Pelvic Floor Weakness - Urinary Incontinence

Defined

The pelvic floor is made up of muscles that attach to the front, back and sides of the pelvic bone and sacrum (the large fused bone at the bottom of your spine, just above the tailbone). The pelvic floor muscles support the bladder, uterus (women) or prostate (men) and rectum. Pelvic Floor Dysfunction (PFD), sometimes called Prostatodynia in men, is a tightening, spasming and/or weakening (dysfunction) of the pelvic floor muscles, which can cause urinary and/or fecal incontinence.

Both men and women can experience urinary incontinence. Men most commonly will develop urinary incontinence after prostate interventions. Women can develop symptoms of incontinence through a variety of factors including childbirth, surgery, weight gain and general de-conditioning. Under-active pelvic floor muscles can result in the involuntary loss of urine and/or feces. Under-active and weak pelvic floor muscles can also result in diminished sexual function for men and women.

There are three types of urinary incontinence:

  1. Stress Incontinence is an uncontrolled urine loss when pressure inside the bladder exceeds the pressure in the urethra--the urethra won't remain closed, so the sphincter doesn't close. This can occur with lifting, straining, coughing, laughing or physical activity. Pelvic traumas, such as childbirth, surgery or impact injuries, are common causes.
  2. Urge Incontinence is the uncontrolled loss of urine preceded by a strong urge to urinate. The bladder is overactive, so the person visits the bathroom frequently, feels "an urge" to urinate, is unable to "hold it" long enough to get to the toilet, urinates more than eight times per 24-hour period, awakens more than once during the night to urinate or leaks a moderate-to-large amount.
  3. Mixed is a combination of the above types of incontinence.

There can be a variety of underlying causes of these symptoms that your physical therapist and physician will work together to determine an appropriate diagnosis and treatment.

Treatment Options

When pelvic floor muscles are strong, they provide support to the openings that pass through them allowing better control and flow of urine. Erectile dysfunction is another area of concern that can be improved with appropriate strengthening of the pelvic floor.

There is a common misconception that physical therapy is just going to tell you to do kegels. Physical therapists have traditionally prescribed and directed exercise programs to strengthen muscles that have been weakened by injury or disuse. Physical therapists use their expertise to assess the quality of the contraction, the endurance and the coordination. These same principles are used in strengthening the pelvic floor muscles as well as muscles associated with the lumbo-pelvic and abdominals.

Many people have been told to do kegel exercises, but have never been shown the correct way. Kegels can be performed incorrectly or may not necessarily be appropriate to do in every situation. At times they can make symptoms worse.

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