Tag Archives: incontinence

I’ve gotta go – NOW!

Connie Continence – “Hey, I’ve got an idea! Wanna go for a ride and check out the scenery?”
Overactive Odette – “Oh, I’d love to, it’s so pretty out, but I can’t. We’d be too far away from a bathroom.”
C – “Oh,OK. How about we go to the beach?”
O – “Seriously? You know I can’t do that. The bathrooms are way back by the parking lot, too far from the beach. I’d never make it. Plus, the sound of the waves? Forget about it!”
C – “Huh, bummer. Well how about the mall? There are bathrooms there.”
O – “If we can go online and pull up a map of the mall showing the bathrooms I guess we could do that.”

Connie Continence is fortunate to have normal bladder control, while her good friend, Overactive Odette, suffers from overactive bladder (OAB), or urge incontinence (UI).  Urge incontinence is the strong, sudden need to urinate due to bladder spasms or contractions.  The symptoms of urge incontinence, or OAB, can be triggered by things such as turning a key in the door, washing dishes (Remember the old trick of  putting someone’s hand in a bucket of warm water?), or hearing running water.  As compared to stress incontinence where small leaks occur, urge incontinence leaks are usually of a larger scale emptying almost all of the contents of the bladder.  One in five adults over the age of 40 are affected by OAB or recurrent symptoms of urgency and frequency, a portion of whom don’t reach the toilet before losing urine. (http://www.nafc.org/media/statistics/urge-incontinence-and-oab/)  There are many different potential causes of urge incontinence, and in many cases the cause cannot be identified.  If you experience overactive bladder or urge incontinence you should discuss this with your healthcare provider to rule out any potential medical causes for the problem.

Mixed incontinence is when an individual suffers both from stress incontinence and the urge of the stress incontinence.  Typically it starts with stress incontinence.  As a result of the stress incontinence the individual may decide to use the facilities before they feel the urge, “just in case.”  As a result they rarely allow the bladder to completely fill.  Over time the nervous system becomes “reset” and sends a message to the brain that the bladder is full and must empty before it is anywhere near being full.  The lesson here is that you should be cautious about forming a habit of regularly urinating before you feel the urge.

So, what is one to do about urge incontinence?  Once medical problems are discussed and addressed with your healthcare provider you may consider behavioral treatments, medications, electrical stimulation, and/or surgery.

Behavioral treatments that I frequently recommend as a Physical Therapist and Yoga Therapist are:

1) Lifestyle changes (See my blog, “Control Issues”.)

2) Urge suppression techniques that help calm the nervous system include belly breathing, sequential muscle relaxation, and visualization of being in a relaxed soothing environment.  These techniques can be practiced on a daily basis.  Other possibilities include meditation techniques and yogic breath techniques that help calm the nervous system.

3) Bladder training – With bladder training you determine when you are going to urinate rather than responding to the bladder anytime that it sends a message that it “has to go really bad.”  The goal is to gradually increase the time between trips to the bathroom up to anywhere between 2-5 hours during the day, and 1-2 trips to the bathroom at night – which are normal frequencies.  Here is a guideline for retraining your bladder.

  • Figure out how often you typically experience the urge to urinate.
    • every __________  hours
  • For the 1st week, during the day, go to the bathroom at this same interval or a little less, whether you feel the urge or not.  (For example, if you usually have to go every 60 minutes, go every 45 minutes whether you have to or not.)
    • Week 1 every _________  hours
  • Each week increase the interval between trips to the bathroom by about 15 minutes
    • Week 2 every _________ hours
    • Week 3 every _________ hours
    • Week 4 every __________ hours
    • And so on until you are able to comfortably spread trips to bathroom out to every 2-5 hours.
  • If you feel the urge to urinate before the scheduled time:
    • Stand or sit quietly until the strong urge passes.
    • To help quiet the urge practice the urge suppression technique (above) that works best for you
    • You can also practice 3 quick contractions or lifts of the pelvic floor as mentioned in my blog “I laughed so hard tears ran down my legs” )
    • If at all possible, once the urge has passed, wait until the next scheduled time to void.
    • If you cannot wait until the next scheduled time be sure to walk SLOWLY to the bathroom.  Rushing stimulates the nervous system and bladder, and can increase the risk of an accidental leak.

If you suffer from urge incontinence consider taking steps to control your bladder, rather than letting your bladder control your life.  Studies have shown success rates up to 75% for improvements in bladder control with bladder re-training, and 12% for complete resolution of the problem.  Consider discussing these symptoms with your healthcare provider, making lifestyle changes, and consulting with an individual trained in Yoga Therapy or Meditation techniques to help you master approaches to quiet your nervous system, and/or a Physical Therapist who is knowledgeable in pelvic floor dysfunction if you have mixed incontinence.

We are not creatures of circumstance; we are creators of circumstance.” ~ Benjamin Disraeli

Katey Hawes, owner and founder of Posabilities, Inc.., is a physical therapist, registered yoga teacher, and yoga therapist.

