The most known type of incontinence is stress incontinence occurring when laughing, coughing, during sexual intercourse, exercises, or any type of activity increases the inter abdominal pressure leading to urine coming out involuntarily. It is not the mental stress that we are used to associating stress to. Stress incontinence is one of the many faces of pelvic floor dysfunction as it cannot exist by itself. Read on to see why that is!
Causes of Stress Incontinence
The two main causes of stress incontinence are:
- Pelvic floor muscle weakness
- Urinary sphincter weakness
To understand the problem, let’s learn a bit about the anatomy and the physiology of the area: 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 go to the bathroom.
When the pelvic floor muscles are weak, it does not have the integrity to hold the contents inside the pelvis (this includes the bladder, uterus, ovaries, prostate, large intestine) so it is easy for the urine to come out involuntarily. Think of a trampoline vs a solid floor and the difference in the integrity of what they are holding.
Stress Incontinence Co-morbidity
In the case of both weak pelvic floor and sphincter weakness, we should always rule out the nerves that actually 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.
Bodyweight, 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 in treating the condition.
Treatment for Stress Incontinence
Stress incontinence is one of the many faces of pelvic floor dysfunction and cannot exist by itself! Addressing just this aspect of pelvic floor dysfunction without the other components only leads to some improvement but it will not be resolved long term. You see, if the floor of the pelvis is weak, the nerves allowing the sphincter and the floor to function properly are compromised, the cause of the problem is still there.
Pelvic floor muscles can get weak due to trauma, let’s say traumatic childbirth or pregnancy. They will continue getting weaker and weaker despite childbirth for instance just as a stretched shirt will continue being stretched regardless of it is being worn or hanging on the hanger.
There are devices and tools people use to strengthen the pelvic floor muscles but frankly, if the cause of weakness is related to let’s say a disc condition or stenosis, those conditions need to be addressed or the source of the problem still exists.
Kegel exercises are great but let’s be real, do you do kegels every day? Do you do 2 sets of 20 or 30 each and every day? How strong are they? Do the Kegel’s you do actually address the deep muscles of the pelvic floor that line the inside of your pelvis or just the entry to the pelvic inlet? There are physical limitations to effective Kegel’s that are not considered.
The manual therapy done by a pelvic floor therapist helps with conditioning the muscles of the pelvic floor but that is similar to you having a bad disc in your lower back and getting massaged.
It can get really frustrating and there are many people (women mostly) who think that is part of being a mom 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?
Best Treatment for Stress Incontinence
The best treatment for stress incontinence includes:
Through evaluation of the movement patterns and posture
The pelvic floor is the bottom of an imaginary bag with the contents inside your body being the contents inside the bag. When the items are pushing on the floor and the floor is sagging, reinforcing the bottom will help but won’t last. We need to see what condition the sides that the floor is attached to are in. In our body, the sides are the abdominals, the side of the torso, the lower back, the abdominal and pelvic diaphragm, and the hips. All of these areas need to be assessed in all cases of incontinence including stress incontinence.
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 actually have 3 diaphragms!) This video tells you more about it.
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 see how babies move and what the logic behind those movement patterns are. We then need to follow the same principles in order to fix the problems. 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 of the ‘bag’ in the example above is not free-floating; it is attached to the ‘body’ of the bag therefore with stress incontinence which only happens over time, that means the sides of the bag are compromised as well. Evidence shows that working on the ‘floor of the bag’ and expecting the whole bag to improve long term is not valid. That is why Developmental Kinesiology exercises and Biological breathing along with Emsella and potentially a few sessions of manual pelvic floor therapy will be the most effective treatment for stress incontinence, a variation of pelvic floor dysfunction.
If you need to be evaluated for effective treatment, contact the office and make an appointment.
Dr. Shakib
