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Beyond Kegels: Take charge of your bladder health

Urinary incontinence is the unintentional release of urine. Even if you’re not familiar with the term, you may be all too familiar with the embarrassment it may cause.

If you think you may have urinary incontinence, you don’t have to live with it. There are many treatment options that can help you gain control of your bladder and improve your quality of life.

More than 11 million women (and many men) in the United States experience urinary incontinence. This condition, which is often treatable, affects women of all ages.

Along with the unintentional release of urine, called leakage, there may be other symptoms of urinary incontinence, such as a strong desire to urinate, even when the bladder is not full; urinating

more than six to eight times a day or more than once every two hours with normal fluid intake, or awakening regularly from sleep three or more times a night because of the urge to urinate.

Although incontinence is not necessarily a natural part of aging, it can be caused by changes in your body. Childbirth, improper lifting of heavy objects, drinking bladder irritants such as caffeine and alcohol, chronic constipation, and menopause may contribute to a weakening of the muscles that surround the openings of the urethra, vagina, and anus known as the “pelvic floor.” It’s this weakening that can lead to poor bladder control.

Bladder control

The bladder’s job is to store and empty urine. When the bladder becomes full, nerves signal the brain giving you the urge to urinate. When you urinate, your sphincter relaxes and the bladder muscle contracts to squeeze urine out of the bladder. The urine leaves your body through a tube called the urethra. A strong sphincter and pelvic floor muscles help keep the urethra closed until you’re ready to urinate.

The most frequent types of incontinence are called stress, urge and mixed. Stress incontinence is the sudden, involuntary loss of urine when you exercise or move in a certain way, for example when you jump, cough, sneeze, or laugh. Urine leakage is caused by weak muscles and poor ligament support. Urge incontinence is urine leakage that occurs as soon as you get the need to go to the bathroom. The sensation is overwhelming; your bladder muscle contracts at the wrong time and you can’t control it.

As the name suggests, mixed incontinence is a combination of the stress and urge incontinence.

Talk to your doctor

Many women do not want to talk to their doctor about such a personal topic. But it is a common medical problem, and millions of women have been treated successfully, according to the U. S.

Department of Health and Human Services on Women’s Health (www.womenshealth.gov). Some doctors don’t treat bladder problems, so they may not think to ask about it. Even if you feel shy, it’s up to you to take the first step and tell your doctor about your symptoms.

Because of their training in assessing and treating musculo-skeletal problems, physical therapists play a decisive role in treatment. A study published in the Annals of Internal Medicine reports that pelvic floor muscle training — also known as Kegel exercises — in conjunction with bladder training resolved the symptoms in women. Talk to your doctor, nurse or physical therapist to learn how to do Kegel exercises correctly. Further research by the American Physical Therapy Association found proper preventive measures and examination and treatment by a physical therapist can help patients manage, diminish and often eliminate incontinence.

Physical therapists who focus on women’s health find that incontinence is one of the most frequent problems they treat. The therapist evaluates the musculoskeletal components of the hip, pelvis, spine and abdomen for strength, flexibility and alignment. Based on these findings, the therapist establishes a home exercise program that is right for you. The exercises usually include relaxation, strengthening and instruction in lifting and moving correctly. The treatment incorporates education in lifestyle changes, eliminating or reducing caffeine and alcohol, common bladder irritants, regulating what you drink and how often you drink them, and exercising effectively to avoid pressure on the bladder.

Knowing that you can do something about urinary incontinence puts you on the path to regaining control over your bladder. If you are experiencing symptoms, speak with your physician. Have a thorough examination to rule out any medical conditions that may be causing your loss of bladder control and then you’ll be ready for the next step, individualized evaluation and treatment from a physical therapist.

Carolyn Bentley is a physical therapist at Cooley Dickinson Hospital in Northampton.

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