Most people think of incontinence as the inability to hold urine or ‘peeing’ a little (or a lot) when laughing, exercising, or coughing. Overflow incontinence is when you think you are done peeing but then there is a little more urine coming out. Yes, it is considered a form of incontinence and is treatable in most cases.

What Causes Overflow Incontinence?

In order to better understand what happens with overflow incontinence, we need to understand that there are a few reasons why one may experience it. For instance, if there is an actual anatomical variation where the tube connecting the bladder to the outside has a small ‘loop’ or ‘twist’, can act as a small reservoir so when the bladder empties, part of the urine stays there.

There may be a mass, bladder stone, or another part of the body that sits on the tube that connects the bladder to the outside which will then make the flow compromised leading to the Overflow Incontinence. The presence of scar tissue can also lead to overflow incontinence by impacting the urethra (the tube that goes from the bladder to the outside). This scar tissue can be due to infection, endometriosis, or surgical procedures for instance.

Weak bladder muscles can make it difficult for the bladder to fully empty, giving the illusion that there is no more urine left. Diseases such as diabetes, alcoholism, Parkinsons’, multiple sclerosis, back problems, or back surgeries, all of which impact the nerves supporting the bladder, can also cause Overflow Incontinence. Finally, some medications such as antidepressants and anticonvulsants that impact the nerves can be the culprit.

What is the Treatment for Overflow Incontinence?

Depending on the cause of incontinence, the treatment options will vary from non-invasive to invasive surgeries. For the sake of this blog, we will focus on the non-invasive treatment for overflow incontinence having to do with weak pelvic floor muscles and poor posture as well as the muscle-skeletal conditions contributing to it.

The treatment of choice at our clinic for patients with pelvic floor dysfunction and overflow incontinence always starts with the assessment of the surrounding areas and listening to the patients’ condition.

With functional assessment and postural evaluation, we are able to find out the underlying postural and movement dysfunction that is leading to issues in the hips, lower back, sacroiliac joints, and lower mid-back. You may wonder how they play a role in incontinence so let’s explore!

Overflow Incontinence, Back and Posture

While most people look at the core as the abdominal area and the back part, your functioning core starts from the top of the neck all the way to the tailbone and pelvis. Yes, that area is your stabilizing zone where everything in this cube is designed to stabilize you while your arms and legs do their part. The issue rises when we use our arms and legs to stabilize ourselves or use our body to do the job of the arms and legs.

An example, is when you throw a ball, it should be your arm throwing but how many times do you see people twisting their body, and involving their shoulder blades with the throw? In a Ballerina dancer, the chest is encouraged to be sticking out while the shoulder blades are pushed back; that means the arms swing behind where they need to be, leading to dysfunctional shoulder joints. This is the beginning of the problem and that’s just 2 examples. Functional movement is the term and something worth looking into before proceeding as it is perhaps the most ignored component in the treatment of overflow incontinence.

playing volleyball

The second most ignored factor in the treatment of overflow incontinence is biological breathing. There are talks about breathing but the actual proper breathing is hardly ever gone over. Biological breathing is what babies automatically do when they are born; that’s because we are designed to breathe that way however, unfortunately, we lose that along the way due to our lifestyle, injuries, habits, and activities we choose to do that are simply against the design of the body.

A great example is sitting and staring at the computer or cellphone; that posture by itself contributes to most of our postural decline because we are sitting slouched, pushing on the main apparatus of proper breathing (the space between the abdominal and the pelvic diaphragm), and de-activating the part of the brain (PMRF) that send the demand to stay upright. No wonder the poor pelvic floor is so weak and abused.

With the postural decline comes the pelvic diaphragm dysfunction which is at the base of the pelvis and right above the pelvic floor. This is the essence of all pelvic floor dysfunction including overflow incontinence caused by postural decline and weak pelvic floor.

These are the core of treatment that are not commonly performed by pelvic floor therapists! Is it the lack of understanding, lack of time, or shortage of therapists? Not sure what the excuse is, but seeking manual therapy of the pelvic floor and calling that the treatment is similar to having a disc herniation and expecting massage to help. Some therapists incorporate some degree of breathing techniques and stretching to their care but that is like adding massage and stretching to treat a patient with a disc herniation.

No amount of massage and stretching works if the movement itself has become dysfunctional. Once again, you may want to pause to educate yourself about the concept of functional movement.

In the absence of non-relaxing incontinence, the next go-to step along with the functional movement exercises is the Kegel chair, Emsella which provides 400 Kegel’s per minute and is an FDA-approved machine for incontinence. Let’s be real, who does Kegel’s everyday and at least 20 of them twice a day, every day? … Exactly!

If you have overflow incontinence, you have pelvic floor dysfunction and the incontinence is just a small part of the ‘story’. In order to address the issue thoroughly, you have the option to do the mediocre treatment and hope for the best or go with the most thorough approach, learn how to keep what you have created for the rest of your life so you get to enjoy the things that your incontinence prevents you from.

If you have questions or need help getting rid of your dysfunction, contact me.

Dr. Shakib