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Pelvic Floor Incontinence: the differences, causes, and treatments

Updated: Nov 7, 2019


Picture of bladder, sphincter, and pelvic floor muscles in a female

Pelvic floor incontinence may be a result of pregnancy and childbirth, infections, chronic low back pain, SI dysfunction, hip trauma, or pelvic floor trauma, surgery or general weakened pelvic muscles, holding going to the bathroom for too long, or lifting very heavy weights with pressure down on your pelvic floor, among others.


How do I know if I have incontinence?

Incontinence or as most people like to call it “leaking” can range from a teaspoon worth of pee to a flow that you cannot stop once started. There are two types of incontinence.


Stress urinary incontinence

This is categorized if you cough, sneeze, laugh, or jump with issues. Anything that causes too much stress to the pelvic floor for it to handle the demand.


Urge incontinence

Urge incontinence is when you feel like you might not make it to the bathroom due to a trigger such as hearing water running, or getting your keys out to unlock your door when you feel like you just can’t make it to the bathroom in time.


Tips for urgent Incontinence.

Retrain your brain by focusing on something else

Identify the trigger

Decrease caffeine or drinking too much liquid


Tips for stress incontinence

Don’t hold a Kegel the entire time of an exercise

Correct your form, posture and how you are loading your pelvic floor

Pelvic floor dysfunction can occur in women a result of weakened pelvic muscles or from post-prostatectomy. Pelvic pain in men is typically common in older men with prostate issues. In some instances, it can be a result of chronic constipation and tightness in those muscles. hormone alteration. Estrogen and progesterone keep the pelvic tissue healthy, but once these hormones levels decrease it can become atrophied or the tissue may thin, leading to more problems.


Overflow incontinence

If your bladder never completely empties, you might experience urine leakage, with or without feeling a need to go. Overflow incontinence occurs when something blocks urine from flowing normally out of the bladder, as in the case of prostate enlargement that partially closes off the urethra. It can also occur in both men and women if the bladder muscle becomes underactive (the opposite of an overactive bladder) so you don't feel an urge to urinate. Eventually the bladder becomes overfilled, or distended, pulling the urethra open and allowing urine to leak out. The bladder might also spasm at random times, causing leakage. This condition is sometimes related to diabetes or cardiovascular disease.


Men are much more frequently diagnosed with overflow incontinence than women because it is often caused by prostate-related conditions. In addition to enlarged prostate, other possible causes of urine blockage include tumors, bladder stones, or scar tissue. If a woman has severe prolapse of her uterus or bladder (meaning that the organ has dropped out of its proper position), her urethra can become kinked like a bent garden hose, interfering with the flow of urine.


Men are much more frequently diagnosed with overflow incontinence than women because it is often caused by prostate-related conditions. In addition to an enlarged prostate, other possible causes of urine blockage include tumors, bladder stones, or scar tissue. If a woman has severe prolapse of her uterus or bladder (meaning that the organ has dropped out of its proper position), her urethra can become kinked like a bent garden hose, interfering with the flow of urine, bladder becomes overfilled, or distended, pulling the urethra open and allowing urine to leak out. The bladder might also spasm at random times, causing leakage. This condition is sometimes related to diabetes or cardiovascular disease.


Reflex incontinence

Reflex incontinence occurs when the bladder muscle contracts and urine leaks (often in large amounts) without any warning or urge. This can happen as a result of damage to the nerves that normally warn the brain that the bladder is filling. Reflex incontinence usually appears in people with serious neurological impairment from multiple sclerosis, spinal cord injury, other injuries, or damage from surgery or radiation treatment

https://www.health.harvard.edu/bladder-and-bowel/types-of-urinary-incontinence


How do you know if you are at risk for pelvic floor dysfunction?

Pelvic floor dysfunction can occur in women at any age. The first signs may arise as young as kids, or when people become sexually active, or it can increase with menopause and aging. Pre-and postpartum women as well as post menopausal women are at higher risk because of hormone alteration. Estrogen and progesterone keep the pelvic tissue healthy, but once these hormones levels decrease it can become atrophied or the tissue may thin, leading to more problems.


Men may suffer from pelvic health issues as a result of weakened pelvic muscles or from post-prostatectomy. Pelvic pain in men is typically common in older men with prostate issues. In some instances it can be a result of chronic constipation and tightness in those muscles.


Athletes are also prone to having incontinence due to tight muscles and the frequency of the use of these muscles. Runners who hold their urine in longer, weightlifters who misuse pressure in their system while lifting and athletes who frequently jump may be more prone to pelvic muscle issues such as gymnasts and dancers.


How is pelvic floor dysfunction diagnosed?

If you are experiencing urinary incontinence or pelvic floor tightness or pain with intercourse these are common symptoms. You can seek a pelvic floor physical therapist who can test to see if you are holding tightness in certain areas. They are able to do an internal exam and work to help release these muscles with different techniques. If this process sounds too intimate you can release these muscles using at home techniques with simple stretches and breathing techniques.


Prognosis

Most women who seek treatment for urinary incontinence find that their symptoms improve. Bladder retraining can lead to good results after only a few weeks. Kegel exercises improve urine control in many women who use them consistently. Surgery for urinary incontinence can be very successful. But it can result in one or more complications.

