floor is part of the body’s core system that acts as a “pressure canister.” When our body isn’t managing this inter-abdominal pressure properly, it creates excess pressure which leads to leaking urine.

Medication or surgery are the only ways to control incontinence.
False.
Like any muscle, the pelvic floor muscles can be trained. Pelvic health physical therapy (PT) is a low-risk option to explore before drugs or surgery. After evaluating how well the patient’s pelvic floor muscles function, a physical therapist will design a program of neuromuscular retraining exercises.

A recent review showed that pelvic floor muscle training should be the first line of conservative treatment for any type of urinary incontinence.

Kegel exercises are the best way to strengthen the pelvic floor.
False.
Kegels don’t fix all leakage issues and make some problems worse. Pelvic health physical therapists evaluate each person’s situation to decide which exercises will work best.

Pelvic health physical therapists also treat men and conditions beside incontinence.
True.
These specialists can help men and children overcome urinary dysfunction. They also treat pelvic and low back pain, chronic constipation, fecal incontinence, pelvic organ prolapse, painful intercourse, erectile dysfunction, and vaginal atrophy or stenosis.

Physical therapy can’t help once you’ve had surgery.
False.
If you are trying to avoid surgery, PT could improve your musculoskeletal function to the point where you don’t need surgery. If therapy doesn’t solve your problem, you at least enter surgery with better muscle function which hastens healing. PT after surgery also helps speed recovery and improves musculoskeletal function even if your surgery took place previously.

If physical therapy would help, my doctor would have told me.
False.
Many doctors are not aware of this specialized therapy, but most therapists are willing to explain their treatment plans to your doctor. This website has information you can share with your doctor.

As a therapist, Ms. Wood considers patients’ lifestyles when designing treatment plans. “I treat people first, not their diagnosis. I ask patients how much time they can set aside for home exercises. The program I prescribe for a new working mother strapped for time might involve doing a couple of chair squats twice a day at work. The person with more time might get a 30-40 minute gym workout three times a week.

Regardless of age or time constraints, it is never too late to try to improve your health.”

 


Nancy Moreland is a regular contributor to UMiami Health News. She has written for several major health care systems and the Centers for Disease Control and Prevention. Her writing also appears in the Chicago Tribune.