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Incontinence: 9 Things I wish More People Knew

Ugh, that dreaded topic that NO ONE wants to talk about… leaking. There, I opened the can of worms. As a physical therapist specializing in pelvic health issues, I talk about this topic at least half of my day, every day. There are things that I wish more people knew about incontinence:

1. Incontinence is common, but IT’S NOT NORMAL.

According to the National Association for Continence website (1), over 25 million Americans experience incontinence symptoms. Advertisements for continence products and pharmaceuticals come at you every time you turn on the TV or internet. Your mother (or friend or even your doctor) told you it was normal to leak after having a baby. The CrossFit community (video

below) has made it a badge of honor to leak when you exercise (Ugh!). Many believe it’s just part of aging, and can’t be improved. THAT IS WRONG! You can do something about it. There are many options for continence management; finding the right one for you will depend on the cause of your incontinence and your personal preferences.

2. Not all incontinence is the same.

Incontinence has been classified broadly into stress, urge, mixed, functional, overflow, and coital.

  • Stress incontinence is leakage of urine with movement or a cough, sneeze, or laugh. Imagine anything that will “squash your balloon” (bladder).

  • Urge incontinence occurs when you have a strong urge to urinate and leak urine on the way to the bathroom.

  • Mixed incontinence is a subtype where the individual has symptoms of both stress and urge incontinence.

  • Functional incontinence happens when something prevents you from getting to the bathroom in time, such as a slow walking speed or decreased cognition.

  • Overflow incontinence occurs when your bladder never fully empties, so it overflows.

  • Coital incontinence is the involuntary loss of urine with intercourse, which may occur during penetration or during orgasm.

3. Incontinence can occur at any age.

Children, teenagers, young adults, middle-aged, and elderly folks. Increasing age is a risk factor for incontinence, as is childbearing. But incontinence is also experienced by potty-trained children, high school athletes, adult women who have never had children and many others.

4. Incontinence happens to MEN too.

Yep, that’s right. I see a LOT of men with incontinence. In my practice, I see mostly men who have incontinence after prostate procedures. However, according to the International Continence Society, urge incontinence is more common in men than stress urinary incontinence, and it’s on the rise.1

5. Incontinence won’t get better on its own.

Ignoring the problem will not solve it. Sorry! It has happened for a reason; an anatomical change, a faulty neuromuscular pattern, and/or poor urinary habits- to name a few. It is important to identify the cause in order to correct it. A physical therapist, urologist, or urogynecologist can be helpful in determining your cause of incontinence. If you ignore it because you think, “eh, it’s just a few drops”, the issue will worsen. In time a few drops turns into a few pads, then looking for bathrooms everywhere you go, decreasing your physical activity, dehydrating yourself…etc. It’s a downward spiral.

6. Incontinence IMPACTS your Quality of Life.

If you are a WOHO participant, you probably enjoy being active and sociable. In fact, you probably highly value these things. They bring you happiness, as Bill Richardson wrote about in a previous blog post. Many of my patients with incontinence report that they have decreased both physical activity and social outings because they are worried about leaking. They also report feeling worse about their bodies.

7. Kegels are NOT always the answer.

I know, how could someone who is an expert Kegel trainer say that? Well, it’s true. There are many different types of incontinence as I stated above, and there are even more causes for each of those types. An experienced clinician (doctors and physical therapists) will work to pinpoint the causes of your incontinence to determine the appropriate treatment options. They will do this via a detailed interview with you (don’t be afraid to talk about it), a physical exam, a bladder diary, and possibly some diagnostic testing.

8. Kegels don’t have to be BORING.

A Kegel is a pelvic floor contraction. And guess what? Your pelvic floor should be contracting throughout your day as it reacts to changes in intra-abdominal pressure as you change positions, move about, exercise, etc. If your pelvic floor muscles have forgotten how to contract, you will likely need some coaching on how to get them working properly again, and possibly some dedicated exercise to that end. Once they are working properly they will be integrated back into your daily activities (lifting, pushing, pulling, sitting up, bending down) and your FUN exercises, like squats, dancing, jumping, clean and press and abdominal exercises.

9. You should tell your doctor or PT if you have back pain, a hernia, or diastasis rectus abdominus (DRA).

Your pelvic floor muscles are part of your deep core musculature (transverse abdominus, multifidi, diaphragm, and pelvic floor). The deep core muscles work together to comprise a carefully orchestrated pressure support system for your body. If you have a defect in one part of this system, it will affect the other parts, and the overall function and efficiency. It’s physics. Go figure. So if you have incontinence, your back pain, hernia, or DRA might be contributing to it. And if you don’t have incontinence, you should still address these issues, because an ounce of prevention is worth a pound of cure.


2. INCONTINENCE. Abrams P, Cardozo L, Khoury S, Wein A, eds. 5th International Consultation on Incontinence. In: Paris. Accessed April 26, 2017.

Dr. Albina Heidebrecht, PT, DPT, CLT is a residency-trained pelvic health physical therapist specializing in the treatment of female and male pelvic floor dysfunction. She attended Wellesley College as an undergraduate, Texas Woman's University for her doctoral degree in physical therapy and for her residency in women's health. She has a special interest in incontinence, interstitial cystitis and painful bladder syndrome, constipation, and pregnancy and postpartum-related dysfunction, and oncology-related diagnoses. When she is not at the clinic she enjoys biking, hiking, running, yoga, traveling, and spending time with friends and family.

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