What You Can Do to Treat Urinary Incontinence
Kelly Huestis discusses urinary incontinence and treatment options.
Featured Speaker:
Kelly Huestis, PT, MPT
Kelly Huestis is a physical therapist at University of Maryland Upper Chesapeake Medical Center in Bel Air, a part of UM Upper Chesapeake Health. She is also part of the UM Rehabilitation Network, a system of rehabilitation providers working together to help people recover from illness or injury. She has been practicing pelvic floor physical therapy for 17 years. She has earned a Certificate of Achievement in Pelvic Floor PT from the Academy of Pelvic Health Physical Therapists and is board certified in Women's Health Physical Therapy through the American Board of Physical Therapy Specialties. Transcription:
What You Can Do to Treat Urinary Incontinence
Caitlin Whyte: Welcome to Live Greater. The health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach. So you have everything you need to live your life to the fullest. This episode is sponsored by the University of Maryland Rehabilitation Network. Offering a range of physical rehabilitation services, The UM Rehab Network brings together a committed team of experts from across Maryland to help patients recover from illness or injury, such as stroke, joint replacement, or traumatic injury. The University of Maryland Rehabilitation Network, bringing world-class comprehensive rehabilitation services directly to your neighborhood. Today, we're talking about urinary incontinence with Kelly Huestis, a Physical Therapist and Clinical Coordinator of the Pelvic Floor Physical Therapy Program at UM Upper Chesapeake Medical Center. So, Kelly, what are the different types of urinary incontinence?
Kelly Huestis: Generally, we think about three main types of incontinence. Stress incontinence is leaking that can occur when there's a change in abdominal pressure. So when you think of leaking with laughing, coughing, sneezing, or jumping urge incontinence is the second type. And that's when someone has a strong sudden need to go to the bathroom, but they can't quite get there in time and they might leak a little bit. So, if you think of that commercial with the got to go, got to go. And then the third type is mixed incontinence, and that is a combination of the stress and urge.
Host: Now, what are the potential causes of incontinence?
Kelly Huestis: We think about the bladder system. The bladder is really like a water balloon. And as your body is making urine, the bladder is stretching and filling. And at the bottom of the balloon, it's like your urethra and that's the tube where the urine leaves the body. So you have this set of muscles called the pelvic floor and they squeeze around the urethra to keep that urine. And so incontinence can be a problem in either part of that system. So if there's irritability of the actual bladder muscle, the detrusor muscle, that can lead to some urge incontinence or going to the bathroom too soon or too frequently, or a really strong urge, or if there's weakness in those pelvic floor muscles or the supporting structures of the bladder, then you can have leaking because the muscles aren't keeping that urethra closed really well.
Host: So, I thought urinary incontinence is something that happens, you know, as we get older, how come some people are experiencing this at a young age?
Kelly Huestis: Well, we're starting to see more reports of incontinence associated with female athletes and women in the postpartum period or after they have a baby. So for athletes, this can be associated with abnormal shock absorption during landings or impact activities, but for women who are postpartum, it might be that there's damage to the pelvic floor muscles from the actual delivery process, or the muscles may have gotten weakened or stretched during the delivery or they're pushing phase. And urinary incontinence prevalence in women who have had a vaginal delivery is up to about 20%. So we are, you know, hearing it reported a lot more often.
Host: So, are there things in my diet that I can drink or eat that cause this? I mean, how does my lifestyle contribute to incontinence?
Kelly Huestis: Definitely, definitely. It's our favorite beverages. Beverages that contain caffeine, carbonation, alcohol or anything that's really acidic can be a bladder irritant. So some of our most common offenders are coffee, caffeinated teas, sodas, and citrus juices like grapefruit or orange. And for some people spicy food can be a problem as well. So the best thing that you can do is really just stay hydrated with water. And you don't, you want to drink enough to maintain urine that's that clear yellow color, but just sip fluids throughout the day. We don't want to chug a lot of water at one time that we can overwhelm the bladder and lead to some pretty strong urges. So it's also good to limit fluids before bedtime to not get up at night and think about things that are not irritating. So some good things to drink our water. Like I said, if I have a lot of clients that don't like water, they say it's too boring. So you can throw some fruit in it or cucumber slices or some mint. Some herbal teas are a great option or juices that are not as acidic, like Apple juice or decaf tea can be good options.
Host: Once we're diagnosed, what are some treatments that are available to help with incontinence?
Kelly Huestis: Sure. Typical treatment options for urinary incontinence include physical therapy, medication and surgery, and the American Urologic Association advocates to start with the most conservative treatment options first, which is physical therapy. But some patients do like to do medications and physical therapy at the same time, which is totally fine.
Host: No, I had never heard of PT for urinary incontinence. What is pelvic floor physical therapy and how does it help?
