STRESS INCONTINENCE
There are many different types of urinary incontinence. The causes of urinary incontinence can vary from muscle weakness, bladder and pelvic floor muscle coordination, poor diet and habits, or a combination of them all. Physical changes can occur from pregnancy, childbirth, hormones (including menopause) and lead to urinary incontinence. Other causes of urinary incontinence include constipation, medications, caffeine and alcohol, infection, nerve damage or excess weight.
Stress incontinence is defined as involuntary loss of urine on effort of physical exertion (such as cough, sneeze, laugh, lifting heavy objects, sporting activities). Leakage happens when excessive intra-abdominal pressure is placed on the bladder or if the bladder suddenly contracts and the pelvic floor muscles are not strong enough to counteract the force and hold back urine. However, sometimes it’s not a matter of strength as much as it is poor timing of the pelvic floor muscles in response to this increased pressure. Stress incontinence is the most common type of incontinence in women but it can also occur in men. The most common occurrence in men usually occurs following procedures such as prostatectomy and radiation. See Incontinence Post-Prostatectomy.
TREATMENT
The first step to treating stress incontinence is Bladder Retraining which will include diet and behavior modifications. In addition to bladder retraining, Kegel exercises may be beneficial (as long as there is not also pelvic pain present). It is also important to work on the timing of the pelvic floor muscles. This can be done by following the protocol below:
EXHALE WITH EFFORT
When exerting effort we tend to hold our breath to create stability. Unfortunately, what this also does is increase your intra-abdominal pressure. Basically you’re trapping the air in your abdomen by closing your epiglottis (throat) which increases the pressure (and increases blood pressure!) to a level that your pelvic floor cannot counter-act against. If the abdominal pressure is greater than the counter pressure of your pelvic floor the result is stress incontinence. This can happen with sneeze, cough, laugh, bending over, exercise, picking up or lifting something, as well as every day activities such as getting in and out of a chair or car.
Exhaling with effort is a technique used to decrease the intra-abdominal pressure so that the pelvic floor muscles can maintain continence during that activity. Ideally the pelvic floor will also contract for counter pressure.
Practice with sit-to-stand first. Once you’ve mastered this you can start utilizing it with any activity that causes leakage. Remember, if you ever find yourself holding your breath immediately exhale even if you don’t leak! NEVER HOLD YOUR BREATH for any activity including and most especially during defecation (See Defecation Mechanics).
SIT-TO-STAND EXHALE WITH EFFORT:
- Scoot to the edge of the chair
- Before you start to rise gently inhale and then exhale through your mouth. Start your exhale first then begin to rise from the chair. You should be able to hear your exhale. The biggest mistake people make is starting the movement first then exhaling or exhaling once the movement is almost complete. By this time the intraabdominal pressure has already increased and you haven’t trained the pelvic floor to contract first.
Another example is lifting. Before you begin to pick up a heavy object, start your exhale first then lift. Remember, if your epiglottis is open (by having your mouth open during exhale) then the pressure will not get trapped and the pelvic floor has a chance to activate and counter pressure against the activity resulting in continence.
One other example is getting out of bed. Do not ‘jack-knife’ out of bed. When laying flat on your back, bend your right knee if you’re rolling to your left, roll on to your left side, then use your arms/hands to push up to sit while exhaling—remember to start the exhale before pushing up to sitting position. Once sitting, follow the steps listed above. If you have a strong urge to urinate before getting out of bed, practice performing 5 quick Kegels before you stand and then walk slowly (do not rush) to the bathroom.
This activity will be a conscious one at first but the more you practice the sooner you will be able to do this automatically.
Even if you don’t leak during activity, you should never hold your breath. Continuing this bad habit will eventually lead to incontinence so retrain your brain and pelvic floor now for prevention!
Once you’ve mastered the exhale with effort, try adding a simultaneous pelvic floor contraction (Kegel) with the exhale to increase the pressure of the pelvic floor even more. This is most important for those with stress incontinence to maintain closure of the urethra during the activity.