RecoverRx Performance and Recovery Blog
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By Dr. Ariel Sernek, PT, DPT
Urinary incontinence (UI) is very common. In fact, incontinence is reported in 48% of young female athletes (Rebullido, 2021), 41% of pregnant women (Moossdorff-Steinhauser, 2021), and 37.1% of older adults around the world (Batmani, 2021). However, these percentages are likely underestimated because most people do not want to report that they are having issues. This issue can be embarrassing, demoralizing, and just out right disappointing. Why isn’t my body working how it should?
There are a multitude of reasons why this might be occurring, but let’s look at some risk factors that might influence why some people experience this more than others. The most important factors that the above studies found included age, obesity, diabetes, women’s education, delivery rank, hypertension and smoking. When we are talking about age related changes, this is due to a decreased ability of our bladder to hold larger amounts of urine and our bladder and pelvic floor muscle getting weaker. Obesity can cause leakage because of the added weight and load to the bladder and pelvic floor muscles. I found the education of women to be a very interesting risk factor, but ultimately the more people are educated to seek help or know that these symptoms are not normal the more likely they are to improve their symptoms and ultimately their quality of life. Diabetes can cause nerve damage to the bladder if not under control, and elevated sugar in your bloodstream increases the amount of urine you produce.
In order to answer the question as to why you are having UI, it’s important to know the type. Stress urinary incontinence (SUI) is when there is a force or pressure on your bladder that cannot be controlled and urine is lost. Urge urinary incontinence (UUI) is when the bladder gives such a strong sensation to use the restroom and you cannot make it on time. Mixed urinary incontinence means that both types are present. I also see overflow urinary incontinence which is when your bladder is so full that any normal activity could cause leakage, but the important part here is that you are not aware that it’s happening.
SUI is treated by identifying the stresses that cause the leakage. Sometimes that could be a jump, cough, sneeze, laugh, or picking up heavy objects. Once we know the stress that causes the leakage, then we have to train you to control that pressure. We do this through retraining your diaphragm and how your body moves through the event that causes leakage. We also strengthen your core, hip, back, and pelvic floor muscles and address postures that can make it harder for your muscles to work together.
With UUI, we have to identify the cause of the urge. Is it an environmental trigger: running water, pulling into the driveway, or putting your hand on a door knob? Is it a food/drink trigger: carbonated beverages, caffeine, tomato based products, acidic fruits? Or is it a change in medication? Once we have the cause, then we train you to manage and overcome that urge with brain, bladder, and body strategies so that you can safely make it to the restroom without an accident.
When it comes to overflow urinary leakage, we have to retrain your bladder to go at a normal frequency and to recognize when your bladder is full. We may also have to release the pelvic floor muscles and soft tissue tension to help your ability to evacuate normally and with less retention of urine. There may be some other factors influencing the leakage too, including urgency or inability to manage pressure that we have to address and treat.
Ultimately, urinary leakage can be treated in a variety of ways, but we have to find the root cause of the leakage first. A full head to toe evaluation, addressing posture, strength, range of motion, pelvic exam, and movement patterns can help us find the cause of leakage. Come in for an evaluation and let’s address this very common, but NOT NORMAL symptom!
Thanks for reading the blog, and please don't hesitate to reach out with additional questions. You can reach out to me directly at firstname.lastname@example.org or check out our Pelvic Health page https://www.recoverrxpt.com/pelvichealth.html. Also, view our Curiosity Corner on this topic, and be sure to subscribe to our YouTube channel for more great health videos.
Rebullido, T; Gómez-Tomás, C; Faigenbaum, A; Chulvi-Medrano, I. (2021) The prevalence of urinary incontinence among adolescent female athletes: A systematic review. J. Funct Morphol Kinesiol. 6(12).
Moossdorff-Steinhauser, H, Berghmans, B, Spaanderman, M et al. (2021) Prevalence, incidence and bothersomeness of urinary incontinence in pregnancy: A systematic review and meta-analysis. Int Urogynecol J. 32, 1633–1652.
Batmani, S, Jalali, R, Mohammadi, M et al. (2021) Prevalence and factors related to urinary incontinence in older adults women worldwide: A comprehensive systematic review and meta-analysis of observational studies. BMC Geriatr. 21(212).
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Dr. Luke Greenwell, Dr. David Bokermann, Dr. Sarah Greenwell, & Dr. Ariel Sernek are Performance Based Physical Therapists with extensive backgrounds in treating the injured athlete. At RecoverRx, they are passionate about returning people to the sports & activities they love. Check out more about them by visiting our About Us page.