The most known type of incontinence is stress incontinence which happens with laughing, coughing, during sexual intercourse, exercises, or any type of activity that increases the intra-abdominal pressure leading to leaking. Stress incontinence is one of the many faces of pelvic floor dysfunction which is very much misunderstood.

What Causes Stress Incontinence?

The two main causes of stress incontinence are:

  • Pelvic floor muscle weakness (but what causes that?!)
  • Urinary sphincter weakness

When the bladder fills, the tube that allows urine to go from the bladder to the outside (called the urethra) stays closed and when the bladder is filled, it pushes on the sphincter which makes you feel the urge to pee.

While the pelvic floor is the floor of the ‘house’ that holds the bladder and is often blamed for being weak, we have to understand that the floor does not just randomly get weak. There are ‘incidents’ that lead to this weak floor but why does it get weak? Is it pregnancy that causes the weakness? Then how come there are plenty of women who never got pregnant or gave birth have it? How come men have it? Sounds like there is more to it, right? Let’s dig in!!

What Are Examples Of Stress Incontinence Co-Morbidity?

In the case of both weak pelvic floor and sphincter weakness, we should always rule out the nerves that send the command to them as well as conditions such as MS, Parkinson’s, lower back injuries, sacroiliac joint dysfunction, disc conditions, and lumbar stenosis can impact those nerves.

Weight, age, smoking habits, previous surgeries, and childbirth can increase the chances of stress incontinence but they should not discourage you from taking the necessary steps to treat the condition.

What Is The Treatment For Stress Incontinence?

Stress incontinence is one of the many faces of pelvic floor dysfunction and is a sign of something beyond incontinence! Pelvic floor muscles can get weak due to trauma, but that is not the only way they get weak. They get weak when the ‘house‘, pelvis is unstable and the muscles are either exhausted from the attempt to stabilize it or deconditioned because they are not used.

Most often people disregard a history of chronic lower back pain, chronic sacroiliac joint pain, hip mobility issues, lower extremity pain, and poor posture as being associated with pelvic instability but they all are. This is the core of improper or incomplete treatment and most importantly prevention of pelvic floor dysfunction.

Kegel exercises are great but not the way they are taught!!! With biological breathing, the breathing we all did as infants and young children, breathing out requires the contraction of the muscles inside the pelvis (floor and wall). That is how nature does its job. How well are you breathing? Do you have any idea what biological breathing is?

The internal manual therapy done by a pelvic floor therapist does produce improvement in many cases but from my experience, they don’t last. That is because it is not easy to continue on your own and there is no way for you to know if you are doing it right. You know you have a problem because you leak but no clue if what you are doing to prevent it on your own is working.

Nature practices conditioning of the muscles of the pelvis on the inside by breathing in and out through Biological breathing. In my practice, this perhaps is the most foreign exercise that my patients feel because after all, we all have been breathing since birth!!!

Failed treatments can get frustrating and there are many people (women mostly) who think that is part of being a woman and getting older!! It is true that as we age, all of our muscles get weak but how is it that it does not happen to everyone? How come there are plenty of women who have had children and given birth but don’t experience stress incontinence?

What Is The Best Treatment For Stress Incontinence?

The best treatment for stress incontinence in the absence of pathology must include the following in my opinion:

  • Thorough Evaluation Of The Movement Patterns And Posture

The pelvic floor is like a trampoline and is the floor of a house we call the pelvis. It gets weak when the house is unstable. This instability can be from the joints within the pelvis and/or what is attached to the pelvis: the spine and the lower extremities.

All of these areas need to be evaluated not for strength but for coordination in movement. This is the part of pelvic floor treatment that IMO is grossly missing.

  • Biological Breathing Assessment And Exercises

Everyone living is breathing but not every breathing is biological. Biological breathing involves both the abdominal diaphragm and the pelvic diaphragm (that is right, you have 3 diaphragms!). 

I have never seen patients who came in knowing how to breathe correctly while this is the foundation of all movements and movement-related issues.

  • Functional Movement Exercises

Since all babies, regardless of the many differences human beings have, go through the same developmental stages, it is fair to assume that we are all born with a pre-designed map and patterns for movement.

When something that has to do with movement in an adult becomes dysfunctional, it only makes sense to go back and use the developmental movement knowledge to fix the issue. This is the essence of Developmental Kinesiology and the missing treatment factor in the treatment of almost all pelvic floor dysfunction cases.

  • Emsella Chair Treatment

The solution to the mediocre-at-best, hope-to-remember-to-do Kegels is the Emsella chair that is FDA-approved for incontinence. The machine provides 400 Kegel’s per minute, exercising all the pelvic floor muscles inside the pelvic inlet. 

While unfortunately, it is looked at as the ‘cure’ for incontinence, you ought to know that the floor is only responding to the overall movement patterns and not a stand-alone issue. Evidence shows that working on the ‘floor’ and expecting the ‘house’ or pelvis to stabilize is invalid.

I use the Emsella chair ONLY when the preliminary work is doneWhen the patient understands and can do Biological breathing. I use my protocol to ensure that the 10 sessions of this chair will produce the maximum result.

Pelvic floor dysfunction, stress incontinence or not, is not a quick fix but a great reason to get on task with turning dysfunctional movement into a functional movement which produces fewer symptoms and a better future for not only your leaking but pelvic stability, better posture and less chances of degenerative joint disease.

If you need to be evaluated for effective treatment, contact me. 

Dr. Shakib

Recommended Reading:

Male Pelvic Floor Dysfunction

Constipation And Pelvic Floor Dysfunction