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Urge Incontinence
Anne Ellis, PT, DPT discusses urge incontinence, why you might experience it, prevention and treatment options.
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Learn more about Anne Ellis, PT, DPT
Anne Ellis, PT, DPT
Dr. Anne Ellis, PT, DPT, earned her doctoral degree in physical therapy from Western University of Health Sciences in Pomona, California. She has completed advanced clinical training to treat and manage pelvic floor dysfunction and to treat pre/postpartum clients. Her previous experience was with a successful clinic in Pasadena where she provided specialized pelvic floor care to her patients.Learn more about Anne Ellis, PT, DPT
Transcription:
Melanie Cole, MS (Host): If you experience urinary leakage, pelvic pain, or dysfunction, you are not alone. Welcome to Palmdale Regional Radio. I'm Melanie Cole and today we’re discussing urge incontinence. Joining me is Anne Ellis. She’s a physical therapy at Palmdale Regional Medical Center. Anne, it’s a pleasure to have you join us again today. Tell us a little bit about incontinence. Is this a normal part of aging? Is it something we just have to accept?
Anne Ellis, PT, DPT (Guest): Hello Melanie. Thank you for welcoming me. It is not normal. It’s common, but it’s not normal. So I always encourage people when I meet them on the street and we happen to chit chat about this type of thing, I will encourage them to seek the help of a medical professional and request a referral to a pelvic floor physical therapy.
Host: So then tell us a little bit about how people describe this condition to you. I mean sometimes people don’t tell their providers about it because it can be embarrassing, and they don’t want to discuss it. They think there’s nothing that can be done. So tell us a little bit about really what it means for people and how it effects their quality of life.
Anne: So it is definitely something that they will hold onto for quite some time. They will live with it for quite some time. They can be embarrassed about it. They don’t always talk to their doctors about it. So usually when they walk into the clinic where I work, they have a referral and they have a diagnosis. So I know what the issue is when they walk in. So I bring it up, so they don’t have to. They can be embarrassed about it. Men more so than women typically from my experience. They will have—I actually bring it up to them. So I’ll say, “Hey this is what’s going on.” I kind of have a way of normalizing that kind of information because I talk about things like incontinence—fecal and urinary—and then I talk with them about pain with intercourse. So I talk about these things all day long. So it’s pretty normal for me. I've had patients say that they were pretty comfortable talking about the situation when they come into the clinic. So I guess that’s a gift of mine. I'm glad that I have it because of what I do.
Host: So tell us why this happens and the different types. We’re talking about urge today, but there are many types, yes?
Anne: There are, yeah. You're absolutely right. So there are three main types of urinary incontinence. Urge, so I’ll explain that one. That’s when you have a really strong urge to urinate and you usually will leak. It’s usually a small leak or a full loss of bladder, but they’ll leak during other times too. It’s kind of interesting. They’ll leak when it’s cold outside or with the sound of running water or when they get home and they're trying to get into the house they usually will have that really strong urge. When they get home and they put their key in the door, that’s called key in door syndrome. So that’s urge incontinence. Stress incontinence is when they leak with some sort of force on the body, like a couch, laugh, sneeze, with a change in position. Those types of things. Next incontinence is the combination of both urge and stress incontinence. Then there are other terms out there, like functional incontinence. That’s where you can't get to the bathroom because maybe you have some sort of medical condition like you're in a wheelchair so you can't quite get there in time to use the restroom. There's a continuous incontinence. That’s just basically a flow. It’s like you can't control any of your urine. Overflow incontinence, which is when the bladder doesn’t empty completely so you will leak. There's an insensible incontinence, which is when you're not aware of the leakage. Then another term that I've heard before is coital incontinence, which is leaking during intercourse.
Host: Well thank you for that very comprehensive answer. So tell us a little bit, if we know, what underlying causes are risk factors and when really it’s time to seek help.
