Physical Therapy for Incontinence

By Lizanne Pastore PT, MA, COMT

Physical therapy plays an important role in the treatment of urinary incontinence in women and men.  Different types of incontinence require different treatment strategies, and a physical therapist (PT) specializing in the treatment of the pelvic floor can offer a wealth of education, skillful manual therapy, and expert muscle reeducation to people suffering from all kinds of incontinence. The bladder and the pelvic floor muscles (PFM) have an important relationship with each other, and a PT, being an expert in muscles, can affect excellent changes in bladder health through working with the pelvic muscles and their synergists as well as teaching simple behavior modifications. In my practice, I often see improved continence in my patients even before a true strength increase occurs simply through better body awareness and habit changes.

Not all people with incontinence should be doing Kegels!  A person with urge incontinence, urgency & frequency, or overactive bladder often has hypertonic or tight PFM.  These people have a hard time “letting go” of their pelvic muscles—imagine tight and elevated shoulder muscles.  Often people are not even aware of PFM tightness.  Physical therapists train their patients to first feel and sense what is happening in their bodies and then teach them to relax these muscles, which helps normalize bladder functioning.  Keeping a bladder diary or “voiding diary” helps people recognize patterns and habits that can be changed.  For example, consumption of bladder irritants such as caffeine or acidic foods can trigger urgency and dribbling; and frequent voiding without an urge trains the bladder to “need” to void too much.  Reducing irritants and minimizing “just in case” voids are strategies that can help the bladder.

Those with stress urinary incontinence should perform PFM exercise or “Kegels,” however many of my patients benefit from “training” rather than “strengthening” their PFM.  Co-contraction of the PFM and the lower abdominal muscle (transversus abdominis,) even gently, can thwart or decrease a leak.  In fact, a woman who is very weak may not be able to fire her PFM strongly, so she needs to learn to grade or ramp up her contraction so as to not fatigue those vital muscles.  “Training” like this is an important step before doing multiple repetitions of strong muscular holds, and ideally, a PT will help women and men know when and how to progress safely.  Some people with stress incontinence perform Kegels incorrectly—bearing down rather than tightening and pulling up—this demonstrates a lack of motor control that a PT would recognize and step in to help.

In an ideal world, everyone who has incontinence would see a PT, but this is not always possible.  So my suggestion is to first verify with your doctor what type of incontinence you have and to ease into a PFM training program gently.  Make sure you can feel your PFM relax fully before you tighten them.  And follow the directions on the NAFC website for strengthening only if your doctor recommends this.

lizanneheadshotAbout The Author: Lizanne Pastore PT, MA, COMT is a physical therapist in private practice dedicated to pelvic health for women and men in Petaluma, CA.

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