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What is Stress Urinary Incontinence?

Ultimate Guide to Stress Urinary Incontinence. What is Stress Incontinence? Why is Stress Incontinence sometimes called “exercised induced incontinence?” What makes stress incontinence worse? How do you treat stress incontinence?

What is Stress Urinary Incontinence (sometimes simply “Stress Incontinence”)?

Stress Urinary Incontinence is whenever anybody has a urine leak with movement. If you jump on the trampoline, if you cough, if you sneeze, if you laugh and you have bladder leaks, even itty bitty leaks of urine, you are suffering from the totally treatable condition known as stress urinary incontinence. Stress urinary incontinence, or stress incontinence, occurs when there is sudden pressure on the bladder and urethra. This pressure causes the muscles of the sphincter to relax, which allows urine to flow. These bladder leaks, or incontinence, when there is stress on these structures is what gives stress incontinence its name. Stress urinary incontinence (or stress incontinence) is one of a multitude of pelvic floor dysfunctions. This just means that your pelvic floor muscles could be healthier than they are and your stress incontinence is merely a symptom. Stress incontinence (as well as urge urinary incontinence) is often considered an early pelvic floor dysfunction, but if not treated stress incontinence could be the first in a line of pelvic floor muscle dysfunctions that include pelvic pain or pelvic organ prolapse.

Sometimes called "Exercise Induced Incontinence" because it affects runners, dancers, athletes of all kinds, stress incontinence is common but not normal. Most people just think it just happens as we get older or occurs for all women after they’ve had babies, but this is simply not true. While common in older adults and following pregnancy, stress urinary incontinence does not occur in all older women or all women after pregnancy. You shouldn't leak any urine, you should never have to say to yourself “Oops I peed my pants” after you cough, sneeze, laugh, or jump. 

What Causes Stress Urinary Incontinence?

If stress urinary incontinence is common, but not a guarantee you might be asking “what causes stress urinary incontinence?” You might thinking that jumping, sneezing, coughing, or laughing  are the cause of stress incontinence. The reality is these are just the symptoms; the causes are much little deeper.  

Stress Urinary Incontinence is caused by weakness in your pelvic floor. We have muscles that sit underneath our abdomen, these are the foundation of our core and they are known as our pelvic floor muscles. These muscles sit under the bladder and if you are sitting right now, you are sitting on them. We also have a muscle that is over our bladder, called the detrusor. Basically, whenever the pelvic floor muscles, sitting beneath the bladder, are too weak to close off the urethra it can cause any sort of leaking when we cough, sneeze, laugh, or jump. This weakness of the pelvic floor muscles is what causes stress urinary incontinence.

Healthy muscles are strong and flexible, unhealthy muscles are tight and weak. Sometimes the leakage is due to muscle weakness that is presenting as poor muscle coordination. So, every time we cough, sneeze, and laugh we actually should reflexively do a little Kegel; if that doesn't happen, that can cause leaking. Another presentation of weak muscles is over tightening of the pelvic floor muscles. If your muscles are too tight, then they're not allowed to do that small contraction when you cough or sneeze. When your pelvic floor muscles are already held up and tight, instead of doing they’re reflexive squeeze, the pelvic floor muscles are going to do their reflexive relaxation (or let go). 

You might be asking “Is incontinence stress related?”

It is, but not in the way that we commonly think about stress. Social and psychological stressors may have a role in your stress incontinence, but the physical stress and strain that is placed on your bladder and urethra is the real reason for your stress incontinence. This is why stress incontinence is sometimes referred to as “exercise induced incontinence” or “exercise incontinence.” When you exercise, particularly when you engage in high impact exercise, like running or jumping, there is added force applied to your body. Because your pelvic floor muscles are the primary muscles in your body responsible for maintaining bowel and bladder control, when you engage in high impact activity you increase the stress and strain on these muscles, which can stretch them out. These muscles act like a hammock for your internal abdominal organs, if you sit on a hammock it goes down and stretches, if you put pressure on your pelvic floor muscles they will go down and stretch. Too much stretching of your pelvic floor muscles, like too much stretching of a hammock, will prevent these muscles from returning to their original shape. However, unlike a hammock, your pelvic floor muscles can be restored through proper stretching and strengthening exercises.

Besides exercise, coughing, sneezing, and laughing are common actions that increase the pressure on the pelvic floor muscles leading to bladder leaks. Other activities, like bending over to pick up a child or sexual intercourse are events that are linked to episodes of stress incontinence.

In summary, Stress Urinary Incontinence is caused by pelvic floor muscle weakness but there are two main types of muscle weakness. Your muscles might be too loose or they could be too tight, but remember unhealthy muscles are weak and tight.

What makes Stress Urinary Incontinence Worse?

There are a lot of things that can make stress urinary incontinence better, but you might be doing some things that unknowingly are making your stress urinary incontinence worse. Here is my list of the top THREE things that make stress urinary incontinence worse:

  1. Smoking. Smokers have really bad pelvic floors. Their coordination of their pelvic floor has been impacted by the repetitive inhalation while smoking. Smoking generally makes pelvic for conditions worse stress urinary incontinence included.
  2. Running. Runners, unfortunately, oftentimes have really weak pelvic floors and can have really bad stress urinary incontinence.
  3. Pregnancy. Any time you have a baby, especially following a vaginal delivery but sometimes even with a C-section, there becomes a weakening of your pelvic floor and the rest of your core muscles. So, it is common for people to think that it's normal to have urine leaking when they cough, sneeze, laugh, or jump after having a baby. While it is common, leaking still shouldn't happen, but unfortunately it does.