Anne: These are risk factors for pelvic floor dysfunction. That can be urge incontinence as well. So if they’ve had pelvic surgeries before if they have a higher body mass index. It usually means higher weight, chronic constipation, chronic coughing, hypertension, diabetes, connective tissue disorders, neurological disorders like multiple sclerosis, Parkinson’s disease, stroke, brain tumor, spinal cord injury. If they have COPD, which is something that effects your lung, if they smoke. For women, it’s for those who have had multiple pregnancies that have reached a viable gestational age, with menopause, and any kind of obstetric trauma. If they’ve given birth and they’ve had a forceps birth or a vacuum birth. With men specifically it’s with prostate cancer or a prostatectomy.
When to seek help? I always say seek help immediately. Like I said earlier, a lot of people will live with it for a long time because they think it’s a normal part of aging or they think, “Well, I gave birth and that means I'm going to leak.” That shouldn’t be the case. Go out and seek a pelvic floor physical therapist. I urge you. Oh that’s funny. No pun intended.
Host: Oh, that is funny. So tell us what you do with people. How do you treat them? Tell us about the environment. Since this is kind of a difficult situation for many people to discuss, what is pelvic floor physical therapy like?
Anne: Well, let’s see. I’ll talk about how I treat pelvic floor issues in general, and then I’ll talk specifically about urge incontinence. So with regular pelvic floor physical therapy, there are different ways that that can be treated. So Kegels, others exercise. Because the pelvic floor muscles, they work in conjunction with the muscles surrounding the hips. So everything should be strong in order to keep you continent or dry. Other types are with the use of dilators, which help to stretch the pelvic floor muscles. There is something called a TENS unit, which most people have used maybe if they have back pain or knee pain. It’s that prickly kind of sensation that they have with the pads that they put on. That actually can be used with a sensor inside the pelvis for strengthening those muscles. There's biofeedback, which kind of gives the patient a visual to know if their pelvic floor muscles are too tight or they're too relaxed or if they're actually doing a Kegel. Some people have not really had a sensation of those pelvic floor muscles and don’t know if the muscles are too tight or too relaxed. So that biofeedback can help them with that as well.
As far as treating urge incontinence specifically, there's something called urge suppression techniques which is a challenge. It definitely takes some time and some energy and some patience with yourself because it takes about 6 to 12 weeks—It’s basically retraining the bladder. So it helps your mind, your bladder to calm yourself down when you have that really strong urge. Then you can slowly and calmly walk to the bathroom and with control. Another thing we do is a bladder retraining program. That’s where you learn how to hold your urine longer because a lot of the times with urge incontinence, some of these people have either waited too long to use the restroom over and over and over for years or they go to the bathroom too often. So the connection between the bladder and the brain, they're just talking to each other too much. So this is a way to retrain the bladder. The other is with pelvic floor muscle strengthening. Now all of the three things that I've explained here are what I can do as a physical therapist.
There are other options out there. If you see a urologist, they might give you some medications, Botox injections. It’s called percutaneous tibial nerve stimulation. It’s where they put a small needle into the nerve at the ankle. That nerve will go up to the sacral nerve plexus is what it’s called. That’s basically the same nerve root that helps to regulate the bladder. So that treatment typically takes about 12 weeks. Then there's also the option of surgery.
Host: Wow. There are s many options today Anne. So are these only for women or can men use it like for prehab if they know they're going to have prostate surgery, or they’ve already had it. Can this help men as well?
Anne: Yes, and that’s such a good question. Men usually come in and they're not even sure why they're here in the clinic. Actually some women too. Yes. I use pelvic floor physical therapy on both women and on men. I think I probably have about 40% of my patient caseload are men. Most of them have had a prostatectomy. So they go in, they get the surgery because they had prostate cancer, they get that prostate removed, and then they’ll have urinary leakage. Side note, they’ll have erectile dysfunction sometimes. So physical therapy can help with both of those. Then you mention prehab. So there have been some research articles out there that show that prehab is really good for post-prostatectomy patients or to help them get ready for the prostatectomy. That’s kind of along the whole physical therapy spectrum, really. So they’ve noticed that prehab is good for like a total knee replacement and other issues as well. So across the board it’s been a good thing to do to get those muscles prepared and strengthened before you go into surgery.
