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Stress Urinary Incontinence: Not Just About Kegels

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Types of Urinary Incontinence

There are many different types of urinary incontinence, and the etiologies are usually more complex than simply having weak muscles. This blog post will focus on stress urinary incontinence. There are three main types of urinary incontinence:

  • stress urinary incontinence (SUI)
  • urge urinary incontinence (UUI)
  • mixed urinary incontinence (MUI)

Stress urinary incontinence is urinary leakage with physical exertion or with laughing, sneezing, or coughing. Urge urinary incontinence is urinary leakage that is associated with a strong urge to urinate. Mixed urinary incontinence is a combination of both stress and urge urinary incontinence.

Typically, stress urinary incontinence is associated with weak muscles and urge urinary incontinence is associated with overactive muscles. However, this is not always the case. To understand why we need to talk about how the pelvic floor muscles work.

How the Pelvic Floor Muscle Work

When we are going about our everyday lives (and not on the toilet), the pelvic floor muscles need to be turned on enough to hold our urine in. I call this resting muscle tone. This means that you do not have to be actively contracting or tightening your pelvic floor muscles to keep urine in. This should just happen. When we urinate, our pelvic floor muscles should be able to relax enough to allow urine to come out.

Many different circumstances can alter the tone of the pelvic floor muscles so that they either do not have enough tone in them to keep our urine in. Or, they can have too much tone in them so that they do not adequately relax when we need to get urine out.

I stated earlier that we typically associate weakness with stress urinary incontinence and overactive muscles with urge urinary incontinence. It is important to note that a weak muscle and overly active muscles are not mutually exclusive. In other words, an overly active muscle can be a weak muscle. This can be confusing, so I use an analogy to simplify. Let’s say you were asked to hold a bucket of bricks all day long, with your elbow bent to ninety degrees. At the end of the day, if I asked you to do a bicep curl, you probably would not be able to. This is because your bicep got “stuck” from having to be on all day long holding the bucket of bricks.

The same thing can happen with your pelvic floor muscles. Sometimes, the muscles are turned on all the time, and when they need to relax or contract, they have a difficult time doing this.

What Causes Stress Urinary Incontinence

Stress urinary incontinence occurs when the pressure from above (in your abdominal cavity) is too much for the pelvic floor muscles to hold. For instance, let’s say you just had a baby and your pelvic floor muscles are still recovering. You live in Texas, so you have bad allergies, and you suddenly have to sneeze. Your pelvic floor muscles need to react quickly and strongly to the increase in pressure from above (the sneeze). When the pressure from your abdomen is greater than the strength generated by your pelvic floor muscles, leaking occurs.

Stress urinary incontinence can also occur if your muscles are overly active. Let’s take the same example that you recently had a baby. It’s possible that with the stress of taking care of a new baby, you are holding tension in your pelvic floor muscles. This is similar to how people hold tension in their neck and shoulders.

Remember the analogy of doing a bicep curl at the end of a long day of holding a bucket of bricks? Compare your pelvic floor muscles to the bicep. If you sneeze, the muscles need to be able to generate a strong contraction to hold urine in. If they have been “on” all day, they may be “stuck”. This makes them unable to release and then contract quickly and strongly.

A good physical therapist will be able to decipher which category of muscle weakness you are in. Treatment plans may look very different for these two women even though they both have post-partum related stress urinary incontinence. This is why you cannot just do Kegels for incontinence.

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