Stress Incontinence

Stress incontinence is the involuntary leaking of urine with activities such as coughing, laughing, changing positions, or exercising. Stress incontinence is usually the result of muscular weakness and incoordination.

Most people are led to believe that the pelvic floor (known as the "kegel" muscle) is the only muscle that needs strength training, this is not true. Incontinence is often a coordination dysfunction. It is the correct isolation of the transverse abdominus (deep abdominal muscles) and the pelvic floor muscles during an increase in intra-abdominal pressure.

The literature has shown a strong correlation with low back pain, incontinence and paradoxical breathing patterns. People with breathing dysfunction are frequently unable to perform a correct isolation of the muscles without holding their breath or mass contracting the wrong muscles.   

Pelvic floor muscle weakness can be the result of childbirth, a tear or episiotomy, hormonal changes, high impact activities, organ prolapse, surgeries, chronic low back pain, hip pain/sacroiliac joint pain or general muscle deconditioning. Physical therapy treatment may include:

• Core stability program (Inner corset includes: the pelvic floor and transverse abdominals)
• Bladder Diary
• Patient education and behavior modification
• Manual therapy treatment for co-existing pain conditions
• Progressive home exercise program
• Range of motion exercises
• Gentle electrical stimulation if needed (performed with internal rectal electrode)
• Biofeedback if needed (computerized device that teaches you to contract & relax your pelvic floor muscles)

Urge Incontinence

Urge incontinence is the involuntary loss of bladder control due to an overwhelming and sudden urge to urinate. It is often difficult to get to the bathroom before having an accident. Physical therapy treatment may include:

• Bladder diary
• Bladder retraining (learning to hold larger volumes of urine and increase time between bathroom trips)
• Dietary modifications
• Biofeedback
• Therapeutic exercises
• Gentle electrical stimulation if needed
• Relaxation techniques
• Manual therapy treatment for co-existing pain conditions

Fecal Incontinence

Fecal incontinence is the inability to control your bowel movements, causing stool (feces) to leak unexpectedly from your rectum. Also called bowel incontinence, fecal incontinence ranges from an occasional leakage of stool while passing gas to a complete loss of bowel control.

Muscle damage is involved in most cases of fecal incontinence. In women, this damage commonly occurs during childbirth. It's especially likely to happen in a difficult delivery that uses forceps or an episiotomy. An episiotomy is when a cut is made to enlarge the opening to the vagina before delivery. Muscle damage can also occur during rectal surgery such as surgery for hemorrhoids. It may also occur in people with inflammatory bowel disease, constipation or diarrhea.

People can often compensate for muscle weakness. Typically, incontinence develops later in life when muscles are growing weaker and the supporting structures in the pelvis are becoming loose.

Damage to the nerves that control the anal muscle or regulate rectal sensation is also a common cause of fecal incontinence. Nerve injury can occur in the following situations:

• During childbirth.
• With severe and prolonged straining for stool.
• With diseases such as diabetes, spinal cord tumors and multiple sclerosis.

Fecal incontinence may also be caused by a reduction in the elasticity of the rectum, which shortens the time between the sensation of the stool and the urgent need to have a bowel movement. Surgery or radiation injury can scar and stiffen the rectum. Inflammatory bowel disease can also make the rectum less elastic.

Because diarrhea is more difficult to control than formed stool, it is an added stress that can lead to fecal incontinence.

Physical therapy treatment may include:

• Manual therapy treatment for co-existing pain conditions
• Bowel diary
• Biofeedback (computerized device that teaches you to contract & relax your pelvic floor muscles)
• Core stability program
• Relaxation techniques
• Patient education
• Progressive exercise home program
• Gentle electrical stimulation as needed (performed with internal vaginal electrode)
• Dietary modifications