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The Pelvic Floor, Part 2: Urinary Incontinence

There’s Help for Your Sensitive Bladder

By Deborah Quilter

If you watch the evening news, it’s hard to avoid the ads for drugs that treat overactive bladders or constipation. Many people take prescription drugs for these symptoms, but a lot of relief can be afforded by simple exercises and lifestyle changes.

According to Manhattan physical therapist Dustienne Miller, MSPT, who works at Beyond Basics Physical Therapy in New York City, many people assume that bladder woes are a normal part of aging that they have to accept, but in a lot of cases their symptoms can be decreased or even eliminated. Miller, who specializes in helping people who have problems with their pelvic floor, outlined several categories of urinary issues:

Stress incontinence happens when you leak urine while coughing, sneezing, or lifting something.

Urge incontinence happens when you have an urge to urinate and you are unable to make it to the toilet in time.

Urinary frequency means you are voiding your bladder more than 5-7 times a day, depending on your dietary intake.

Urinary urgency is when you experience a sudden, uncomfortable and sometimes painful urge to urinate not accompanied by leaking.

What You Can Do

In order to overcome incontinence, Miller suggests the following guidelines:

Drink water. This sounds counter-intuitive to people who want to make fewer trips to the bathroom, but if you are not drinking enough water, the urine becomes too concentrated and irritates the bladder lining, which leads to more irritation and discomfort.

Keep your bladder on a schedule. Stop drinking a few hours before bedtime to avoid multiple night time awakenings.
Eat soluble and insoluble fiber. Constipation plays a big role in urinary incontinence because the heavy stools press on the bladder, creating the sense that you need to go.

Train your bladder. When you feel the need to go, do a few pelvic floor muscle contractions to defer the urge.

Maintain a strong core and cardiovascular system. Abdominal, hip and back strength are closely linked to continence. It is not uncommon for a patient to develop urinary incontinence after a hip surgery if there is a strength deficit, according to Miller.

Avoid bladder irritants. These include coffee, black tea, green tea, soda, seltzer and citrus beverages.

Do Your Kegels. Kegel exercises involve lifting the muscles between the pubic bone and tailbone up and in and very important, relaxing down. If your muscles are too tight, it can lead to incontinence.

Miller notes that sometimes people are taught to locate the muscles involved with the Kegel by stopping the urine mid-stream. She says not to overdo this, because with urge incontinence, this muscle (the detrusor) gets confused. “Then it feels like the person always has to urinate.” This is known as Detrusor instability.

When To See A Physical Therapist

If any of these symptoms sounds like you, first see a urologist or uro-gynecologist to screen for urinary tract disease or other issues.

Physical therapists have many tools to help you, among them: biofeedback, manual techniques, bladder retraining and therapeutic exercise. “These modalities will help clients regain not only continence but also confidence,” Miller says.

To learn more: Dustienne Miller recommends that you check out this 65-page book on incontinence at http://www.womenswaterworks.com.au/

Next up: In Part 3 (coming soon), we will look at reasons for pelvic pain in men and women.