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Sunday, March 24, 2013
America's Best Kept Secret...Urinary Incontinence!
This is the first article in our series of pelvic health. Although it is sometimes embarrassing to talk about, incontinence is a problem that both men and women face and can be a common topic around runners. Seasoned runners or athletes may even jokingly say that it's an initiation of sorts to pee while you're racing or training.
Would you wait an average of 3-6 years to talk to your doctor about your knee or back pain? Most would say no! Then why would you wait that long to talk to your doctor or health care provider about urinary leakage. Many men and women have one thing in common…they would rather not talk about their urinary leakage with their health care provider. Incontinence can be an uncomfortable topic for many people but it does not have to be because it is a common, treatable occurrence. Some people remain quiet about their bladder control because they believe it cannot be improved or that it is a “normal part of aging”. Men and women of all ages have trouble with urinary incontinence but it is more common in women. THE GOOD NEWS IS THAT 80% OF ALL INCONTINENCE CASES CAN BE SIGNIFICANTLY IMPROVED!
The Agency for Health Care Policy and Research (AHCPR) reports that one in four women age 30-59 have experienced urinary incontinence. A March 2011 report provided by the United States Food and Drug Administration (FDA) states that up to 50% of the female adult US population experience some form of urinary incontinence. The annual cost for caring for people with urinary incontinence in the community is $11.2 billion (an additional $5.2 billion spent on those in nursing homes). The majority of this money is spent on management measures such as pads for protection vs. treatment.
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has developed an organization (The Women’s Urologic Health Program) with two goals in mind:
Increase the number of people reporting and seeking treatment for urinary incontinence.
Raise health professional’s awareness and knowledge about urinary incontinence.
There are many systems that must work together to provide control of the bladder. The pelvic floor muscles hold the bladder in place. The sphincter muscles keep the urethra (tube that carries the urine out of the bladder) closed. The bladder muscles relax as the bladder fills with urine and these same muscles contract when it’s time to empty the bladder. Nerves carry signals from the brain to tell the bladder when it’s time to empty. Hormones help to keep the lining of the bladder and urethra healthy. Bladder control problems occur when any one or combination of these systems are not working correctly.
There are six types of urinary incontinence. The three main types of urinary incontinence are stress, urge and mixed incontinence. Stress incontinence occurs during physical activities that cause an increase in intra-abdominal pressure such as coughing, sneezing, exercise, lifting or laughing. Normally the pelvic floor and sphincter muscles are strong enough and can handle the extra pressure (or “stress) from a cough, sneeze, or laugh but when these muscles are weak, that sudden pressure can push urine out of the bladder.
Urge incontinence is leakage caused by a sudden, strong desire to urinate. This type of incontinence is generally caused by either an involuntary bladder contraction or neurological impairment common with diabetes, a stroke, an infection or another medical condition.
Mixed incontinence is a combination of stress and urge incontinence. You may leak urine with a laugh or sneeze one time and at another time you may have a sudden uncontrollable urge to urinate just before you leak.
There are many ways to treat urinary incontinence including changing daily habits, exercises, medications, using a device such as a pessary or surgery as a last resort. As reported above, 80% OF ALL INCONTINENCE CASES CAN BE SIGNIFICANTLY IMPROVED through a combination of behavioral changes and pelvic floor exercises.
Exercises that strengthen the pelvic floor muscles are called “Kegel” exercises. They don’t require any equipment and can be done in any position at any time and if done correctly. The key is finding the correct way to contract these muscles. Without proper education or instruction 50-70% of women do Kegel exercises incorrectly and 25% of those do them in a manner that makes their leakage worse. There are several ways to find your pelvic floor muscles. Women will feel a slight pulling in the rectum or vagina. Men will feel a pulling in the rectum or a movement in the penis. One of the most common mistakes people make when trying to do a pelvic floor contraction is using the wrong muscles. Many people use their upper abdominal muscles, buttock muscles or hold their breath. If you are using the correct muscles, no one should be able to tell that you are squeezing your pelvic floor muscles – except you! The nice thing about doing these exercises is that you can do them in any position at any time. Make these exercises part of your daily routine so that exercising your pelvic floor muscles becomes a habit. Some good times to do them are standing at the sink when doing dishes or washing your hands, sitting on the couch during a commercial, sitting in your car at a red light, sitting at your desk when checking your email or while standing in the grocery line.