Host: Absolutely. Anne as we wrap up, because this is really such great information, what would you like listeners to know about urge incontinence and they help that’s available at Palmdale Regional Medical Center and things that you encourage them to do at home to live a healthy lifestyle that can help them and whether or not it can even be prevented.
Anne: I would say to pay attention to your body. If you are having any kind of issue with urination, seek help. Seek help right away. Talk to somebody, see where you can go to get a referral to get into pelvic floor physical therapy. Maybe pelvic floor physical therapy won't work for you, but it’s a good starting point because the other options are, like I said, surgery and Botox injections. Those types of things. Medications. So it might be a good idea to start with the more conservative side. You can also, to stay healthy, maintain a healthy weight. If you're a little bit on the bigger side, that could lead to issues as well. Keep yourself exercising. So keep those hips strong, do your Kegels. Although sometimes Kegels are not right for everyone. Some patients depending on the issue that they are having shouldn’t be doing Kegels. So always seek the help of a pelvic floor physical therapist to see where your pelvic floor stands and what you should be doing for that. Stop smoking if you're smoking. That can lead to chronic coughing and issues with the muscles. So that’s not a good idea, as you know. Keep yourself regular so you're not constipated because that can lead to pelvis floor dysfunction. So drink enough water, exercise, get enough fiber in your diet. Don’t hold your urine for too long. The normal amount is every two to four hours. So you should be urinating every two to four hours. Then don’t go to the bathroom too frequently because then the bladder will start to send signals up to the brain quicker that say, “okay. I have to go to the bathroom. I have to go to the bathroom” over and over again. So basically just stay healthy, pay attention to your bladder, see what's going on. If you have any kind of change in bladder or bowel function, seek the help of a pelvic floor physical therapist.
Host: Great information. What a great message for listeners to hear. Thank you so much Anne for coming on and sharing your expertise with us today. That concludes another episode of Palmdale Regional Radio with Palmdale Regional Medical Center. Please visit our website at palmdaleregional.com for more information and to get connected with one of our providers. Please also remember to subscribe, rate, and review this podcast and all the other Palmdale Regional Medical Center podcasts. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. I'm Melanie Cole.
Melanie Cole, MS (Host): If you experience urinary leakage, pelvic pain, or dysfunction, you are not alone. Welcome to Palmdale Regional Radio. I'm Melanie Cole and today we’re discussing urge incontinence. Joining me is Anne Ellis. She’s a physical therapy at Palmdale Regional Medical Center. Anne, it’s a pleasure to have you join us again today. Tell us a little bit about incontinence. Is this a normal part of aging? Is it something we just have to accept?
Anne Ellis, PT, DPT (Guest): Hello Melanie. Thank you for welcoming me. It is not normal. It’s common, but it’s not normal. So I always encourage people when I meet them on the street and we happen to chit chat about this type of thing, I will encourage them to seek the help of a medical professional and request a referral to a pelvic floor physical therapy.
Host: So then tell us a little bit about how people describe this condition to you. I mean sometimes people don’t tell their providers about it because it can be embarrassing, and they don’t want to discuss it. They think there’s nothing that can be done. So tell us a little bit about really what it means for people and how it effects their quality of life.
Anne: So it is definitely something that they will hold onto for quite some time. They will live with it for quite some time. They can be embarrassed about it. They don’t always talk to their doctors about it. So usually when they walk into the clinic where I work, they have a referral and they have a diagnosis. So I know what the issue is when they walk in. So I bring it up, so they don’t have to. They can be embarrassed about it. Men more so than women typically from my experience. They will have—I actually bring it up to them. So I’ll say, “Hey this is what’s going on.” I kind of have a way of normalizing that kind of information because I talk about things like incontinence—fecal and urinary—and then I talk with them about pain with intercourse. So I talk about these things all day long. So it’s pretty normal for me. I've had patients say that they were pretty comfortable talking about the situation when they come into the clinic. So I guess that’s a gift of mine. I'm glad that I have it because of what I do.
