Incontinence

Incontinence: Some people experience incontinence, also known as leakage.  This leakage can be urinary, fecal, or anal. Even small amounts of leakage are abnormal.  

Incontinence can also mean that the individual is unintentionally letting out gas (also known as anal incontinence).  An example, is being unable to hold gas in an elevator.  

It is still considered incontinence if this occurs only during sport activities such as running and weight lifting.  Even if you can live with it, it is a sign that there is a disconnect between your core, pelvic floor, and your diaphragm.  Seek care earlier, because the treatment time and visits required to heal will likely be less!

The leakage can be triggered based off of urgency, stress or a combination of both.  

Stress incontinence is due to an imbalance of pressure throughout the abdominal system. This can occur during activities such as when you cough, sneeze, laugh, or lift something heavy.  

Urge incontinence occurs when there is an inability to hold long enough to make it the bathroom.  Urgency is a sense of needing to go immediately, such as if you are unlocking the door to your home and you can't hold long enough to make it the bathroom prior to leakage.  In this instance, you are aware of the urge to go but cannot make it in time.

Reflex incontinence describes a form of incontinence where you are unaware that you are having leakage.  This may be that you are simply having poor awareness throughout the day or a sign of neurogenic bladder. Neurogenic bladder is when there is a disconnect between the brain the bladder, and the muscles that are normally under conscious control can't be controlled.  You will need to manage this with your medical team. 

Treatment of stress incontinence involves training the pelvic floor muscles, the core, and the breathing muscles to coordinate and better manage the demands of stress placed on the pelvic floor.  Posture and appropriate form during sport activities, such as weight lifting, is also a key to the puzzle!  Urge incontinence can be treated by adjusting daily habits, routines, and reducing bladder irritants.  

A lot of people have complications to the pelvic floor because of breathing dysfunctions, such as COPD, cystic fibrosis, COVID, a deviated septum, or even allergies to name a few. When breathing patterns are different, the pelvic floor accepts pressure differently.  This pressure influences the demands put on the pelvic floor muscles.

The pelvic floor is also directly influenced by nutrition and how the GI system digest your foods.  If someone has diarrhea or constipation, they will have different demands on the pelvic floor. For instance, if someone is straining to go the bathroom (breath holding or bearing down), there will be more pressure placed on the pelvic floor. These muscles can get lengthened and fatigued.  

Until your pelvic floor physical therapist acknowledges the different systems that are influencing how your pelvic floor behaves, and until these other body systems are addressed appropriately by other members of your health care team, the dysfunction in the pelvic floor will not go away.  Choose a therapist that will help fix the underlying cause of your symptoms.

It depends.  If you have stress incontinence, where leakage is occurring during intense physical activity, seek a physical therapist to guide you.  Sometimes the activity can be continued but may need be modified.  Your therapist will determine whether you are meeting points of performance required for you to safely continue the activity.  In other cases, modifying the duration or dose of the activity is all that is needed until strength within the system can be built up.