There are 2 main types of incontinence: Fecal Incontinence and Urinary Incontinence. Urinary Incontinence has its own subgroups that will be discussed below. Please make sure to review my other blogs that have to do with incontinence and pelvic floor dysfunction in general.
In the case of fecal incontinence, it is the holding and evacuating of the fecal matter that is the issue of concern. In most cases, it is as a result of trauma or a medical condition (nerve or health condition) that involves the sphincter, the muscles of the pelvic floor related to the anus, a health issue causing chronic diarrhea or constipation, or an actual nerve condition.
It is very important to make sure you are fully evaluated for all aspects of fecal incontinence so while the more likely point of contact for you starts with your primary care physician, and perhaps manual pelvic floor therapy comes next, you need to understand that it is possible to have more than one causative agent.
In my practice, doing Postural Neurology and Functional Movement, I am keenly aware of the nerve contribution to the problem; while almost no one pays enough attention to the importance of your posture in even fecal incontinence. My video below, while about incontinence, shares with you the role of posture and constipation as an example of a health condition that is directly related to posture. Reminding you that for instance, constipation can be one of the causes of fecal incontinence.
There are many different types of urinary incontinence, but the 2 main categories of incontinence are:
- Non-Relaxing Incontinence: As the name implies, this is when the bladder itself is not able to relax leading to incontinence. In non-relaxing incontinence, any devices that encourage kegel exercise should be avoided; however, the internal manual work by a Pelvic Floor Therapist (which does not have to be a physical therapist btw) can be beneficial, but not the only method of treatment. Once the internal manual work is being performed, it is crucial to coordinate breathing with that work. Typically, some therapists use biofeedback treatment along with manual work which is highly beneficial.
The problem I see taking place is the minimal amount of work spent on teaching the breathing technique which should be performed by patients several times a day. In the video below, you will learn the concept better.
- Relaxing Incontinence:
Most incontinence falls under this category and includes:
- Overflow incontinence
- Urge incontinence
- Functional incontinence
- Stress incontinence
- Reflex incontinence
While I have written different blogs about each one, you ought to remember that incontinence is not a woman problem, a pregnancy problem, nor a childbirth issue; it is also not for smokers and overweight individuals only. It is easy to blame many things as the cause but the focus should be on fixing it and more importantly, making sure it does not come back. I have written a blog on the subject of pelvic floor dysfunction that explains this in detail. What I see being the common misconception is that people think a device or surgery, and learning to ‘live with it’ is going to be the solution.
As explained in my blog, while the cause may have to do with the bladder having lost its integrity to empty, the floor of the pelvis may not be as strong as it should be. Unfortunately, this issue is more and more common among younger individuals due to their sedentary lifestyles. Pelvic Floor Dysfunction does not discriminate age or gender and the current treatment is simply a partial approach which makes it more frustrating.
Who to Seek for Treatment?
While most pelvic floor therapists are physical therapists, thankfully we are seeing more and more chiropractors getting involved in pelvic floor dysfunction treatment. Not all chiropractors have a similar practice style so do your due diligence to find the chiropractor who is familiar with postural improvement through concepts of functional movement.
In my practice, the focus of all treatments is postural neurology and functional movement such as neurokinesiology (DNS) but I incorporate them along with the Emsella Chair treatment for the Relaxing type of incontinence patients with Pelvic Floor Dysfunction while skipping the Emsella Chair for the non-relaxing incontinence and pelvic floor dysfunction cases.
Sometimes collaboration with the gynecologist or a urologist is necessary to rule out certain factors impacting the treatment; however, in most cases, patients seek care as a direct referral by their medical doctor. The most important take-home message is that if manual pelvic floor treatment is all the rehab you are receiving, you are not addressing the problem thoroughly.