Functional incontinence, also known as functional urinary incontinence, is the type of incontinence that has to do with the person’s lack of functionality and ability to make it to the bathroom in time! You should always remember that incontinence is one of the many faces of pelvic floor dysfunction and when patients and providers are only looking at incontinence, they miss all the other aspects of effective treatment. This leads to frustration and hopelessness that most patients with incontinence experience.
To treat functional incontinence, we first need to find out what is interfering with the person making it to the bathroom in time. Are there physical conditions that prevent the person from getting there? Is it because there is lower back pain, knee pain, or other musculoskeletal conditions that are present? Is the person having a hard time taking their pants off to sit on the toilet? Is the path to the bathroom cluttered so much that maneuvering around is difficult?
Does the person have neurological conditions such as MS, Parkinson’s, or Dementia which then leads to incontinence? At times, side effects of certain medications may lead to grogginess which then interferes with the person getting to the restroom or transferring themselves to the toilet seat in a timely manner.
The bottom line is the source needs to be addressed first and since in cases of musculoskeletal conditions there is a physical condition that is the cause, in this blog we will be discussing the options available. These options are still applicable to patients with multiple sclerosis, for example, given that there are different levels of neurological decline and therefore the patient’s ability to perform these exercises vary.
What is Pelvic Floor Dysfunction?
My blog on pelvic floor dysfunction gets in the nitty-gritty of it but to summarize, pelvic floor dysfunction involves the pelvic floor muscles, lower back pain and/or dysfunction, sacroiliac pain and/or dysfunction, lower abdominal dysfunction, and hip pain and/or dysfunction. Notice that pain is not necessarily present and once you have a chronic dysfunction in one of the areas named above, you do have the dysfunction of the pelvic floor with or without incontinence!
Functional Incontinence Treatment
Treatment varies from one cause of dysfunctional movement to another. In my practice, all incontinence cases are evaluated for the extent of pelvic floor dysfunction as explained above.
Treatment starts:
- Step one is the evaluation of the patient including Postural Neurology and Functional Movement. This allows evaluation of the whole path of movement, from the brain and the resources that allow the brain to get information to balance and coordinate movement to the body parts that ultimately have to perform the command coming from the brain. This type of exam is fully missed when it comes to incontinence of any kind.
Then there is medication evaluation:
We need to see if there are side effects that are contributing to functional incontinence. Collaborating with the prescribing physician is needed in this case to consider other options or full elimination of medication if indicated.
Then we can get to the Kegel exercise:
I am a big fan of Kegels but Kegel’s is not for all types of incontinence. For instance, it should be avoided in non-relaxing incontinence cases. With that said all pelvic floor dysfunction cases with or without incontinence benefit from Kegel exercise. Typically, when we do Kegel’s ourselves, we work on the perineum at best, which is not the only part of pelvic floor muscles. Use the diagram below to see the areas involved in pelvic floor dysfunction and how the whole inside lining of the pelvic inlet gets missed with doing Kegel’s yourself.
The solution is offered by Emsella chair which is FDA approved for incontinence and provides 400 Kegels a minute involving what self Kegels don’t do. At our clinic, we have invested in this device for all pelvic floor dysfunction cases with or without incontinence. Devices such as EMS do not and cannot provide treatment to all the muscles of the pelvic floor lining and pelvic inlet and is not something I consider to be effective.
Emsella Chair
Manual Pelvic Floor Therapy:
Just as tension in any musculoskeletal muscle, massage, and manual work can be helpful, however manual pelvic floor therapy can be beneficial. The problem is that unfortunately, it is looked at as the primary method of treatment when it is not. This is as if massage is considered the main treatment for complications from disc herniation!
Biological Breathing:
Another unappreciated part of treatment is the impact of breathing on not only the abdominal diaphragm but also the pelvic diaphragm. Some therapists incorporate breathing with their manual therapy but not the right type of breathing!! The right type of breathing is what we do as babies without anyone teaching us how to breathe. What we innately do as babies is a reflection of how we are designed to move and is important in the functionality of our bodies. Here is what Biological breathing is all about:
If you experience functional incontinence, do know that you have more choices than you realize, and don’t be disappointed if previous treatments have not been effective; after all, partial treatments only provide partial solutions.
Contact me with your questions or if you wish to be evaluated for pelvic floor dysfunction.
Dr. Shakib