Host: So tell us why this happens and the different types. We’re talking about urge today, but there are many types, yes?
Anne: There are, yeah. You're absolutely right. So there are three main types of urinary incontinence. Urge, so I’ll explain that one. That’s when you have a really strong urge to urinate and you usually will leak. It’s usually a small leak or a full loss of bladder, but they’ll leak during other times too. It’s kind of interesting. They’ll leak when it’s cold outside or with the sound of running water or when they get home and they're trying to get into the house they usually will have that really strong urge. When they get home and they put their key in the door, that’s called key in door syndrome. So that’s urge incontinence. Stress incontinence is when they leak with some sort of force on the body, like a couch, laugh, sneeze, with a change in position. Those types of things. Next incontinence is the combination of both urge and stress incontinence. Then there are other terms out there, like functional incontinence. That’s where you can't get to the bathroom because maybe you have some sort of medical condition like you're in a wheelchair so you can't quite get there in time to use the restroom. There's a continuous incontinence. That’s just basically a flow. It’s like you can't control any of your urine. Overflow incontinence, which is when the bladder doesn’t empty completely so you will leak. There's an insensible incontinence, which is when you're not aware of the leakage. Then another term that I've heard before is coital incontinence, which is leaking during intercourse.
Host: Well thank you for that very comprehensive answer. So tell us a little bit, if we know, what underlying causes are risk factors and when really it’s time to seek help.
Anne: These are risk factors for pelvic floor dysfunction. That can be urge incontinence as well. So if they’ve had pelvic surgeries before if they have a higher body mass index. It usually means higher weight, chronic constipation, chronic coughing, hypertension, diabetes, connective tissue disorders, neurological disorders like multiple sclerosis, Parkinson’s disease, stroke, brain tumor, spinal cord injury. If they have COPD, which is something that effects your lung, if they smoke. For women, it’s for those who have had multiple pregnancies that have reached a viable gestational age, with menopause, and any kind of obstetric trauma. If they’ve given birth and they’ve had a forceps birth or a vacuum birth. With men specifically it’s with prostate cancer or a prostatectomy.
When to seek help? I always say seek help immediately. Like I said earlier, a lot of people will live with it for a long time because they think it’s a normal part of aging or they think, “Well, I gave birth and that means I'm going to leak.” That shouldn’t be the case. Go out and seek a pelvic floor physical therapist. I urge you. Oh that’s funny. No pun intended.
Host: Oh, that is funny. So tell us what you do with people. How do you treat them? Tell us about the environment. Since this is kind of a difficult situation for many people to discuss, what is pelvic floor physical therapy like?
Anne: Well, let’s see. I’ll talk about how I treat pelvic floor issues in general, and then I’ll talk specifically about urge incontinence. So with regular pelvic floor physical therapy, there are different ways that that can be treated. So Kegels, others exercise. Because the pelvic floor muscles, they work in conjunction with the muscles surrounding the hips. So everything should be strong in order to keep you continent or dry. Other types are with the use of dilators, which help to stretch the pelvic floor muscles. There is something called a TENS unit, which most people have used maybe if they have back pain or knee pain. It’s that prickly kind of sensation that they have with the pads that they put on. That actually can be used with a sensor inside the pelvis for strengthening those muscles. There's biofeedback, which kind of gives the patient a visual to know if their pelvic floor muscles are too tight or they're too relaxed or if they're actually doing a Kegel. Some people have not really had a sensation of those pelvic floor muscles and don’t know if the muscles are too tight or too relaxed. So that biofeedback can help them with that as well.
