April showers bring welcomed bunches of smiling flowers in the spring.  But another type of “shower” may not have women smiling, and that is the “shower” that comes from urinary incontinence.  According to the National Institute of Diabetes and Digestive and Kidney Diseases, more than 13 million men and women in the United States have urinary incontinence.

Urinary incontinence is any undesired leakage of urine. According to the American Physical Therapy Association (APTA), “People with urinary incontinence may have trouble starting the urine stream or holding urine.”  Urinary incontinence involves the muscles of the pelvic floor. These muscles attach to the bottom of the pelvic bones and run front to back, forming a hammock structure that lifts to support the internal organs and controls the sphincter muscles. The pelvic-floor muscles also help support the low back, stabilize the pelvic bones, and help with sexual function. Women may be more likely than men to have urinary incontinence; however, the condition in men may be underreported.

There are different types of urinary incontinence, including:

• Stress incontinence.This occurs when there is increased intra-abdominal pressure and when weak pelvic-floor muscles that surround the urethra do not have the control to maintain continence. Those with stress incontinence leak urine during a physical activity, such as playing a sport, or simply laughing or sneezing. Common causes are pregnancy and childbirth, episiotomy, injury or trauma such as a pelvic fracture, inflammation, surgery, and lack of exercise.
• Urge incontinence. People with urge incontinence can experience a sudden, strong need to pass urine, and leak before reaching the bathroom. Pelvic-floor muscle weakness or tightness may cause the urethra to stay open when it should be closed; anxiety may also contribute to this type of incontinence, along with associating a certain time of day or activity with urination, even if the bladder is not full. Foods, such as caffeine and sugar, acidic foods, and smoking can irritate the pelvic floor, causing inflammation and that can make the bladder lining contract more, contributing to urge incontinence.
• Mixed incontinence. Some people experience both stress and urge incontinence.
• Functional incontinence. Even without an intense urge to urinate, people with functional incontinence may leak urine on the way to the bathroom, typically due to other conditions such as low back pain, or hip pain, confusion, dementia, delirium, depression, slow gait, or due to obstacles that block entrance to the bathroom.
• Urinary frequency. Some people feel the need to empty the bladder frequently throughout the day and more than once during the night. Sensitivities to certain foods or beverages may cause this.

Urinary incontinence can be diagnosed by a primary care provider, specialist, or physical therapist. The examination for this condition should include asking the patient to describe their symptoms and daily experiences. They may assess the muscles of the pelvis, hip, and low back, as well as the coordination, strength, and flexibility of the muscles of the pelvic floor. Additional tests may also be required, such as urodynamic testing, diagnostic ultrasound, or magnetic resonance imaging (MRI) to show any pelvic-floor muscle problems, to ensure an accurate diagnosis.

Based on the evaluation results, a health care provider will create an individualized treatment program that could include improving the pelvic-floor muscle function to help gain control over symptoms and reduce the need for pads and special undergarments, incontinence medications, and possibly surgery.

Treatments to improve pelvic-floor muscle control may include:

• Kegel exercises.The Kegel exercise is performed by squeezing the sphincter muscles or imagining that you are trying to stop the flow of urine.
• Depending on the symptoms and level of comfort, a physical therapist may gently employ electrodes to measure pelvic-floor muscle activity. The biofeedback obtained can help make the patient more aware of the correct way to use the pelvic-floor muscles.
• Muscle strengthening exercises.A physical therapist can teach specific exercises to stretch and strengthen other important muscles that help support proper bladder function, such as deep abdominal muscles like the transverse abdominis. These typically need to be performed daily and correctly to be effective.A physical therapist can teach these exercises and there are plenty of YouTube videos that can reinforce proper technique.
• Electrical stimulation.A physical therapist may apply gentle electrical stimulation to help improve awareness of muscle function.

Other Tips to Help Urinary Incontinence:

• Avoid food and drinks that may irritate the bladder (like caffeine)
• Learn the correct technique for muscle strengthening or stretching (see a physical therapist)
• Maintain a healthy bathroom schedule
• Maintain bowel regularity
• Drink healthy fluids regularly to maintain hydration
• Maintain a regular exercise regimen or active lifestyle

If urinary incontinence prevents you or someone you know from participating in “life,” please see a health care provider to learn more about returning to a “clear skies” weather forecast for this spring!

Resources: apta.org; moveforwardpt.com