The Maine Women's Journal - Fall 2007

Finding Help for Urinary Incontinence

Alison Oulette , DPT, PT

Do you leak urine with a cough, sneeze or laugh? Or maybe you have to rush to the bathroom every time you are washing the dishes. Do you know where every bathroom is in town? You are not alone!

More than 17 million Americans have problems with urinary leakage, and women are twice as likely than men to suffer from it. Urinary incontinence (UI) is common in women of all ages. It can happen to women in their teens to their nineties, and anywhere in-between. More money is spent annually on urinary incontinence products than menstrual products. As you can see, urinary incontinence is common, but should never be considered normal. Women shouldn't tell themselves that UI is something they just have to deal with after having a baby or getting older. There is something they can do about it.

There are many types of urinary incontinence, caused for several different reasons. Often, problems with UI can be related to poor bladder habits and/or decreased strength, endurance or coordination of the pelvic floor muscles. The best treatment option is to try a behavioral approach along with an exercise routine. However, there are instances when more serious issues cause UI. This is why a physician should always evaluate women before treatment begins.

Throughout the United States, there are physical therapists specially trained to evaluate and treat women who suffer from UI. In fact, Women's Health Physical Therapy has proven to effectively reduce or eliminate urinary symptoms by 80%. Physical therapy is a conservative method of treating UI, and if tried first, may diminish the need for medication or surgery.

So what can a woman expect from physical therapy? All treatment sessions are in a private room for the patient's confidentiality and comfort. Patients are even encouraged to bring a friend or family member for support if needed. After the initial evaluation, a comprehensive treatment plan is made based on the individual's needs. The woman is usually asked to keep a diary for a few days in order to see if she has poor bladder habits. Once the poor bladder habits are discovered, treatment consists of behavioral modification through education and retraining of the bladder.

Every physical therapy program also includes exercises designed to strengthen the pelvic floor muscles, also known as kegels. Surprisingly, greater than one-third of women perform kegels incorrectly, which may be why many women who do kegels on their own find it frustrating that it doesn't help with their symptoms. This is where a qualified physical therapist trained in strengthening the pelvic floor is helpful. In addition to kegels, a device called biofeedback is used at each treatment session. This device works much like an EKG. Just as an EKG will pick up the muscle activity of the heart, biofeedback will pick up muscle activity of the pelvic floor by using external electrodes. In this way, a woman can see how she is progressing with strengthening the pelvic floor at each session. By committing to this comprehensive approach, many women have success with gaining control over symptoms of urinary incontinence.

Anyone experiencing symptoms of UI should talk with their doctor. There are many options available to treat this condition, physical therapy being one of them. If physical therapy does not alleviate the problem, there is a new procedure called the Suburethral Sling performed by a gynecologist. This is an outpatient, minimally invasive surgical procedure that often eliminates UI. Suburethral slings are made of a synthetic mesh material placed under the urethra, where it acts like a hammock, compressing the urethra to prevent leakage. This procedure is less invasive than other surgical techniques available and requires only a small incision, has a short recovery time and a high rate of success. Women should talk with their doctor to find out what treatment option is best for them.

There are various degrees and severity of urinary leakage. Many people find success with physical therapy, and those who don't, take medication or have surgical options such as the sling procedure. The sooner women address the problem, the sooner they can return to living life without worrying where the nearest bathroom is!

For more information or a free brochure explaining treatment options, call 373-2293.

- Alison Ouellette, DPT, PT, specializes in Women's Health Physical Therapy at Parkview Adventist Medical Center in Brunswick, Maine.

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