What's Happening

Urinary Incontinence (UI)

by Eryn Kirschbaum, PT, DPT, PRPC

Urinary Incontinence (UI) is a phrase often associated directly with the aging population or with women who have given birth.

However, it often occurs in younger populations, women who have never given birth, and also in men. The term “incontinence” does not necessarily mean complete loss of bladder control; even a small amount of unintended leakage is considered incontinence, and despite its prevalence, it is never normal to leak! Read ahead to learn more about the different types of incontinence and some common misconceptions.

There are different forms of UI. The most familiar form is stress urinary incontinence (SUI), which is involuntary leakage associated with an increase in abdominal pressure due to coughing, sneezing, laughing, jumping, exercise, etc. Another common form is urge urinary incontinence (UUI), which is the sudden strong urge to use the restroom with involuntary leakage while attempting to reach the toilet. Often, people are affected by both of these forms of incontinence depending on the situation.

A large misconception regarding incontinence is the belief that the muscles of the pelvic floor are too relaxed or loose, which leads people to perform Kegel exercises (pelvic floor muscle contractions). In reality, many people suffer from increased tension in the pelvic floor which can actually lead to increased tightness and subsequent weakness of these muscles. It is imperative that a muscle can go through its full range of motion to be considered strong. Imagine tightening your bicep muscle all day long so that your elbow was in fully bent position, then trying to perform a bicep curl… it wouldn’t happen! Your muscle would not be working appropriately due to the tightness. The same thing can happen with your pelvic floor muscles. Therefore, it can be very helpful to see a pelvic floor physical therapist if you suffer from any sort of incontinence to have an assessment performed. Once a proper diagnosis is made, treatment can begin.

Another misconception about pelvic floor strengthening is the concept of a Kegel contraction. People often perform Kegel exercises by quickly and repeatedly squeezing and tightening their pelvic floor muscles in fast bursts. However, our muscles are made up of two types of muscle: slow twitch muscles fibers, which are needed for postural endurance, and fast twitch muscle fibers, which are needed for quicker movements. The pelvic floor consists of approximately 70 percent slow twitch fibers and 30 percent fast twitch fibers, which means we need to train both types of muscle fibers for optimal outcomes. Therefore, a proper exercise program should include longer hold contractions, as well as quick bursts. A pelvic floor physical therapist is trained to develop an appropriate exercise program depending on the needs of each patient.

As with any dysfunction in the body, it is better to address the issue early on to decrease chances of worsening of symptoms in the future. It can be an embarrassing topic to broach, but know that it is much more common than most people believe and no one should have to worry about leaking!