As far as treating urge incontinence specifically, there's something called urge suppression techniques which is a challenge. It definitely takes some time and some energy and some patience with yourself because it takes about 6 to 12 weeks—It’s basically retraining the bladder. So it helps your mind, your bladder to calm yourself down when you have that really strong urge. Then you can slowly and calmly walk to the bathroom and with control. Another thing we do is a bladder retraining program. That’s where you learn how to hold your urine longer because a lot of the times with urge incontinence, some of these people have either waited too long to use the restroom over and over and over for years or they go to the bathroom too often. So the connection between the bladder and the brain, they're just talking to each other too much. So this is a way to retrain the bladder. The other is with pelvic floor muscle strengthening. Now all of the three things that I've explained here are what I can do as a physical therapist.
There are other options out there. If you see a urologist, they might give you some medications, Botox injections. It’s called percutaneous tibial nerve stimulation. It’s where they put a small needle into the nerve at the ankle. That nerve will go up to the sacral nerve plexus is what it’s called. That’s basically the same nerve root that helps to regulate the bladder. So that treatment typically takes about 12 weeks. Then there's also the option of surgery.
Host: Wow. There are s many options today Anne. So are these only for women or can men use it like for prehab if they know they're going to have prostate surgery, or they’ve already had it. Can this help men as well?
Anne: Yes, and that’s such a good question. Men usually come in and they're not even sure why they're here in the clinic. Actually some women too. Yes. I use pelvic floor physical therapy on both women and on men. I think I probably have about 40% of my patient caseload are men. Most of them have had a prostatectomy. So they go in, they get the surgery because they had prostate cancer, they get that prostate removed, and then they’ll have urinary leakage. Side note, they’ll have erectile dysfunction sometimes. So physical therapy can help with both of those. Then you mention prehab. So there have been some research articles out there that show that prehab is really good for post-prostatectomy patients or to help them get ready for the prostatectomy. That’s kind of along the whole physical therapy spectrum, really. So they’ve noticed that prehab is good for like a total knee replacement and other issues as well. So across the board it’s been a good thing to do to get those muscles prepared and strengthened before you go into surgery.
Host: Absolutely. Anne as we wrap up, because this is really such great information, what would you like listeners to know about urge incontinence and they help that’s available at Palmdale Regional Medical Center and things that you encourage them to do at home to live a healthy lifestyle that can help them and whether or not it can even be prevented.
Anne: I would say to pay attention to your body. If you are having any kind of issue with urination, seek help. Seek help right away. Talk to somebody, see where you can go to get a referral to get into pelvic floor physical therapy. Maybe pelvic floor physical therapy won't work for you, but it’s a good starting point because the other options are, like I said, surgery and Botox injections. Those types of things. Medications. So it might be a good idea to start with the more conservative side. You can also, to stay healthy, maintain a healthy weight. If you're a little bit on the bigger side, that could lead to issues as well. Keep yourself exercising. So keep those hips strong, do your Kegels. Although sometimes Kegels are not right for everyone. Some patients depending on the issue that they are having shouldn’t be doing Kegels. So always seek the help of a pelvic floor physical therapist to see where your pelvic floor stands and what you should be doing for that. Stop smoking if you're smoking. That can lead to chronic coughing and issues with the muscles. So that’s not a good idea, as you know. Keep yourself regular so you're not constipated because that can lead to pelvis floor dysfunction. So drink enough water, exercise, get enough fiber in your diet. Don’t hold your urine for too long. The normal amount is every two to four hours. So you should be urinating every two to four hours. Then don’t go to the bathroom too frequently because then the bladder will start to send signals up to the brain quicker that say, “okay. I have to go to the bathroom. I have to go to the bathroom” over and over again. So basically just stay healthy, pay attention to your bladder, see what's going on. If you have any kind of change in bladder or bowel function, seek the help of a pelvic floor physical therapist.
Host: Great information. What a great message for listeners to hear. Thank you so much Anne for coming on and sharing your expertise with us today. That concludes another episode of Palmdale Regional Radio with Palmdale Regional Medical Center. Please visit our website at palmdaleregional.com for more information and to get connected with one of our providers. Please also remember to subscribe, rate, and review this podcast and all the other Palmdale Regional Medical Center podcasts. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. I'm Melanie Cole.