TREATMENT FOR INCONTINENCE- A MANUAL THERAPY APPROACH
Urinary and Fecal Incontinence affects people of all ages- children as well as adults. It is more common in women then men and more common in older adults then in younger ones. It is not considered a normal part of aging. Reports show up to 90 million Americans are affected by Urinary Incontinence and another 5.5 million Americans affected by Fecal Incontinence.
Physical Therapy treatment with emphasis on the pelvic floor, low back and abdominal regions is effective for treatment of Urinary and Fecal Incontinence. The bladder, rectum, cervix and prostate are supported in the pelvis by a complex series of muscles. Proper functioning of these pelvic floor muscles is necessary in the process of urination and defecation.
There are four main types of Urinary Incontinence- all of which are treatable:
Stress Incontinence (sudden urine loss) is the unintentional release of urine during normal everyday activities. This is the most common type of incontinence accounting for 60% of all cases. The symptoms of stress incontinence include unexpected urine loss when you:
- laugh, sneeze or cough
- Walk, exercise or lift something
- Get up from a seated or lying position
- Frequent trips to the bathroom to avoid accidents which leads to urgency and furthers the inability to hold urine.
There are two main causes of stress incontinence. The most common is poor support of the bladder and urethra in the pelvis caused by weakened pelvic floor muscles. Less commonly is weakness or a deficient urethral sphincter. Urge Incontinence is a sudden, intense urge to urinate, followed by a loss of urine. You may feel like you never get to the bathroom fast enough or you may be awakened several times a night by a strong urge to urinate. Urge incontinence is most commonly caused by overactive bladder muscles. “Overactive bladder” can result from damage to the nerves of the bladder, damage to the nervous system (brain or spinal cord), or to the pelvic floor muscles. Many times, a specific cause for injury to the nerves or muscles cannot be identified Mixed Incontinence is a combination of urge and stress incontinence and is common in women.
Overflow Incontinence can occur when the bladder doesn’t completely empty. You may pass only a small amount of urine when you try to void and you may dribble urine frequently. Overflow incontinence may be caused by a blockage in the urethra that prevents urine flow, or by neurological problems that leave the bladder partially full. Functional Incontinence occurs with people who have trouble communicating or who may have physical disabilities that prevent them from getting to the bathroom in time.
Transient Incontinence is temporary and is triggered by medications, urinary tract infections, mental impairment, restricted mobility and stool impaction (severe
constipation), which can push against the urinary tract and obstruct outflow. Fecal Incontinence is an inability to control the bowel. This can be an inability to control the urge for a bowel movement or unexpected leakage of stool from the rectum.
Common causes of Fecal Incontinence include:
- Constipation
- Damage to the anal sphincter muscles.
- Damage to the nerves of the anal sphincter muscles or rectum.
- Loss of storage capacity in the rectum
- Diarrhea
- Pelvic Floor Muscle Dysfunction which includes any abnormalities of the pelvic floor muscles. A Rectocele is a protrusion of the rectum through the vagina which is caused by generalized weakness of the pelvic floor muscles.
Treatment Options:
Physical Therapy is known to be a valuable conservative management option for incontinence. Conservative management techniques associated with incontinence are considered to be the first line of defense among treatment strategies due to their high rate of effectiveness and low rate of side effects. Conservative management techniques include: biofeedback, electrical stimulation, bladder and bowel retraining, pelvic floor muscle retraining, pelvic floor strengthening and manual therapy techniques. Manual therapy is a direct, hands on technique performed by a trained therapist. In the treatment of incontinence, it can either be utilized directly on the pelvic floor muscles or indirectly on the supporting musculature (spine, trunk, pelvis, extremities). Hands On Physical Therapy emphasizes a manual therapy approach in the treatment of incontinence with Myofascial Release being the core of our treatment. Myofascial Release can directly affect the ability of the pelvic floor muscles to either have a better contraction or reduce muscle tone in muscles that are too tight thus allowing pelvic floor muscle training to be more productive. Research studies have well documented the efficacy of pelvic floor exercises in the treatment of incontinence since the introduction of Kegel exercises in 1948. Whether utilized internally directly on the pelvic floor muscles supporting the bladder and rectum, or externally to correct abnormal muscle tone and postural
compensations, the outcome is better awareness and control, decreased pain and increased function of the pelvic floor. Behavioral techniques, which include lifestyle changes and bladder retraining, are utilized along with manual therapy techniques to help restore proper bowel and bladder function.
For more detailed information on the pelvic floor muscles and manual therapy treatment, please refer to our past articles, which are available on our website: www.handsonpt.net “The Role of Physical Therapy and Manual Therapy in Treating Pelvic Floor Dysfunction in Men and Women” “Pelvic Floor Muscles: What They Are And What They Do”
Jody Hendryx, PT |
