Honestly, no. There are several different types and causes of urinary incontinence, and some types cannot be directly improved and/or treated with physical therapy. The types of urinary incontinence that we’ll discuss in this article are stress, urge, functional, and overflow urinary incontinence.
Before we explore the types of urinary incontinence and their causes, let’s look at normal bladder function.
Urinating every 2-5 hours is normal. This adds up to peeing approximately 5-8 times during the day, and urinating more often than this is considered urinary frequency. Nighttime voiding should be 0-1 times per night, so waking to pee more than once per night is considered abnormal.
During the day, our pelvic floor muscles (PFM) should stay active, meaning they should be contracting, to help to support our organs, maintain continence, and provide stability to our pelvis. When we urinate, our PFM relax and then the bladder contracts. The bladder is under involuntary control which means that we cannot actively squeeze the bladder to urinate, but there’s a neurological loop from the bladder to the brain that helps this process occur.
Since you cannot squeeze the bladder voluntarily, why do you feel like you can pee faster if you squeeze your muscles?
When you “push” and use your PFM to assist with urination, you are actually causing dysfunction in your PFM because they should be relaxed during urination. Although it might feel like you are able to pee quicker when you do this, contracting your PFM may lead to incomplete emptying of your bladder because the muscles around the urethra are contracting when they should not be.
To avoid this from occurring, ladies should sit to urinate rather than hovering over the toilet seat, and everyone should relax their muscles when urinating rather than attempting to push to pee faster.
Now that you know what normal looks like, let’s explore the types of urinary incontinence.
Stress urinary incontinence or "SUI" occurs when the PFM are not able to withstand increases in intra-abdominal pressure (IAP). Increased IAP occurs when lifting weights, jumping, sneezing, shouting, laughing, coughing, picking objects up from the floor, etc.
As a reminder, the PFM should remain active all the time in order to maintain continence. If our PFM or hips are weak, they may not be strong enough to overpower the increases in IAP, and this can lead to unwanted leaking.
SUI is also strongly related to poor toileting habits. Hovering to urinate in public or using PFM to assist with urination throws off the neurological loop because it keeps our PFM active when they should not be. When you regularly do these things, it can lead to dysfunction.
SUI responds very well to physical therapy! Your physical therapist can educate you on proper toileting habits and work on improving muscle function to improve continence!
Urge urinary incontinence occurs when you have a sudden urge to urinate and you are not able to control your bladder. This may be related to muscle weakness, bladder irritants, or lifestyle habits.
If urgency is present and your PFM are weak, then your PFM may not be able to contract properly which can lead to incontinence.
Bladder irritants can also cause UUI and may include alcohol, caffeine, chocolate, dairy, spicy foods, citrus foods, tomato products, and more. When you consume bladder irritants, the lining of the bladder may become irritated, which can lead to urinary frequency or a sense of urgency. A physical therapist can help to assess for bladder irritants in your diet, and they can help guide you on removing them.
An example of a lifestyle habit that may contribute to UUI is urinating every day once you arrive at work. If you do this regularly, then you may start to have a sudden urge to urinate each day when you walk through the door. This is an example of an environmental cue that contributes to urgency.
If you are experiencing UUI, your physical therapist can provide you with techniques to reduce the sense of urgency in order to help you get to the restroom in time.
While most cases of UUI can be treated with PT, there are some cases that have an underlying neurological component. If there is an underlying neurological component, then this type of incontinence may not improve with physical therapy.
Functional urinary incontinence occurs when you cannot make it to the bathroom in time to urinate. This can occur due to being weak and unable to walk to the restroom in time, having an amputation that limits ambulation, having obstacles in the home that you are unable to navigate in a timely manner, and more.
FUI can be treated with physical therapy because the underlying cause is typically muscle weakness that limits someone’s ability to get to the restroom.
OUI occurs when the bladder is too full. This can be caused by urinary retention due to blockage of the urethra, weak muscles, or nerve damage.
This is the type of incontinence that physical therapy may not directly improve because OUI may be neurological. With OUI, the brain does not receive the signal from the bladder that it is filling or is full. This, in turn, causes unwanted leaking because the bladder cannot contain the amount of urine that’s inside, and it must eventually empty itself.
A physical therapist can have you fill out a bladder diary to assess your voiding intervals. If you are waiting too long between voids, your physical therapist can educate you on modifying your voiding intervals.
If you are experiencing urinary incontinence, trying physical therapy is a great choice! Your physical therapist can complete a thorough evaluation where they will discuss your symptoms and assess for muscle weakness, lifestyle habits, or the presence of bladder irritants that may be contributing to your urinary incontinence.
If, after an in-depth examination, your physical therapist determines that physical therapy cannot help your symptoms, they’ll let you know!
While not every patient’s incontinence may improve with physical therapy, there is absolutely no harm in having an initial evaluation with a physical therapist to see if your symptoms can be improved.
If you are in the Birmingham, Alabama area, Vulcan Performance & Therapy provides pelvic floor therapy. You can read more about our pelvic health therapist Dr. Lauren Potter and our pelvic therapy services by clicking here.