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What is urinary incontinence?

Categories: Pelvic Health

We’ve all seen the ads:  a trim, female waistline rejoices over the discreteness of a new absorbent pad that hides away her bladder leaks. She returns to daily life, bliss across her face and supposedly down below.  She fades into the background with a smirk-ful smile, hinting that no one will ever know of her incontinence issues (except for you, dear privy commercial watcher).  It’s “just a little leak,” the ad implies, “fix it with this undies soaker upper.”

Urinary incontinence is the involuntary loss of urine, which affects both women and men alike.  However, a pad-ful of polymers adhered to one’s undies or disposable underwear do not begin to solve this critical health issue. Don’t get me wrong – pads occupy and important space in this world – they are absolutely functional and critical to preserving dignity and confidence.  However, pads need not be on a permanent purchase order or a life-long norm.  Hope lies ahead: for many, urinary incontinence is changeable! 

The thing is, it’s “not just a little leak”:  urinary incontinence, whether a few small drops or full emptying, is a problem that tells an underlined tale of misbehaving bodily systems.   Normal aging is not a cause of UI, however, normal age-related bodily changes can make one more susceptible to UI, along with lifestyle factors and other health issues.  Lots of research informs us that incontinence can have grave implications on our social life, mental health, physical health and overall quality of life, as well as weigh heavily on health care costs/resources and independent living for older adults.  However, great news, dear bladder-owners!  Urinary incontinence IS changeable at any age!  Often a testament to underlying musculoskeletal issues, incontinence can be resolved or remarkably improved with the help of a Pelvic Physical Therapist.                     

How many people have urinary incontinence?

Estimates vary widely on prevalence of incontinence – in part, because, many are hesitant to report their leakage problem, and thus, either underreported levels or variance in wide ranges – but, research  finds that very generally speaking, 5%-81% of the population has urinary incontinence.1,2  This is a huge problem that adversely affects quality of life, disability and living independently.   To the surprise of many, incontinence occurs even in younger women who have not been pregnant as well as men.  Estimates from research studies include:

 

  • Female athletes who’ve never been pregnant:   Varies from 5.7% to 80%, more prevalent (higher instance) in high-impact sports, including trampolining, gymnastics, volleyball.
  • Pregnant women:  More than 33% during second and third trimesters
  • Postpartum women:  About 33%  UI after pregnancy
  • Men (living in the community):  Ranges from 21% to 32% (in longer term care) 
  • Women over 65:  35% (living in community)  to 65% (in longer term care)
  • Frail* elderly women:   80% 

 

Other contributors to incontinence can include genetic factors, smoking, cardiovascular issues (including high blood pressure), higher body mass index (BMI) and obesity, diabetes, among other lifestyle factors.

What are different types of incontinence?

Many bodily systems and processes contribute to a person’s ability to control urination and eliminate urinary waste, including neurological, endocrine, musculoskeletal, cardiovascular, and immune systems. Incontinence can be a result of a number of different issues stemming from these systems, including illness, infection, medication or medical treatments, neurological changes, metabolic issues, muscular weakness, repeated stress (ie respiratory issues, persistent coughing), pain, injury, among others.  These issues can contribute to different types of urinary incontinence, including:   

  • Urinary urge incontinence:  Leakage that occurs with sudden and overwhelming urge, often en route to the restroom. Can occur with or without a full bladder. Often considered synonymous overactive bladder, where a person has an urge to urinate more frequently than normal during the day and/or night.
    • Urinary stress incontinence:  Leakage that occurs during physical exertion that increases the pressure within the abdomen (like sneezing, coughing, laughing, jumping, impact exercises). Here, the pelvic muscles the lack strength or control needed to prevent leakage. 

 

  • Mixed urinary incontinence:  Leakage that occurs when a person experiences both urge incontinence and stress incontinence 
  • Functional incontinence:  Leakage that occurs during daily activities in people who have a normally functioning urinary system but often on account of a person’s illness or disability interfering with ease of accessing the restroom. 

 

  • Overflow incontinence:  Leakage that occurs in a person with an overly full bladder, often without an urge and with either weak pelvic muscles or blockage of the urethra.  A person may have difficulty fully emptying their bladder. 

 

So, how can Physical Therapy help a person with incontinence?

Leaky bladders (and their owners), have hope!  Research tells us that working with a Pelvic Physical Therapist can help improve and often resolve  symptoms of incontinence.  No matter the type of incontinence or underlying cause, we are all built with pelvic floor muscles and related structures at the base of our pelvis that serve as the important gatekeepers or controllers of continence – and thankfully, these are changeable and trainable!  As PTs, we are experts in movement and function – and we can help our patients learn how to best improve the function and strength of their pelvic floor muscles to lessen the burden of incontinence and improve their quality of life.  Some of our best days are when you retire your pads for good, ditch the constant worry of having an accident and confidently return to the activities you love!  Call 970-221-1201 to schedule an appointment with one of our pelvic health specialists! 

Dr. Gina Yeager is a physical therapist

References:

 

Sensoy N et al. Urinary incontinence in women: prevalence rates, risk factors and impact on quality of life. Pak J Med Sci. 2013;29(3):818-822. 

 

Almousa S and Van Loon A.  The Prevalence of Urinary Incontinence in Nulliparous Female Sportswomen: A Systematic Review. J Sports Sci2019 Jul;37(14):1663-1672.

Woodley SJ et al.Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database of Systematic Reviews.  2017, Issue 12.

 

Shamliyan TA et al.  Male Urinary Incontinence: Prevalence, Risk Factors, and Preventive Interventions. Rev Urol. 2009; 11(3). 145-165.

 

Kwon et al. Quality of life of women with urinary incontinence:  a systematic literature review . Int Neurourol J. 2010;14:133-8.   

Murukesu et al. Urinary incontinence among urban and rural community dwelling older women: prevalence, risk factors and quality of life. BMC Public Health. 2019; 19(Suppl 4):529.  

Aly W, Sweed H and Mossad N.  Prevalence and Risk Factors of Urinary Incontinence in Frail Elderly Females. J Aging Res. 2020 April. Volume 2020. p1-8. 8p.

 

Clegg A et al.  Frailty in older people.  Lancet. 2013 March 2; 381(9868): 752–762.