You may find her at Facebook.com/posabilities4u, Twitter @Posabilities4u, and .

I laughed so hard tears ran down my legs

Rather than being hilariously funny, stress incontinence can be frustrating, inconvenient, and even embarrassing.  Stress incontinence is an involuntary release of urine that occurs when downward pressure is put on the abdomen during activities such as sneezing/coughing, laughing, exercising, or having sexual relations.  This is the most common type of urinary incontinence in women, and can be common in men following prostate surgery.  The good news is that with treatment stress incontinence can likely be managed.  A 2007 study showed that pelvic floor exercises can result in better control of the bladder with coughing, laughing, sneezing, or exercising in up to 70% of women. (Lentz, GM, 2007)

Treatment options for stress incontinence include:

  1. Exercises
  2. Lifestyle changes – (Read my blog from last week, “Control issues”)
  3. Medications and/or injections
  4. Devices (pessaries) and/or Surgery

Exercises and life-style changes are typically the first line of defense and recommended before considering medications and/or surgeries.

Before I discuss some great exercises for improved bladder control I’d like to give you a brief overview of the anatomy of the pelvic floor and urinary system.

  • Bladder – The bladder wall is made up of the detrusor muscle that contracts to expel urine, and remains relaxed as it fills.  This is a smooth muscle so is not under voluntary control.
  • Urethral sphincters – There are 2 of these, the internal and external sphincters.
    • The internal urethral sphincter is a continuation of the detrusor muscle and is located at the base of the bladder and is also involuntary.
    • The external urethral sphincter is located just beyond the internal sphincter in women, and just beyond the prostate in men.  This muscle is a voluntary muscle, so we can voluntarily contract and relax it.
  • Pelvic floor muscles – The primary muscles of the pelvic floor are the levator ani muscles which form a hammock that supports the bladder, uterus or prostate, and rectum.  These muscles attach to the tail bone, pubic bone, and the obturator internus which is a deep hip rotator muscle.
  • Transversus abdominis (TVA) – While this muscle is not actually part of the urinary system or pelvic floor anatomy it is worth mentioning.  The TVA runs side to side across the front and side of the abdominal wall and is the deepest of the abdominal muscles.  (For more information on the TVA, see my blog post “Accessing the Core.”)

Now that you are familiar with the muscles involved in bladder control here are some fun facts  (At least I think that they are fun!):

  • The pelvic floor and the TVA work in synch with each other.  When one contracts the other automatically contracts.
    • If you aren’t sure how to contract the pelvic floor, engage the TVA by pulling your belly button up and back towards your spine and that lifting you feel between your tailbone and pubic bone is your pelvic floor!
  • When the pelvic floor is weak the “hammock” sags allowing the neck of the bladder to drop down too low decreasing the effectiveness of the sphincter muscles in controlling the release of urine.
    • Strengthen your pelvic floor, and your sphincters can work more effectively!
  • The external sphincter and the detrusor (bladder) muscles work in opposition to each other.  When on contracts the other relaxes.
    • Engage your pelvic floor or TVA to relax your detrusor (bladder) muscle.  Gotta go really bad, but no bathroom in sight?  Do 3 quick contractions of the pelvic floor and buy yourself some time!

5 exercises to help combat stress incontinence:

1) Kegels

  • First practice finding your pelvic floor muscles.  You can do this by stopping urination midstream.  If you do this successfully you found the right muscles.  (Do not make it a regular habit to stop urination mid stream.  This can lead to other problems.)
  • Start out lying on your back and tighten your pelvic floor muscles and hold for 5 seconds, then relax for 5 seconds, repeat 5 times.  You can gradually increase up to a 10 second contraction, 10 second relax, and 10 repetitions.  Repeat 3 times a day.
  • Begin practicing in different positions – sitting, standing, squatting, and standing on one leg.
  • Also practice quick kegels – contract 1-2 seconds, relax 1-2 seconds.  Practice while coughing, sneezing, lifting, and laughing.

2) Belly scoops

  • Begin lying on your back with both knees bent.  Breathe out and scoop your belly button up and back toward your spine, keeping your belly button scooped breathe in, breathe out, and on your next inhale relax your belly.  Repeat 3-5 times.
  • You can progress this to lying on your back legs lifted up toward the ceiling, on all fours, sitting, standing.

3) Clamshell – Lying on your side, with both hips and knees bent about 45 degrees and legs stacked on top of each other, keep the feet together and lift your top knee up only as far as you can without your pelvis rolling back, then lower the knee.  Repeat 10-30 times on each side.

4) Knee squeezes – Lying on your back with your knees bent, or sitting up, place a pillow or 8” ball between your knees.  Squeeze both knees into the pillow/ball, hold 3 seconds, and then relax.  Repeat 10-30 times

5) Walking – Walking helps tone almost all of the exercises involved in your bladder control.  As I have mentioned before this is almost the perfect exercise for most people!

