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As a pelvic floor physical therapist at Origin, I will work with people who confidently state that they “do not have incontinence.” When I talk to them about their pelvic floor and ask for more specific details about their bladder function, they will often admit to peeing a little with a sneeze, but only if they’ve had a glass of wine, or leaking a little on the way to the bathroom, but just with a full bladder. 

Here’s the thing: If your bladder leaks at all — even a little — that’s incontinence, and it’s incredibly common. Four out of every 10 women over the age of 20 experience some form of urinary incontinence. 1 That number is staggering but what’s worse is that only about 25-50% of those with incontinence will actually seek help for this condition. 2  Most are unaware that urinary incontinence is treatable, and that the current gold standard for tackling unwanted leakage is pelvic floor physical therapy.

So what are the pelvic floor muscles exactly?

The pelvic floor is a group of muscles located at the base of your pelvis (check out the diagram below). They include several layers of muscles that extend from the pubic bone to the tailbone, from sit bone to sit bone, and everywhere in between. They surround the opening of the anus, vagina and urethra, and while they have certain automatic functions, you can also voluntarily make them contract or relax.

When pelvic floor muscles contract…

  • They hold in gas or feces
  • They support and lift our pelvic organs
  • They stabilize our pelvic joints
  • They hold in pee

When pelvic floor muscles relax…

  • They allow you to pass bowel movements without straining
  • They allow you to deliver a baby
  • They allow you to have penetrative sex
  • They allow urine to pass freely

How does pelvic floor PT help with incontinence?

If your pelvic floor muscles aren’t functioning properly, you may start to notice changes in your bowel, bladder and/or sexual function, which may include urinary incontinence. 

The purpose of pelvic floor muscle training is to restore function to these muscles so that if you suddenly have the urge to pee or have a coughing fit, for example, you can hold in your urine. A trained specialist can provide guidance and the tools necessary to restore pelvic floor function and reduce leaking by: 

  1. Improving your awareness and coordination of these muscles
  2. Rebuilding the range of motion, flexibility and resting tone of these muscles
  3. Increasing the strength and endurance of these muscles

Fully-functioning pelvic floor muscles also provide the best possible foundation to incorporate additional treatment strategies such as bladder retraining, dietary changes, pessary use, and radiofrequency or laser treatments to reduce bladder leaks. But if the muscles work well, then pelvic floor physical therapy is often all that is needed in order to fully cure urinary incontinence. 

What causes incontinence?

There could be any number of reasons why your pelvic floor muscles are dysfunctional. The change can happen seemingly overnight or over decades. Urinary incontinence is most often tied to advanced age, obesity, smoking, and vaginal childbirth, but even breaking a hip or experiencing PTSD can contribute to a change in these muscles’ ability to function.

The important thing to realize is that these muscles are resilient, capable, and can be re-trained. However long you may have been dealing with incontinence, it’s still possible to make a difference in these muscles that can lead to life-changing results. 

Consider reaching out to a physical therapist who specializes in treating the pelvic floor. As a member of your care team, they can assess your current muscle function, provide education for strategies to reduce your symptoms, give clear guidance on how to restore your pelvic floor, and offer you the support you need to stop bladder leaks for good.

 

 

Sources

Abufaraj M, Xu T, Cao C, Siyam A, Isleem U, Massad A, Soria F, Shariat SF, Sutcliffe S, Yang L. Prevalence and trends in urinary incontinence among women in the United States, 2005-2018. Am J Obstet Gynecol. 2021  Aug;225(2):166.e1-166.e12. doi: 10.1016/j.ajog.2021.03.016. Epub 2021 Mar 13. PMID: 33727114.

 

McKinney JL, Keyser LE, Pulliam SJ, Ferzandi TR. Female Urinary Incontinence Evidence-Based Treatment Pathway: An Infographic for Shared Decision-Making. J Womens Health (Larchmt). 2022;31(3):341-346. doi:10.1089/jwh.2021.0266

 

Mary H. Palmer, Mona Baumgarten, Patricia Langenberg, Jeffrey L. Carson, Risk Factors for Hospital-Acquired Incontinence in Elderly Female Hip Fracture Patients, The Journals of Gerontology: Series A, Volume 57, Issue 10, 1 October 2002, Pages M672–M677, https://doi.org/10.1093/gerona/57.10.M672

 

Catherine S. Bradley, Ingrid E. Nygaard, Michelle A. Mengeling, James C. Torner, Colleen K. Stockdale, Brenda M. Booth, Anne G. Sadler, Urinary incontinence, depression and posttraumatic stress disorder in women veterans, American Journal of Obstetrics and Gynecology, Volume 206, Issue 6, 2012, Pages 502.e1-502.e8, ISSN 0002-9378, https://doi.org/10.1016/j.ajog.2012.04.016.[/vc_column_text]

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AUTHOR

Celestine Compton, PT, DPT is a doctor of physical therapy specializing in women's health. Dr. Compton is both Herman & Wallace and APTA trained in the areas of pelvic pain and pelvic floor dysfunction, myofascial mobilization, and pregnancy and postnatal care. She has acted as a consultant and content developer for various websites and blogs related to women's health and continues to enjoy writing on the subject. Dr. Compton began exploring her passion for women's healthcare and developing her specialization in women's health physical therapy following her experience in the Women's March of 2017.

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