Kelly Huestis: Sure. Pelvic floor physical therapy is a specialized area of physical therapy that focuses on the treatment and strengthening of the pelvic floor muscles. So those muscles are the layer of muscle in the bottom of your pelvis. That acts as the floor of your torso and closes around the urethra to keep the urine in. And physical therapists are specially trained in the anatomy of these muscles and the function of these muscles. So with therapy, we focus on teaching patients the correct way to contract the pelvic floor muscles because actually about 50% of women and men do the exercises incorrectly on their own. And then we develop personalized strengthening programs for them. So if you've heard of Kegel exercises, those are contractions of the pelvic floor muscles. But like I said, we know that a lot of people try Kegels and they aren't successful because they might be doing them incorrectly or not the right amount.
And we also know that the pelvic floor muscles work as a part of your core and they work with your breathing and with the abdominal muscles. So we do exercises that tie all those muscles in together. We also have a tool called biofeedback, which allows patients to see a graph that shows how strong their contractions are. And if they're contracting accurately and that's really helpful because these muscles can't be seen, but you can only feel them. So a lot of people aren't sure if they're doing them correctly and that just lets you know. And typically patients will come to therapy about once a week for six to eight weeks and they might see about 60 to 80% improvement in their symptoms, sometimes a hundred percent. And the benefit is that there's no side effects. So it's always a good place to start for your symptoms.
Host: Now wrapping up here. What are some things I can do now to reduce my urinary continence in the future?
Kelly Huestis: Well, you want to be mindful of what you're drinking and eating and how it might be impacting your body. So it's a good idea sometimes to make a log of how often you're going to the bathroom or when the leaks are happening. And then look at also a logging, what you're drinking to see what's going in your body and what's going out. Are there any patterns, sometimes your symptoms are worse than you think of anywhere, or you see that pattern when you see it on paper. So you might see that, Oh wow. All my leaks happen after I drink my morning coffee or you know, I get up at night, but it's because I drink two glasses of water right before bed. So just things that you can see on your own. You want to try not to go to the bathroom just because, or just in case, because that can lead to going to the bathroom too often and your body can get in that habit. Reducing fluids before bedtime can help with getting up at night and most importantly, talk to your doctor or health professional. So I think that too often, people will suffer in silence with these symptoms of urine leakage and accept them as a normal part of being a mom or aging. But there's actually a number of really easy treatment options that aren't expensive and that are covered by insurance and don't require a ton of commitment. So you have that conversation, I think. And if you do want to try pelvic floor physical therapy, you could always ask your physician for a prescription. And if they know of any local therapists to refer to, because we do have a number in the system.
Host: Well, thank you so much, Kelly, for all of this information. You can learn more about how the UM Rehabilitation Network can help you with urinary incontinence and other pelvic floor problems at UMMS.org/rehab-network. That's UMMS.org/rehab-network. Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. I'm Caitlin Whyte, we look forward to you joining us again.
What You Can Do to Treat Urinary Incontinence
Caitlin Whyte: Welcome to Live Greater. The health and wellness podcast brought to you by the University of Maryland Medical System. We put knowledge and care within reach. So you have everything you need to live your life to the fullest. This episode is sponsored by the University of Maryland Rehabilitation Network. Offering a range of physical rehabilitation services, The UM Rehab Network brings together a committed team of experts from across Maryland to help patients recover from illness or injury, such as stroke, joint replacement, or traumatic injury. The University of Maryland Rehabilitation Network, bringing world-class comprehensive rehabilitation services directly to your neighborhood. Today, we're talking about urinary incontinence with Kelly Huestis, a Physical Therapist and Clinical Coordinator of the Pelvic Floor Physical Therapy Program at UM Upper Chesapeake Medical Center. So, Kelly, what are the different types of urinary incontinence?
Kelly Huestis: Generally, we think about three main types of incontinence. Stress incontinence is leaking that can occur when there's a change in abdominal pressure. So when you think of leaking with laughing, coughing, sneezing, or jumping urge incontinence is the second type. And that's when someone has a strong sudden need to go to the bathroom, but they can't quite get there in time and they might leak a little bit. So, if you think of that commercial with the got to go, got to go. And then the third type is mixed incontinence, and that is a combination of the stress and urge.
Host: Now, what are the potential causes of incontinence?
Kelly Huestis: We think about the bladder system. The bladder is really like a water balloon. And as your body is making urine, the bladder is stretching and filling. And at the bottom of the balloon, it's like your urethra and that's the tube where the urine leaves the body. So you have this set of muscles called the pelvic floor and they squeeze around the urethra to keep that urine. And so incontinence can be a problem in either part of that system. So if there's irritability of the actual bladder muscle, the detrusor muscle, that can lead to some urge incontinence or going to the bathroom too soon or too frequently, or a really strong urge, or if there's weakness in those pelvic floor muscles or the supporting structures of the bladder, then you can have leaking because the muscles aren't keeping that urethra closed really well.
Host: So, I thought urinary incontinence is something that happens, you know, as we get older, how come some people are experiencing this at a young age?
