As a pelvic floor physical therapist, I treat many women and men with incontinence. I often hear two questions: “is this normal?” and “can this be fixed?”. The short answers are “no” to the first and “yes” to the second.
No, it’s not normal to be incontinent, but in some cases, such as immediately post-partum, it can be expected for a short time due to weakened pelvic muscles., However it should resolve on its own with the proper physical therapy treatment to strengthen the pelvic muscles. Yes, in most cases, incontinence can be fixed conservatively without surgery.
Understanding the Different Types of Incontinence
What is incontinence? Incontinence is the involuntary loss of urine, and there are three kinds: stress incontinence, urge incontinence, and mixed incontinence, a combination of the first two. Stress incontinence occurs when there is a quick change in your abdominal pressure, such as with jumping, laughing, sneezing, or coughing, and the pressure from your abdominal contents is greater than the pressure from your pelvic floor muscles, so urine leaks out.
Urge incontinence typically occurs in response to a trigger. An example is when someone feels the urge to urinate, but the urge is mild and manageable. However, as soon as they see the toilet and start pulling down their pants, they lose all control. The treatment for stress and urge incontinence is slightly different, but both are absolutely treatable with physical therapy techniques such as pelvic muscle exercises..
Determining Whether Kegel Exercises are Right for You
Should I kegel? Again, this isn’t a straightforward “yes” or “no” answer, even though most people with urinary incontinence are told, “just do Kegels.” Kegels is a contraction of the pelvic floor muscles, which are the group of muscles that support the bladder, uterus, and rectum in the pelvic region and are important for maintaining proper blood pressure and bowel movements. They are the muscles we use to stop urine flow (but please don’t practice Kegels while urinating!).
Understanding the Different Types of Pelvic Floor Muscle Dysfunction and Their Treatment Options
When people have urinary incontinence, they often fall into one of two categories regarding treatment. The first group has pelvic floor muscles that are hypotonic or weak, in which case strengthening exercises are the optimal solution. The second group has pelvic floor muscles that are hypertonic or overactive; they are weak because they are always “on” and never get a chance to rest. Pelvic floor health is of pivotal importance.
This group benefits most from learning how to down train, or relax, their pelvic floor muscles. Often this is enough to resolve their issues, but if they continue to have some incontinence, they benefit from down training first, followed by strengthening.
Hope for Incontinence Sufferers: Proven Treatment Options Available
If you have resigned to believe that you will have to wear pads or diapers for the rest of your life to manage your incontinence, please know that you don’t have to live like this and there are proven treatments available! My strengthening program is a great place to start your treatment journey if you are struggling with urinary incontinence.
Dr. Alona