These are the most common triggers for stress urinary incontinence, but there are some other less common ones as well. If you have questions talk to your ObGYN or your Pelvic Floor Physical Therapist.

How to Treat Stress Urinary Incontinence?

If it is common, but not guaranteed, there has to be something you can do about stress Urinary incontinence. The reality is that there are a variety of things people use to deal with Stress Urinary Incontinence. You can take medications with a laundry list of side effects, or use a pad, but these are just masking the underlying pelvic floor weakness. When it comes to a cure, Pelvic Floor Physical Therapy is your best option. A pelvic floor physical therapist can treat your stress urinary incontinence without medication or surgery. Many people, maybe even most people, do not realize that you can actually stop your bladder leaks, especially your stress urinary incontinence. 

Stress urinary incontinence is usually a pretty simple fix with pelvic floor physical therapy, but it does require a little effort from you to get the most out of your sessions. In Physical Therapy, you will learn how to do a proper pelvic floor muscle contraction or “Kegel.” We also teach you how to properly coordinate pelvic floor muscle contractions and relaxation with breathing. We want to make sure that you're doing a proper Kegel when you cough, sneeze, or laugh and that you have good tone in your pelvic floor muscles. A healthy tone will allow you to jump without leaking. You might notice a trampoline in the corner of FYZICAL Oklahoma City, it isn’t there to make you cringe, it’s there to help you jump for joy once you are free from leaks. We also want to strengthen the surrounding and supporting abdominal and hip muscles; making sure that your whole core so your abs, your back, and your pelvic floor are all nice and strong, so that you have no leaks when you cough, sneeze, laugh, or jump. We want to help you Love Your Life.

How Does Stress Urinary Incontinence Impact Quality of Life?

Why pelvic floor physical therapy and why now? Stress Urinary Incontinence can severely impact your quality of life, but everyone’s symptoms vary. Stress Urinary Incontinence can range from rampant urine leaks requiring you to wear several pads throughout the day, which is a huge cost for people, to where the symptoms are just a little inconvenience whenever you cough, sneeze, or laugh. And it can just be sometimes or every once in a while when you cough, sneeze, or laugh or it can occur frequently throughout the day with even minor movements. I know that when I was exercising after I had my first son that I really didn't like. It was really uncomfortable and made me self-conscious, and I did not like leaking when I was jumping. So, it prevented me from exercising, which is never good. You need to be active; it's important for your cardiovascular activity, that you do the exercises that you like to do. Do not let stress urinary incontinence or any sort of leaking keep you from exercising or enjoying the things you love to do. Don’t let it be an extra cost for pads or medication. It is highly possible you can stop leaking with some simple exercises alone and it will be much more cost effective now and in the future.

The other cost of stress incontinence is the management of it. The average cost for symptom management is more than double the cost of pelvic floor physical therapy. You could be pee free and loving life.

Who is Affected by Stress Incontinence?

Stress incontinence affects nearly one in three women, and that number jumps to one in two women after the age of 65. Because pelvic floor dysfunction of all types has been a taboo topic, or at least relegated to “all women deal with that,” or “that’s just part of being a woman,” these numbers may actually be lower than what is really occurring. Women are affected throughout the lifespan, but there are 3 times when stress incontinence is more readily apparent.

  • During Pregnancy. While pregnant, there is the added weight of your baby, of your uterus, of your amniotic fluid, and it is all contributing to pressure on your bladder and your pelvic floor muscles. This increased weight leads to greater stress and strain on these structures, and for some women this means bladder leaks are occurring. Stress incontinence is still more likely to occur during episodes of laughing, coughing, or sneezing, but the added weight increases your chances of having a less than optimal pelvic floor.
  • After Delivery. Once you have had your baby vaginally, the risk of pelvic floor dysfunction, and stress incontinence in particular, increases. The muscles of your pelvic floor have been stretched to their max and possibly beyond (ripping and tearing of the perineum cannot always be avoided, but it is important to realize as a possibility). Once these muscles are stretched, your pelvic floor muscles must be properly exercised to return to their optimal functioning.
  • After Menopause. Once menopause strikes, the muscles and tissues around the vagina are likely to atrophy. You will lose pelvic floor muscle mass, which will make it harder to support your bladder and urethra, and will make it harder to prevent bladder leaks. Hormonal changes at this time are very real, but treatment is not unlike in the other two time frames, it may just take a little longer to build up the proper muscle strength.

What about Stress Incontinence in Men?

While more women are affected by stress incontinence than men, pelvic floor dysfunction in men still occurs. Male stress incontinence most commonly occurs following prostate surgery like a radical prostatectomy. It can also happen in the later decades of life with weakened muscles, but this generally follows an episode of prolonged bed rest (e.g., following a stroke). Urine leaks in men are less common because the prostate sits against the urethra, which helps slow the flow. Men have the added benefit of a longer urethra, which means there is more friction for the urine to flow.   

Whether you are a woman, a man, pregnant, or an older adult, the treatment for stress incontinence is relatively straightforward. Stop waiting, get treatment started today and Love Your Life!

-FYZICAL Therapy & Balance Centers of Oklahoma City

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FYZICAL Therapy & Balance Centers of Oklahoma City provide world class orthopedic rehabilitation to our patients. Our physical therapists specialize in orthopedic rehabilitation, balance and falls prevention, and Pelvic Health. Our practitioners take a patient-centered individualized approach that focuses on your pelvic health needs. If you are unsure about your pelvic health, or you want to see the FYZICAL Difference for yourself, schedule a free consultation today.