Kelly Huestis: Well, we're starting to see more reports of incontinence associated with female athletes and women in the postpartum period or after they have a baby. So for athletes, this can be associated with abnormal shock absorption during landings or impact activities, but for women who are postpartum, it might be that there's damage to the pelvic floor muscles from the actual delivery process, or the muscles may have gotten weakened or stretched during the delivery or they're pushing phase. And urinary incontinence prevalence in women who have had a vaginal delivery is up to about 20%. So we are, you know, hearing it reported a lot more often.
Host: So, are there things in my diet that I can drink or eat that cause this? I mean, how does my lifestyle contribute to incontinence?
Kelly Huestis: Definitely, definitely. It's our favorite beverages. Beverages that contain caffeine, carbonation, alcohol or anything that's really acidic can be a bladder irritant. So some of our most common offenders are coffee, caffeinated teas, sodas, and citrus juices like grapefruit or orange. And for some people spicy food can be a problem as well. So the best thing that you can do is really just stay hydrated with water. And you don't, you want to drink enough to maintain urine that's that clear yellow color, but just sip fluids throughout the day. We don't want to chug a lot of water at one time that we can overwhelm the bladder and lead to some pretty strong urges. So it's also good to limit fluids before bedtime to not get up at night and think about things that are not irritating. So some good things to drink our water. Like I said, if I have a lot of clients that don't like water, they say it's too boring. So you can throw some fruit in it or cucumber slices or some mint. Some herbal teas are a great option or juices that are not as acidic, like Apple juice or decaf tea can be good options.
Host: Once we're diagnosed, what are some treatments that are available to help with incontinence?
Kelly Huestis: Sure. Typical treatment options for urinary incontinence include physical therapy, medication and surgery, and the American Urologic Association advocates to start with the most conservative treatment options first, which is physical therapy. But some patients do like to do medications and physical therapy at the same time, which is totally fine.
Host: No, I had never heard of PT for urinary incontinence. What is pelvic floor physical therapy and how does it help?
Kelly Huestis: Sure. Pelvic floor physical therapy is a specialized area of physical therapy that focuses on the treatment and strengthening of the pelvic floor muscles. So those muscles are the layer of muscle in the bottom of your pelvis. That acts as the floor of your torso and closes around the urethra to keep the urine in. And physical therapists are specially trained in the anatomy of these muscles and the function of these muscles. So with therapy, we focus on teaching patients the correct way to contract the pelvic floor muscles because actually about 50% of women and men do the exercises incorrectly on their own. And then we develop personalized strengthening programs for them. So if you've heard of Kegel exercises, those are contractions of the pelvic floor muscles. But like I said, we know that a lot of people try Kegels and they aren't successful because they might be doing them incorrectly or not the right amount.
And we also know that the pelvic floor muscles work as a part of your core and they work with your breathing and with the abdominal muscles. So we do exercises that tie all those muscles in together. We also have a tool called biofeedback, which allows patients to see a graph that shows how strong their contractions are. And if they're contracting accurately and that's really helpful because these muscles can't be seen, but you can only feel them. So a lot of people aren't sure if they're doing them correctly and that just lets you know. And typically patients will come to therapy about once a week for six to eight weeks and they might see about 60 to 80% improvement in their symptoms, sometimes a hundred percent. And the benefit is that there's no side effects. So it's always a good place to start for your symptoms.
Host: Now wrapping up here. What are some things I can do now to reduce my urinary continence in the future?
Kelly Huestis: Well, you want to be mindful of what you're drinking and eating and how it might be impacting your body. So it's a good idea sometimes to make a log of how often you're going to the bathroom or when the leaks are happening. And then look at also a logging, what you're drinking to see what's going in your body and what's going out. Are there any patterns, sometimes your symptoms are worse than you think of anywhere, or you see that pattern when you see it on paper. So you might see that, Oh wow. All my leaks happen after I drink my morning coffee or you know, I get up at night, but it's because I drink two glasses of water right before bed. So just things that you can see on your own. You want to try not to go to the bathroom just because, or just in case, because that can lead to going to the bathroom too often and your body can get in that habit. Reducing fluids before bedtime can help with getting up at night and most importantly, talk to your doctor or health professional. So I think that too often, people will suffer in silence with these symptoms of urine leakage and accept them as a normal part of being a mom or aging. But there's actually a number of really easy treatment options that aren't expensive and that are covered by insurance and don't require a ton of commitment. So you have that conversation, I think. And if you do want to try pelvic floor physical therapy, you could always ask your physician for a prescription. And if they know of any local therapists to refer to, because we do have a number in the system.
Host: Well, thank you so much, Kelly, for all of this information. You can learn more about how the UM Rehabilitation Network can help you with urinary incontinence and other pelvic floor problems at UMMS.org/rehab-network. That's UMMS.org/rehab-network. Thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. I'm Caitlin Whyte, we look forward to you joining us again.