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Improving urinary incontinence through physical therapy

Sam Howzit

We’ve probably all seen a commercial at some point for medication to help a weak bladder, but it isn’t something we generally want to talk about if we have one.

This week on “Take Care,” Dr. Jenni Johnson Gabelsberg explains this problem, known as urinary incontinence, and how to fix it through physical therapy. Gabelsberg is a nationally prominent physical therapist whose focus is on pelvic floor rehabilitation. She has a doctor of physical therapy degree, and lectures widely on evaluation and treatment for female and male pelvic floor dysfunctions, such as urinary and fecal incontinence.

Urinary incontinence can be broken down into two categories:

  • Stress urinary incontinence
  • Urge urinary incontinence

Gabelsberg says with stress urinary incontinence, the muscles of the pelvic floor aren’t doing their job of keeping the bladder shut. This can cause someone to leak urine due to something as simple as sneezing.
With urge urinary incontinence, the bladder is contracting too often and can cause a sudden, severe feeling of having to go to the bathroom right away. Gabelsberg says urge incontinence can even be a side effect from surgery designed to fix stress incontinence. She also says eating or drinking things that are bladder irritants in excess can be a cause.

But unfortunately for women, the biggest risk factors for developing urinary incontinence are vaginal child birth and menopause.

When a woman gives birth, the vaginal walls are stretched three and a half times their normal length, which can cause long-term damage, according to Gabelsberg. As a comparison, she says to imagine if your hamstring muscle were subject to this. The damage caused would not be easily fixed.

Since vaginal child birth can cause urinary incontinence, it can be seen in women as early as their 20s. These women often have trouble keeping their bladder shut or have pelvic organs, such as the uterus, which dropped lower in the vaginal canal from the stretching, says Gabelsberg.

In post-menopausal women, the reason for urinary incontinence stems from lower estrogen levels.

“Normally, when your estrogen levels are high, the urethra [the tube that excretes urine from your body] stays shut,” Gabelsberg said. “But after menopause, when our estrogen levels start to drop down, that urethra sits more widely open…it’s not able to close quite as well.”

Gabelsberg says about 35 percent of women suffer from urinary incontinence, but thinks this number is highly underestimated, due to women thinking it’s a normal side effect after having children.  

Although Gabelsberg says urinary incontinence isn’t as common in men, it is possible for them to suffer from the problem after a prostate surgery.

So how do you get rid of a urinary incontinence?

Well, there are a few options, such as the medicine you may have seen advertised in commercials; or surgery, but Gabelsberg says the most effective way is through physical therapy.

Gabelsberg says the main goal of physical therapy for urinary incontinence is to strengthen the muscles of the pelvic floor, and lift pelvic organs through exercises.

In order to do this, muscles around the pelvic region also need to be strengthened, such as:

  • Gluteal muscles
  • Inner and outer thighs
  • Deep abdominals

“There are about five muscles that we consider making up the team that help keep the bladder shut,” Gabelsberg said. “Typically a treatment plan runs eight to 12 weeks.”
After a treatment plan is completed, Gabelsberg said improvement in patients is anywhere between 85 and 100 percent.

To find a specialist that will help with urinary incontinence, Gabelsberg says there are resources available on the American Physical Therapy Association website, under the 'Find a PT tab. She also mentions her DVD, which demonstrates exercises and behavioral techniques you can do at home.