Urinary Incontinence

Perhaps it’s a little leak when you sneeze, or you need to change your outfit after the “key in the door” urgency has overtaken you. You might think it’s a normal part of growing older, or the price to pay for those adorable children, or something to quietly ignore and hope it goes away. Current research indicates 1 in 4 women over 18 experiences some leakage. Please know that help is available, and you don’t need to suffer quietly!

The Almighty Pelvic Floor is responsible for the structural support of the bladder in addition to the other pelvic organs. Typically, these muscles contract with storage and relax with emptying.  The muscles and fascia of the pelvic floor can be too tight, too loose or be contracting in a discordant fashion. Reestablishing appropriate support of this little “hammock” can result in great improvements with both urinary and fecal continence.

Another consideration is the network of neural pathways involved in urination. Our sympathetic nervous system (fight, flight or freeze) impulses “stop and store” while the parasympathetic (rest and digest) impulses are necessary for emptying the bladder. Neurological control of urination falls under the heading of Bradley’s Loops- 1, 2, 3 and 4. Disruption of these loops by certain neurological conditions or local trauma can influence our ability to hold urine.  Unopposed parasympathetic impulses of the pelvic nerve in Loop 3 results in the symptoms of urge incontinence (key in the door leakage). Check out this link for answers to some frequently asked questions: https://www.womenshealth.gov/a-z-topics/urinary-incontinence

Bladder retraining, pelvic floor physical therapy and behavioral modification are first line treatments for urinary incontinence. Urge incontinence may also be treated with medication or electrical stimulation of the bladder nerves. Further on down the line, there are other more aggressive treatments such as surgery, pessaries or indwelling catheters but I’d say pretty much everyone prefer the more conservative treatments!

As a Holistic Women’s Healthcare Provider, I always consider the whole person when assessing my patient’s concerns. Incontinence is typically multifactorial and there are many angles to address it. We consider the history of symptoms, any known triggers, anything that seems to make it better or worse, and a physical exam to consider any physical causes. Together we will set goals and work our way towards them, celebrating your successes along the way and changing up anything that does not seem to be helping. And there will be homework! Yes, homework…. but I promise to work as hard as you do!

If incontinence is impacting your quality of life, I invite you to schedule an office visit today.

 

Linda Anzalone, WHNP