This article is courtesy of Lisa Kiesel, PT, DPT, BCB-PMD; ProRehab's pelvic health specialist. Her contact information is listed at the bottom of this article.
Would you wait an average of 3-6 years to talk to your doctor about your knee or back pain? Most would say no! Then why would you wait that long to talk to your doctor or health care provider about urinary leakage. Many men and women have one thing in common…they would rather not talk about their urinary leakage with their health care provider. Incontinence can be an uncomfortable topic for many people but it does not have to be because it is a common, treatable occurrence. Some people remain quiet about their bladder control because they believe it cannot be improved or that it is a “normal part of aging”. Men and women of all ages have trouble with urinary incontinence but it is more common in women. THE GOOD NEWS IS THAT 80% OF ALL INCONTINENCE CASES CAN BE SIGNIFICANTLY IMPROVED!
The Agency for Health Care Policy and Research (AHCPR) reports that one in four women age 30-59 have experienced urinary incontinence. A March 2011 report provided by the United States Food and Drug Administration (FDA) states that up to 50% of the female adult US population experience some form of urinary incontinence. The annual cost for caring for people with urinary incontinence in the community is $11.2 billion (an additional $5.2 billion spent on those in nursing homes). The majority of this money is spent on management measures such as pads for protection vs. treatment.
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has developed an organization (The Women’s Urologic Health Program) with two goals in mind:
Increase the number of people reporting and seeking treatment for urinary incontinence.
Raise health professional’s awareness and knowledge about urinary incontinence.
There are many systems that must work together to provide control of the bladder. The pelvic floor muscles hold the bladder in place. The sphincter muscles keep the urethra (tube that carries the urine out of the bladder) closed. The bladder muscles relax as the bladder fills with urine and these same muscles contract when it’s time to empty the bladder. Nerves carry signals from the brain to tell the bladder when it’s time to empty. Hormones help to keep the lining of the bladder and urethra healthy. Bladder control problems occur when any one or combination of these systems are not working correctly.
There are six types of urinary incontinence. The three main types of urinary incontinence are stress, urge and mixed incontinence. Stress incontinence occurs during physical activities that cause an increase in intra-abdominal pressure such as coughing, sneezing, exercise, lifting or laughing. Normally the pelvic floor and sphincter muscles are strong enough and can handle the extra pressure (or “stress) from a cough, sneeze, or laugh but when these muscles are weak, that sudden pressure can push urine out of the bladder.
Urge incontinence is leakage caused by a sudden, strong desire to urinate. This type of incontinence is generally caused by either an involuntary bladder contraction or neurological impairment common with diabetes, a stroke, an infection or another medical condition.
Mixed incontinence is a combination of stress and urge incontinence. You may leak urine with a laugh or sneeze one time and at another time you may have a sudden uncontrollable urge to urinate just before you leak.
There are many ways to treat urinary incontinence including changing daily habits, exercises, medications, using a device such as a pessary or surgery as a last resort. As reported above, 80% OF ALL INCONTINENCE CASES CAN BE SIGNIFICANTLY IMPROVED through a combination of behavioral changes and pelvic floor exercises.
Exercises that strengthen the pelvic floor muscles are called “Kegel” exercises. They don’t require any equipment and can be done in any position at any time and if done correctly. The key is finding the correct way to contract these muscles. Without proper education or instruction 50-70% of women do Kegel exercises incorrectly and 25% of those do them in a manner that makes their leakage worse. There are several ways to find your pelvic floor muscles. Women will feel a slight pulling in the rectum or vagina. Men will feel a pulling in the rectum or a movement in the penis. One of the most common mistakes people make when trying to do a pelvic floor contraction is using the wrong muscles. Many people use their upper abdominal muscles, buttock muscles or hold their breath. If you are using the correct muscles, no one should be able to tell that you are squeezing your pelvic floor muscles – except you! The nice thing about doing these exercises is that you can do them in any position at any time. Make these exercises part of your daily routine so that exercising your pelvic floor muscles becomes a habit. Some good times to do them are standing at the sink when doing dishes or washing your hands, sitting on the couch during a commercial, sitting in your car at a red light, sitting at your desk when checking your email or while standing in the grocery line.
Lisa Kiesel, PT, DPT, BCB-PMD
Doctor of Physical Therapy, Board Certified in Biofeedback for Pelvic Muscle Dysfunction
ProRehab, PC.
Indiana St Clinic 476-0409
If this is something that speaks to you, it is time to get help. Talk to your physician about a referral to see Lisa!!
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