These include:

  • Difficulty emptying the bladder

  • Bladder spasms

  • Bladder infection

  • Injury to the bladder during surgery

  • Return of incontinence


How can a corrective exercise specialist help with pelvic floor dysfunction?

Through a combination of custom exercises, stretches, and patient education, either your corrective exercise specialist will be able to pinpoint the cause of your pelvic floor dysfunction and create a plan of care that is unique to your body and specific symptoms. Your pelvic floor is simply another muscle in the body. The pelvic floor actually has a lot of muscles that integrate and affect it, including your hip rotators. For more information on your hip rotators look for our other blog article here.


The difference between a specialist and a physical therapist is that a corrective exercise specialist will be able to evaluate an all over examination of your entire kinetic chain that might be causing the issue in your pelvic floor vs. just looking at the public floor itself.


When should I seek a physical therapist versus a corrective exercise specialist?

Depends! No pun intended. :)

Are you having symptoms of heaviness in your pelvic floor? Do you have birth trauma? Sexual trauma? Do you have pain in your glutes or tailbone pain?

With trauma, speaking to a counselor is a great place to start. Yoga meditation practices can also help.


Are you a hypertonic person (usually high stress)? Or are you hypotonic? Are you more relaxed and less inclined to work out?

Still not sure what you are? Here are some typical symptoms.

Generally speaking, a hypotonic person will have a decrease in pelvic floor tone, turned off with vaginal delivery, not necessarily weak but deconditioned.


Hypertonic people will have tight muscles, difficulty with contracting, shallow breathing, or lots of belly breathing, sometimes accompanied with diastasis as well.

Both can be weak both can be treated.

Treatment for hypertonicity is to see a pelvic PT for manual release first. Once the therapist sees progress and is no longer are tight in the area, you can see a corrective exercise specialist. You may still have symptoms even after manual release, requiring focus on meditation, pressure management, strengthening in the hips, core, and your deep hip rotators, adductors, or Kegels, done the right way.


With education, you are better equipped to handle changes in the pelvic floor. If you’re in menopause, hormone treatment may help. Educating yourself on how to do correct Kegels, seeking treatment from past trauma or birth trauma, posture and alignment, core and pressure management from lifting, and doing an exercise incorrectly, holding going to the bathroom for long periods of time, pushing too long in defecation over time are all contributing factors. We can all benefit from knowledge and awareness of the pelvic floor and what might be a leading cause of issues.


“Simply astounding! I cough, I pee, I sneeze, I pee, I jump, I pee, I laugh, I pee… How embarrassing. I was self-motivated to illuminate urinary incontinence, therefore sought the help in the guidance of Jessa’s expertise as a recommendation from my OB/GYN. Surprisingly the exercises were more mental than physically challenging but fun, yet so rewarding because I could incorporate time with my newborn simultaneously. After three months of homework (four days a week for one hour, three times at home, one hour with seeing her) I can laugh, jump rope, hide and go seek, run, and chase my two incredible boys around, fully participating in their childhood activities depends/sanitary pad free.


With education, you are better equipped to handle changes in the pelvic floor. If you’re in menopause, hormone treatment may help. Educating yourself on how to do correct kegels, seeking treatment from past trauma or birth trauma, posture and alignment, core and pressure management from lifting, and doing an exercise incorrectly, holding going to the bathroom for long periods of time, pushing too long in defecation over time are all contributing factors. We can all benefit from knowledge and awareness of the pelvic floor and what might be a leading cause of issues.


Can I prevent pelvic floor issues from starting?

Treatment for hypertonicity is to see a pelvic PT for manual release first. Once the therapist sees progress and is no longer are tight in the area, you can see a corrective exercise specialist. You may still have symptoms even after manual release, requiring a focus on meditation, pressure management, strengthening in the hips, core, and your deep hip rotators, adductors, or Kegels, done the right way. in defecation over time are all contributing factors. We can all benefit from knowledge and awareness of the pelvic floor and what might be a leading cause of issues.


Did you know about 50% of women have incontinence?

They are just too afraid or too embarrassed to talk about it. Or they think it is something that is untreatable. Good news! It’s fixable. It’s common but not normal to be peeing yourself doing daily activities. Plus who wants to wear diapers and pads the rest of our lives anyway? That just goes directly into the garbage dump and is not biodegradable. By fixing your pelvic floor you are also helping the Planet. :) Pilates and yoga are both great ways of maintaining your core and hip strength for long-term pain or issues. Core strength, awareness of the spine and pelvis, and meditation are all amazing practices long-term.


Testimonial:

If you are experiencing urinary incontinence or pelvic floor tightness or pain with intercourse these are common symptoms. You can seek a pelvic floor physical therapist who can test to see if you are holding tightness in certain areas. They are able to do an internal exam and work to help release these muscles with different techniques. If this process sounds too intimate you can release these muscles using at-home techniques with simple stretches and breathing techniques., three times at home, one hour with seeing her) I can laugh, jump rope, hide and go seek, run, and chase my two incredible boys around, fully participating in their childhood activities depends/sanitary pad free.

MAHALO Jessa!”

-JN




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