You just discovered that what you did not consider to be incontinence is actually a form of incontinence and are wondering why you have it? To make it simple and yet not dismiss the needed information we need to divide the approach into two sections:

  • The actual lower tract structure of the organ(s) involved in the process of urination (Ureter, bladder, urethra, sphincter, and the pelvic floor muscles around it) and
  • The command of urination coming from the brain to the urinary ‘parts’; we are talking about the nerves involved with the bladder, ureter, sphincter, and pelvic floor muscles.

Structural Component of Urinary Incontinence

The main parts are the bladder, the connection of the bladder to the outside called the ureter, the sphincter at the opening to the outside, and the actual floor of the pelvis where everything is pushed against. Anything that compromises the balance of the floor and the flow of the urine through this path can lead to incontinence.

Urinary tract

Urinary Tract Courtesy of Kidney and  Urology Foundation of America

This means excess weight of the organs pushing on these structures or the pelvic floor which holds everything above; so for instance, an enlarged prostate can lead to urinary incontinence, and so do fibroids in the uterus. If the person is overweight, there is fat surrounding many internal organs so the weight of all structures above the urinary tract imposes excess weight, leading to incontinence as well.

Sometimes 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.

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 pelvic floor dysfunction in forms other than incontinence which almost always precedes the incontinence. I strongly suggest you read my blog on pelvic floor dysfunction.

Neurological Component of Urinary Incontinence

Essentially all the nerves going to the lower urinary tract come from the lower back and sacrum (part of the pelvis). The breakdown is as such:

  • 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 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 not does not only occur when giving birth and can easily be caused by improper exercise or dysfunction in movement over time.

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 physical therapist manually enters the pelvic inlet, the ‘bowl’ of the pelvis, with in attempt to get rid of trigger points and relax the area. While this works for a spastic pelvic floor, it is not a long-term solution to the most common causes of dysfunction of the pelvic floor.

If you have lower back pain, will you see a massage therapist as the solution to your lower back pain? While massage helps alleviate the pain and discomfort, it does not address the cause of the problem. This is not to downplay the role of trigger point therapy of the muscles, 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 pelvis itself and is therefore at the mercy of the surrounding structures that impact the pelvis. This means, lower back, lower mid-back, hips, sacroiliac joints, and lower abdominals. I am not talking about stretching them nor going to the gym to get ‘buns of steel’ or ‘abs of steel’. I am talking about functional movement of these areas- if movement is a concert, I am talking about how well the musicians play their part separately and together.

What is the Solution to Urinary Incontinence?

The solution is to make sure the structures and the nerves going to those structures are optimal and then make sure individual components can ‘play’ together well. That is only assured by:

  • Biological breathing which allows all internal organs to oscillate back and forth with inspiration and expiration
  • Postural neurology to assure all nerves, from the brain to the body part behave as they are designed to at birth
  • Functional movement when all body parts play their parts well and know how to ‘play’ with each other.
  • Emsella Chair treatment which provides 400 Kegels per minute (that’s more than 1 a second) to strengthen the floor of the pelvis

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