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Urinary Incontinence

Pelvic floor physical therapy services to help you with urinary incontinence, urinary urgency and frequency, and nocturia.

I help with...
  • Urinary leakage with coughing, sneezing, laughing, running, jumping

  • Urinary urgency

  • Urinary frequency

  • Nocturia (night-time voiding)

  • Hesitancy with urinary stream

  • Slow urine stream

  • Post-void dribbling

  • Painful urination

  • Incomplete emptying of bladder

"I saw Katrina for pelvic floor physical therapy for 6 sessions due to having 15+ years of urinary leakage with running and jumping workouts.  I was told by my OB that leaking was normal and that it would just go away from my 2nd pregnancy; however, it only continued to get worse.  Katrina helped me with my running form, improved my body awareness, and gave me exercises to strengthen my pelvic floor and hip muscles.  I was surprised at how fast I noticed progress - I am now able to run 3-4x/week for 4 miles without leakage, and also no longer have to wear a pad!"

L.Z. | Mountain View, CA

Let's define some terminology. 

Urinary Urgency: a sudden urge to urinate that is difficult to control.​

Urinary Frequency: frequent urination of > 8 times/day, or having to go more than every 2-4 hours

Stress Urinary Incontinence: urinary leakage with activities with increased intraabdominal pressure, including laughing, coughing, sneezing, bending, lifting, jumping, running, weight-lifting.

Urge Urinary Incontinence: urinary leakage associated with a strong urge that is difficult to delay; may occur in situations like "key in the door," opening the garage door, hearing running water, or stress.

 

Nocturia: condition in which you have to wake up at night to urinate.  If you find yourself waking up more than 1-2x/night, you may have nocturia. 

stress incontinence.jpg

Permission to reproduce copyrighted content from myPFM, Inc.

I can't make it to the restroom and I leak!  Why do I also have to go every 30 minutes?

Urinary urgency is defined as a strong urge to urinate that is difficult to delay.   When an urge happens, the detrusor muscle, which surrounds the bladder, starts to contract and squeeze the bladder.   Sometimes the urge can be so strong that you cannot delay it to get to the bathroom on time.  Urinary urgency and contributing to urinary frequency.  If you have to pee very 30 minutes to 1 hour, this is not normal.  Urgency and frequency can be due to several contributing factors, including:

  • Bladder irritants: Consuming coffee, tea, spicy and acidic foods, citrus, and alcohol can "irritate" the bladder lining.

  • Upregulated nervous system:  Your bladder muscle is controlled by your nervous system.  If you nervous system is very stressed or "over-excited," this can over-excite the bladder muscle, causing the urge.

  • Scar tissue restrictions: Scar tissue in your abdominal and pelvic floor region are connected to the fascia (connective tissue) surrounding the bladder and the ligaments that attach to the bladder.   Scar tissue is tight and adheres to nearby structures, affecting the function of vital organs, including the bladder.  Physical therapy can help release any scar tissue from previous surgeries, including a hysterectomy, c-section, or gallbladder removal.

  • Just-in-case peeing: Do you pee "just in case?"  If you urinate very frequently, and when you don't have the urge to go, the bladder tells the brain that it is full of urine, even when it might only be 1/3 or 1/2 full.  As a result, your bladder and brain now have a new definition of what is considered "full," so a little bit of urine in the bladder can actually "irritate" the bladder, causing a strong urge

  • Dehydration: Being dehydrated can irritate the bladder and cause urgency.

  • Pelvic floor muscle tightness: Your pelvic floor muscles wrap around your urethra and maintain tone or a degree of tightness to counteract the pressure of the bladder as urine fills.  If your pelvic floor muscles are tight, and unable to counter act that pressure from the bladder, you bladder will send a signal to your brain to empty to relieve the strain off the pelvic floor. 

I leak when I laugh, cough, sneeze, AND run!

You are probably very frustrated and embarrassed that you are leaking with such simple activities, like sneezing or coughing, or maybe even your favorite form exercise, like running!  In addition to some of the contributing factors listed above, you may also have:

  • Pelvic floor muscle weakness and impaired coordination: Your pelvic floor muscles form the base of your pelvis.  It supports several key organs, like your bladder.  Your pelvic floor muscles need to function as a trampoline and must be strong in its entirety.  Imagine trying to catch a 50 lb ball with very stiff arms - that would be a lot of stress on your body!  But what if you caught a 50 lb ball and your arms were allowed to drop down a little to absorb the shock - that would be a lot easier! This is the same as your pelvic floor muscles.  Your pelvic floor muscles must have strength in its full range of motion, to be able to absorb the high load/forces from sneezing, coughing, and running!  Fun fact: coughing and sneezing puts more pressure on the pelvic floor than running. 

  • Foot mobility restrictions:  If you are a runner, your feet are the first body part to absorb the forces from the ground when you land.  Your feet have several joints and require optimal mobility to absorb shock.  Imagine having a very stiff and immobile foot - the foot would not do well with absorbing forces from the ground.  But if you have a mobile, flexible, and strong foot, your foot will be able to absorb forces so that your knee, hip, and even pelvic floor wouldn't have to work as hard.  So...it all starts from the feet!  

  • Hip/Glute weakness: Your pelvic floor muscles do not function alone.  The pelvic floor muscles also work with your glutes, and abdominals!  Having strong gluteus is important for shock absorption and pelvic stabilization. 

  • Posture and alignment: How do you cough? Sneeze? Even run?  Not surprisingly, your posture and alignment can affect how well your body efficiently absorbs load and forces.   Luckily, pelvic floor physical therapists are movement experts and I can help optimize your posture!

  • Your shoes: This is for my runners.  Like I mentioned before, your feet need to be mobile and flexible to absorb forces from the ground.  Wear very rigid and supportive shoes can make your feet stiff, causing excessive force up the body, and into your pelvic floor.

I've had these issues for 10+ years. Is it too late? 

It is never too late to start physical therapy.  I see women who struggle with urinary urgency and frequency and leakage for 10, 20, sometimes 30-40 years!  I see women who have tried everything, who have seen multiple doctors, who have tried all the medications to stop their leakage.  If you haven't tried pelvic floor physical therapy before, I ask that you try this! 

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