A Surprising Treatment for an Embarrassing Problem

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Licensed Physical Therapist Gail O’Neill with Armonk Physical Therapy & Sports Training with tips on the benefits of PT for urinary incontinence

Gail O'Neill, PT

Most would never think of PT as a treatment option. but it can be extremely effective. The secret is to find a specially trained therapist who can help you regain control.

It’s not just an issue for old ladies—or pregnant (or recently pregnant) ladies, either. Urinary incontinence, or UI, which is the involuntary loss of urine, affects roughly one in four US women. That includes new and expectant mothers as well as young female athletes, all of whom find themselves with inadequate bladder control.

Stress urinary incontinence, or SUI, is the most common form of UI in women under 60, accounting for more than half the estimated 18 million cases. Other types of UI are urgency urinary incontinence (UUI), and a combination of the two known as mixed incontinence. UI is twice as common in women than men.

In SUI, leakage occurs during physical activity—something strenuous, like lifting a heavy object, or something as small as laughing, coughing or sneezing. UUI, on the other hand, is a sudden and uncontrollable urge to urinate, caused by a contraction of the muscles in the bladder that can occur while sleeping, after drinking, or just hearing water running in a sink or shower.

But unpleasant as the problem can be, UI can often be resolved without medication or surgery, says Gail O’Neill, PT, a physical therapist specializing in women’s health issues at Armonk Physical Therapy & Sports Training. “Many women with UI feel embarrassed and think they just have to live with it,” O’Neill says. “Most would never think of PT as a treatment option.” But it can be extremely effective, she says. The secret is to find a specially trained therapist who can help you regain control.

Understanding What’s Going On
Urinary incontinence occurs when the muscles and/or nerves that control the storage and release of urine are damaged or dysfunctional. SUI develops when the pelvic floor muscles are weak, or if pressure in the abdomen causes the urethra, the tube that carries urine away from the bladder, to shift. In UUI, damaged nerves may be sending bad information to the muscles surrounding the bladder, telling them to contract (and force urine through the urethra) at inappropriate times.

And even though pregnancy and delivery are the most common causes of UI in women, the list of other contributors is long, O’Neill says. It includes age-related loss of pelvic muscle tone as well as obesity, menopause (decreasing estrogen seems to weaken urethral tissue), an anatomical predisposition, or a history of heavy lifting or participating in high-impact sports. UI has also been tied to certain medications, including hormone replacement therapy. Hip and spine issues can also contribute to this. “Some women suffer nerve or muscle damage from hysterectomy or other abdominal surgery,” O’Neill adds.

PT Options
Happily, women can often remedy a case of UI with targeted physical therapy. Here are three things you can expect to discuss with your therapist:

Pelvic floor muscle training (PFMT), also known as Kegel exercises
Exercising your pelvic floor muscles can reduce or cure UI—if you do it correctly. “You have to focus on the right muscles,” O’Neill explains. “Squeezing the wrong ones can actually make things worse by putting extra pressure on the pelvic floor.”

To properly identify your PFMs, pinch, squeeze and brace the muscles in your genital area as if you’re trying to stop the flow of urine, but don’t tighten your abs, legs or buttocks.

In some cases, PFMT is combined with biofeedback, a procedure that uses electrical sensors to provide information (feedback) on various bodily functions. The information helps you track when your bladder and urethral muscles contract, which can help you control them more effectively.

“Biofeedback helps you make subtle changes—relaxing specific muscles while engaging others, for example—so you get the most out of the exercises you’re doing,” O’Neill says. Research shows that combining Kegels with biofeedback can restore continence in roughly 40 percent of women.

Bladder diary
Therapists often ask women to keep a “bladder diary,” in which fluid intake and every urination is recorded, intentional or otherwise. The diary often reveals patterns, which can help the therapist devise a program of bladder training. This will have you use the bathroom at regular timed intervals, which can help you make fewer trips to the toilet by “teaching” your bladder to hold more urine.

Gail O’Neill, LPT, is a licensed physical therapist specializing in women’s health and orthopedics. With degrees in both physical therapy and biology, she has practiced for 30 years in New York and Connecticut.

Armonk Physical Therapy & Sports Training provides personalized, integrative, and skilled one-on-one physical therapy services. http://www.armonkptst.com/

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