Leaking urine is common, especially among post-partum and post-
menopausal women but it should never be considered a normal part of aging. I often reassure patients while urine loss is not normal it’s very treatable. Nobody should be living with urinary incontinence at any stage of life.
If you tell your care provider you are experiencing urine leaks they may ask questions to determine if you are dealing with urge urinary (overactive bladder) or stress incontinence. Let’s look at the differences. Urge urinary incontinence or “overactive bladder” is the loss of urine associated with a sudden intense urge to urinate. Although it may occur spontaneously, it is most often triggered by specific activities such as hearing running water, seeing a bathroom or putting your key in the door upon arriving home. It can also be triggered by position changes, anxiety, or a sudden exposure to cold air. Many women describe a strong "I gotta go, get out of my way!" feeling followed by a moderate to large volume urine loss. Urge incontinence is often accompanied by high urinary frequency (needing to urinate more than 6-7 times a day during the day) and waking more than one time a night to urinate. With urge incontinence patients may have a large loss of urine causing them to have to change clothes. When patients experience urge incontinence it can be emotionally distressing and can lead to unhealthy behavior changes such as restricting water intake or avoiding social activities. Urinary incontinence can lead to negative mental and overall health consequences.
Stress incontinence is loss of urine without an urge to void triggered by
physical activity causing an increase in intra-abdominal pressure. This is the type of urinary loss caused by coughing, sneezing, laughing, jumping, lifting or bending forward. It is often associated with exercise such as lunging after a pickle ball, hitting a golf ball, running, or jumping jacks. Typically, patients will report a small volume loss of urine, enough to wet their underwear and feel uncomfortable but they usually don’t find it as emotionally distressing as urge incontinence. Women who experience stress urinary incontinence after a vaginal delivery or menopause often consider it to be a normal part of motherhood…. or a normal part of aging. They may have heard their mothers and grandmothers complain for years about not being able to sneeze without leaking and because of this “it’s normal to leak” messaging they may not seek treatment for themselves. The truth is it is never normal to leak urine for any reason at any age. Urinary incontinence is common, it is not normal, and it IS treatable.
I often see women with a combination of stress and urge
incontinence, also known as mixed incontinence. A familiar clinical presentation is a patient reporting a years-long history of stress incontinence who has altered her behavior over time to avoid leaks (restricting intake, running to the bathroom often, urinating before leaving the house “just in case”.) These attempts to manage stress incontinence can lead to the development of urge incontinence. While patients may put up with stress incontinence for years, they will often seek medical help when they begin to notice urge incontinence.
If you are leaking urine for any reason the good news is most cases of stress incontinence, urge incontinence and mixed incontinence can be
conservatively managed with pelvic physical therapy and without the use of medications or surgical intervention. Pelvic physical therapy involves taking a full medical history, especially any gynecological and
pelvic/abdominal surgical history, questions to determine the type of
incontinence, a full orthopedic exam (the abdominal and hip muscles heavily influence the function of the pelvic floor muscles!) and if you are comfortable, an internal assessment to measure the strength, coordination, and endurance of your pelvic floor musculature. Treatment includes manual therapy, biofeedback therapy, patient education, exercises to improve your pelvic floor and abdominal muscle function, posture correction exercises and a progressive home program to complete between visits. Typically, patients report resolution of their urine leaks within 6 visits over an 8-10 week period.
Remember, urine leaks are common but not normal and you do not have to live with them! You can get your bladder and your life back! Let me know how can help you.
Robyn Lowry, PT, MSPT, PCES
Certified Pelvic Health Physical Therapist
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