Leaking urine (urinary incontinence) is a common issue among women and athletes. However, it should not be considered “normal.” The prevalence of urinary incontinence (UI) in females is between 12% and 53%1 while the prevalence of UI in athletes is between 28% and 80%2. A careful evaluation of these individuals often reveals weakness, lack of coordination, and/or excess tension in the pelvic floor or abdominal muscles and commonly combines with other issues such as low back pain, hip pain, bowel or sexual dysfunction, poor posture, or improper breathing patterns. Fortunately, many people with UI can see significant improvements with noninvasive behavioral techniques used by a skilled physical therapist.
Types of Urinary Incontinence
In general, incontinence refers to the leakage of urine at inappropriate times. There are several types of urinary incontinence:
Occurs when urine leaks on effort or exertion such as during coughing, laughing, sneezing, changing positions, and lifting. It usually results from weakness, poor timing, and lack of support in the muscles of the pelvic floor.
This is the leakage of urine associated with a strong urge to urinate. The underlying cause of urge incontinence is often unclear but may be caused by muscle and nerve dysfunction, urinary tract infections, bladder irritants, bowel problems, or it may be associated with another disease process such as Parkinson’s disease, Alzheimer’s disease, stroke, or multiple sclerosis. Urge incontinence is also sometimes called overactive bladder. It is suspected that poor bladder habits (especially going to the bathroom too frequently) and bladder irritants (such as caffeine, nicotine, and alcohol) contribute to the condition. Pelvic floor muscle weakness with impaired muscle performance is often found in patients with urge incontinence.
This is a combination of stress and urge incontinence symptoms.
Defined as the loss of urine because of gait and locomotion impairment—an inability to get to the toilet quickly enough. It is not unusual for an elderly or disabled person to require 5 to 10 minutes to rise from a chair, walk with a walker to the toilet, maneuver in front of the toilet, lower his or her clothes, and sit down.
5 Questions to Discover If You Have Urinary Incontinence
It is a very distressing situation for an adult to lose bladder function. Knowing what is normal bladder function may help guide you in making the decision to ask for help:
- Do you urinate more than 8 times during an average day?
- Do you wake up to urinate more than once after going to sleep?
- Do you rush to get to the bathroom for fear of losing urine?
- Do you worry about finding a bathroom quickly when you are away from home?
- Do you leak urine when you cough, laugh, sneeze, or lift something?
If you answered “yes” to any of the above questions, it may indicate a bladder condition that can be addressed by a physical therapist trained in this area. We can provide skilled training in exercises for the pelvic floor and the urinary sphincter muscles as well as look at any other contributing factors in posture, breathing, and muscles of the back, abdomen, and hips. Impaired muscle performance (impairment in strength, power, or endurance) is the most commonly treated impairment of the pelvic floor muscles. The muscles’ performance may be impaired by pregnancy, trauma during vaginal delivery, scar tissue from a c-section, nervous system dysfunction, surgical procedures, decreased awareness of pelvic floor muscles, disuse, prolonged increased pressure in the abdomen, and back or pelvic pain. We can determine if you are contracting the right muscles or use biofeedback techniques to help you identify and contract the right muscles. These interventions can be effective for both stress and urge incontinence and benefit those who are pregnant, postpartum, and people who have not had any pregnancies.
If you are embarrassed about having a bladder control problem, you may try to cope on your own by wearing absorbent pads, carrying extra clothes, frequently staying at home, or avoiding exercise. You may even cut back on drinking liquids and risk dehydration to avoid incontinent episodes. However, there are better ways to manage urinary incontinence, and new treatments are continually being developed. It is important to know that there are options for improving your symptoms. You’ll be on your way to regaining an active and confident life—and control of your bladder.
Dr. Alyssa George, PT, DPT, OCS
Alyssa wants to get you back to doing what you love, whether that be sports/recreational activities, your career, or caring for your family. Specializing in treating pelvic and orthopedic conditions, Alyssa develops individualized treatment plans because she understands that no two bodies are alike. She has been involved in research projects to help advance the field of physical therapy. Most recently she has written a case series detailing the benefits of dry needling for chronic pelvic pain and presented on the function of breathing muscles in pelvic pain at the American Physical Therapy Association’s Combined Sections Meeting. She has over nine years of experience as a physical therapist and has started and led pelvic health programs at clinics in Texas, Ohio, and now Minnesota, her home state.
Alyssa earned a Bachelor of Arts degree in biology from Gustavus Adolphus College, a Master of Physical Therapy degree from the University of Wisconsin-Madison, and continued her education at the University of Montana, earning her Doctorate in Physical Therapy. She is a board-certified clinical specialist in orthopedics and earned her certification in pelvic physical therapy from the American Physical Therapy Association Section on Women’s Health. She has been a lecturer and faculty mentor of both orthopedic residency and manual therapy fellowship programs at The Ohio State University and is a credentialed clinical instructor for physical therapy students. Alyssa has been certified in dry needling and utilizes other various manual therapy techniques in her management of abdominopelvic disorders (including incontinence, constipation, lumbopelvic pain, and pregnancy-related musculoskeletal disorders) and orthopedic conditions of the neck, back, shoulder, hip, knee, and foot/ankle.
Goldstick O, Constantini N. Urinary incontinence in physically active women and female athletes. Br J Sports Med. 2014;48(4):296–298.
Bo K, Borgen JS. Prevalence of stress and urge urinary incontinence in elite athletes and controls. Med Sci Sports Exerc. 2001;33(11):1797–1802.