Incontinence is the accidental or unwanted leakage of urine or fecal matter.  Incontinence can develop at any age, but becomes more common as we grow older.  Stress Incontinence is leakage caused by increased pressure on the bladder and is common with sneezing, coughing, laughing, jumping, or jogging. Urge Incontinence is leakage caused by the uncontrollable pressure/urge to urinate. It commonly occurs when one is en route to a bathroom, hears water running, or arrives home/unlocks the door.  Mixed Incontinence is a combination of stress and urge incontinence.  Finally, anal Incontinence is the leakage of feces or gas due to poor control of rectal muscles. 

Physical therapy can help.  Often, incontinence is the result of weak/uncoordinated pelvic floor muscles or core muscles.  Pelvic trigger points or malalignment may cause or perpetuate the problem.  Diet and behavior can also contribute to incontinence. 

WOMEN:

Fifty percent of women ages 60 and over suffer from urinary incontinence. However, studies show that only about 30 percent of people with incontinence seek treatment.   Women may decline to seek treatment due to embarrassment or a belief that nothing can be done.  Treatment is possible and many cases of incontinence can be improved or cured. 

Women are more susceptible to incontinence because of physical changes resulting from pregnancy, childbirth, and menopause.  Childbearing can stretch pelvic muscles and nerves, weakening support of the bladder and urethra.  During vaginal delivery excessive tearing can result in disruption of the anal sphincter, resulting in leakage of stool or gas. The decrease in estrogen during menopause can also weaken pelvic and vaginal muscles, increasing the likelihood of incontinence.  

MEN:

Many men do suffer from incontinence, its prevalence increasing with age. 

Any disease, condition, or injury (such as diabetes, stroke, or MS) that damages nerves can lead to urination problems. Prostate problems (BPH, prostatectomies, or radiation therapies) are a leading cause of male incontinence.  

Evaluation and Treatment of Incontinence:

Biofeedback: 
Biofeedback measures specific and quantifiable physical functions and conveys the information to the patient so to increase the patient's awareness of these functions.  In so doing, Biofeedback allows users to gain control of seemingly "automatic" physical processes.

• Surface Electromyography(EMG) is a form of biofeedback  which measures the electrical activity of muscle contractions and gives constant feedback on exercise performance. It assists patients in controlling their muscles and muscular response. The EMG biofeedback machine connects to the body with electrodes and uses sounds and visual feedback to guide your exercise

 

• Rehabilitative Ultrasound Imaging is use of a diagnostic ultrasound to obtain an image of an organ or a muscle during activity or exercise. For treatment or evaluation of incontinence, an image of the bladder while attempting a pelvic muscle exercise (“Kegel”) to identify appropriate movement or lift of the bladder and coordination of the core muscles.

Postural Evaluation and Correction of alignment is important in reducing pressure on the bladder and allowing for efficient use of the muscles and appropriate nervous system response. Postural exercises, joint mobilization, stretching and strengthening, and soft tissue release help to achieve optimal physiological function.

Core Muscle Strengthening is an important element of treatment of incontinence. Many people are unaware that the “core muscles” include the pelvic floor muscles, and the proper coordination of these muscles with some of the larger trunk muscles can reduce bladder pressure and enhance support.

Behavioral Modification can be important tools in treatment of incontinence. This may include dietary considerations to decrease bladder irritation or improve bowel function, timed voiding, and techniques to inhibit urgency.

The multiple changes occurring in a woman’s body during the childbearing year can result in a variety of complaints. Hormonal changes, weight gain, edema, and changes in the musculoskeletal system to accommodate the growing fetus can all contribute to pain and dysfunction during pregnancy and the post-partum period. 

• Sciatica is a term commonly used to describe pain in the low back, buttock and leg occurring during pregnancy. Often there is instability in the pelvis which may cause the sacro-iliac joint (the joint between the spine and the pelvis) to lose its proper alignment. This can result in joint pain, and overuse of the surrounding muscles.

 

• Thoracic Outlet Syndrome can occur as a result of shifts in the position of the rib cage during pregnancy, creating pressure between the collarbone and the first rib. Symptoms generally include numbness, tingling or pain into the arms.

 

• Carpal Tunnel Syndrome is a compression of the median nerve, which supplies sensation and strength to the thumb and first 2 fingers. Swelling in the wrist, postural changes, and hormonal effects can be causative factors.

 

• Pubic Symphysis Separation is a possible result of hormonal changes and pelvic ring instability. Symptoms include pain at the pubic bone and sometimes the inner thighs, which can interfere with the ability to walk.

 

• Back and Neck Pain is common in pregnancy and often results from a change in the center of gravity and subsequent postural adaptations to this change. Muscular overuse and spasm frequently play a role in the severity of back and neck pain.

 

• Blocked milk ducts create pain which may interfere with successful breastfeeding.

 

• Dyspareunia is a term meaning painful intercourse. Many women experience this problem in the postpartum period due to decreased vaginal lubrication, episiotomy scarring, and pelvic floor muscle spasm and pain.

 

• Coccydynia refers to pain in the coccyx or tailbone. This is common after a fall or following childbirth.

 

Evaluation and Treatment in Pregnancy and the Post-Partum Period:

Postural Evaluation and Correction of alignment is important in normalizing muscle tone and allowing for efficient use of the muscles and appropriate nervous system response. Hormonal  and postural changes can soften the ligaments supporting the joints, putting the pregnant woman at risk for poor alignment of the pelvis and spine. Treatment includes:

• Instruction in postural correction and body mechanics,
• postural exercises
• joint mobilization
• stretching and strengthening
• soft tissue release/trigger point release

The Pelvic core muscles are weakened by pregnancy and require strengthening during pregnancy and rehabilitation during the post-partum period to restore support of the spine, pelvis, and abdominal organs. In the postpartum period, Rehabilitative Ultrasound Imaging can assist in visualization of the pelvic core muscle function to assist in restoring strength.

Treatment of blocked breast ducts includes use of therapeutic ultrasound and manual drainage.

Treatment of dyspareunia includes manual therapy and modalities as mentioned in the description of treatment of pelvic pain. 

The therapists at Specialty Physical Therapy are trained experts in orthopedics and rehabilitation after injury.  Physical therapists will assess strength, fliexibility, stability, posture, balance, and gait in order to diagnose the pain.  Manual therapy techniques such as deep tissue massage, trigger-point release, or joint mobilization may be used to speed the healing process.  An individualized exercise program will also be prescribed.