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Urinary incontinence comes in different forms from not being able to tell if you have to urinate to feeling to urinate all the time. In this blog, we are going to explore the different causes of urinary incontinence to outline what the treatment for urinary incontinence should be.Overview Of Urination

  • Your urination process consists of the actual structures involved in urination and the nerves that make these structures perform their job. They are therefore:
    • The ureter, bladder, urethra, sphincter residing in the abdominal cavity and pelvis
    • The nerves come from the lower back and pelvis area.
  • Structural Component Of Urination

The bladder, the connection of the bladder to the outside called the ureter, and the sphincter at the opening to the outside, all reside within the pelvis, the house that the pelvic floor is the floor of. When it comes to pelvic floor dysfunction, it seems that most attention is given to the floor of the pelvis when the floor is simply not a stand-alone part.

Urinary tract

Urinary Tract Courtesy of Kidney and  Urology Foundation of America

When it comes to incontinence, sometimes the bladder function is compromised, sometimes other organs within the pelvis put pressure over the bladder (fibroid and enlarged prostate are examples here), then there is the actual tilting of the pelvis toward the front or back that causes the compression of the bladder, sometimes infection causes the incontinence, and sometimes the nerves in charge of its function are altered.

There are instances where the anatomy of the bladder, ureter, or urethra is such that urine does not completely empty; for instance, the connection of the ureter to the bladder is not a straight path but sags down some. This becomes a reservoir for some leftover urine and grounds for infection over time. Chronic infection of the urinary tract can cause the inner lining of the bladder to be damaged, leading to interstitial cystitis, and urinary incontinence.

  • Lifestyle Role

Habits such as smoking, exercise without paying attention to the form, and poor diet lead to loss of integrity of the soft tissue including the pelvic floor muscles, thus urinary incontinence.

The most undermined cause of urinary incontinence is the postural contribution which is explained in my blog pelvic floor dysfunction.

  • Neurological Component Of Urinary Incontinence

    Pelvis bones

    Pelvis bones (courtesy of https://orthoinfo.aaos.org/)

Essentially all the nerves going to the lower urinary tract come from the lower back and sacrum (part of the pelvis).

  • The Bladder is controlled by the pelvic parasympathetic nerves coming from the sacrum to squeeze while the lower back sympathetic nerves relax it.
  • The Urethra is stimulated by the lower back sympathetic nerve and relaxes by the pelvic parasympathetic nerves (opposite of the bladder).
  • The Sphincter is controlled by the Pudendal nerve which comes from the sacrum
  • Pelvic floor muscles are controlled by the nerves coming from the sacrum
Nerve innervation of Urinary Tract

Nerve Innervation (courtesy of Medbullets)

Once again, anything interfering with the function of the lower urinary system can lead to urinary incontinence. This can be a disc disease such as disc protrusion or herniation, pelvic trauma impacting the sacral nerves, cyst, or any mass pushing against the exit of the associated nerves from the spine and sacrum. Trauma to the pelvic area does not only occur when giving birth but can easily be caused by improper exercise or dysfunction in movement over time. In my practice, I see the majority of cases as a result of dysfunctional patterns of movement.

The Most Missed Cause Of Incontinence

Unfortunately, urinary incontinence is almost always looked at as a weakness of the pelvic floor and the solution seems to be pelvic floor manual physical therapy where the trained therapist manually enters the pelvic inlet, the ‘bowl’ of the pelvis, with the attempt to get rid of trigger points and relax the area or strengthen those muscles. While this works in many instances, the result seems to not be long-term.

If you have lower back pain, will you see a massage therapist for the actual treatment of the pain? While massage may help relieve the pain and discomfort to some degree, it does not address the cause of the problem so the problem returns. This is not to downplay the role of trigger point therapy of the muscles, of the pelvic floor, or elsewhere. It is important to understand that unless the whole picture is addressed, the problem will return.

The pelvic floor is NOT suspended in air; it is attached to the walls of the pelvis covered with muscles. It is, therefore, at the mercy of the structures that are attached to the pelvis as well. We are talking lower back, lower mid-back, hips, sacroiliac joints, and lower abdominals. I am not talking about stretching them or going to the gym to get ‘buns of steel’ or ‘abs of steel’. I am talking about the functional movement of these areas. Let’s look at movement as a concert, where the musicians are the body parts. How well the ‘musicians’ play determines how well the concert sounds. Not every movement therefore is a functional movement and it is the presence of dysfunctional movements that lead to pelvic floor dysfunction with incontinence being one of its many presentations.

What Is The Solution To Urinary Incontinence?

The comprehensive solution has to involve the assessment of all parts involved. That means we have to make sure the structures and the nerves going to those structures are optimal and then make sure individual components can ‘play’ together well which means the actual stability of the pelvis in movement is intact. That is only assured by:

  • Biological breathing which allows all internal organs to oscillate back and forth with inspiration and expiration
  • Postural neurology assures all nerves, from the brain to the body part behave as they are designed to at birth
  • Functional movement is when all body parts play their parts well and know how to ‘play’ with each other. I use methods such as Dynamic Neuromuscular Stabilization or DNS to ensure this important part.
  • Emsella Chair and this is only AFTER some degree of stability through the functional movement exercises. If the person can stay stable and be under proper supervision, then the work of this chair with 400 Kegels a minute makes a big difference, allowing the muscles INSIDE the pelvis to work in sync with the muscles outside the pelvis. We have a specific protocol that has proven to be highly effective under those circumstances.

To understand what pelvic floor dysfunction is, its associated symptoms, what the best and worst exercises for it are, and much much more, visit my blog page and contact me with any questions you may have.

Dr. Shakib

Recommended Reading:

Are Yoga Exercises Good For Pelvic Floor Dysfunction?

Male Pelvic Floor Dysfunction