As always, inform your healthcare practitioner of any changes in your health status, and check with them before starting any new exercise program.  Oh, did I mention that both Yoga and Pilates are great practices to help strengthen your pelvic floor and core, and that your favorite physical therapist can work with you one-on-one to help you determine the best way to improve your bladder control?

“I am thankful for laughter, except when milk comes out of my nose.”  ~ Woody Allen

Lentz GM (2007). Physiology of micturition, diagnosis of voiding dysfunction, and incontinence: Surgical and nonsurgical treatment. In VL Katz et al., eds., Comprehensive Gynecology, 5th ed., pp. 537–568. Philadelphia:  Mosby Elsevier.

Katey Hawes, owner and founder of Posabilities, Inc.., is a physical therapist, registered yoga teacher, and yoga therapist.

You may find her at Facebook.com/posabilities4u, Twitter @Posabilities4u, and .

Control Issues

Bladder control issues that is.  Urinary incontinence can affect individuals of all ages and genders.  A NIH article indicates the following prevalence rates of urinary incontinence in the US: young adult women 20-30%, middle aged women 30-40%, elderly women 30-50%, and males of all ages 3-11%. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1476070/).  There is a variety of factors that can contribute to urinary incontinence including pelvic floor dysfunction or weakness, over sensitivity of the bladder, hormonal changes, pregnancy, lifestyle factors (dietary intake, smoking, and obesity), decreased sensation due to chronic conditions, as well as declines in functional mobility.

The primary types of incontinence are :

  • Stress incontinence – Small leaks with coughing, laughing, lifting, etc. associated with pelvic floor and/or sphincter weakness.
  • Urge incontinence – Strong urge to urinate, generally with larger leaks resulting.  (You know, “gotta go, gotta go.”)
  • Mixed incontinence – A combination of stress and urge incontinence
  • Functional incontinence – Inability to get to the bathroom in a timely manner due to declines in functional mobility.
  • Overflow incontinence – Results when bladder completely fills and the individual does not void, and there is a slow continuous leakage.  This most typically indicates a visit to the urologist.  

The first step in addressing urinary incontinence is considering if you have lifestyle habits that may be contributing to the problem:

Here are some lifestyle changes to consider for improving your bladder control:

  • Drink adequate water – If you are not drinking enough water your urine can become quite concentrated and irritate the lining of your bladder, resulting in urge incontinence.  How much water should you drink?  Here is a simple formula to estimate an appropriate amount of water intake for your weight – Divide your weight (in pounds) by 2, then multiply that by 80%.    *  (___lbs / 2) x .80 = _____ ounces of water per day.
  • Avoid trigger beverages / foods – Different people have different things that may irritate their bladders.  If you are having problems with frequent urination or strong urges, consider what foods you consume on a very regular basis, and consider eliminating or decreasing them for 2-3 days to see if the problem improves.  Some common irritants include caffeinated or decaffeinated coffee or tea, citrus fruits and  juices, sodas, artificial sweeteners, , alcohol, tomatoes and tomato based products, large amounts of dairy products, chocolate (argh!), spicy foods, vitamin C supplements, and in some cases even cranberry!
  • Keep your weight in check – As little as 5-7 extra pounds of body weight can decrease your bladder control by increasing the pressure on your bladder.
  • Kick the habit, stop smoking – Studies show that women who smoke are two times as likely to develop incontinence, than women who don’t smoke.  This may be due to the “smoker’s cough” which can stretch and weaken the pelvic floor, and aggravate the bladder.
  • Stay regular, keep constipation under control – Choose high fiber foods to improve your bowel function.  Constipation can increase pressure in the pelvic region irritating the bladder.  Also, adequate hydration and regular exercise can help you keep regular.
  • Get out and walk! – For many, walking can be the almost perfect exercise.  Walking helps strengthen many of the pelvic floor exercises, improves your functional mobility, helps maintain healthy bowel function, and just feels great!

Bladder control issues can have significant negative effects on individuals’ quality of life including inability to participate in certain enjoyable activities, fear of being too far away from an available toileting facility, increasing costs of incontinence medications and supplies, skin and hygiene issues, social isolation and depression.  The good news is that, in many cases, urinary incontinence can be resolved, or at least better controlled, with changes in lifestyle, exercises to improve function of the pelvic floor, and retraining of the neurological system to reduce the urge to urinate into a more appropriate balance.  

Over the next few weeks, I will be addressing the different  types of urinary incontinence and tips to address them using strengthening exercises, neurological quieting, and bladder retraining.  Please share these blogs with your friends, family, and acquaintances if you suspect that they may have “control issues.”

By changing nothing, nothing changes.” ~ Tony Robbins

Katey Hawes, owner and founder of Posabilities, Inc., is a physical therapist, registered yoga teacher, and yoga therapist.

You may find her at Facebook.com/posabilities4u, Twitter @Posabilities4u, and .