Incontinence in Women

Debi Schneider and Kelley McClinton, physical therapists at Memorial's Orthopedic and Neurosciences Center, help women with incontinence as they age or after childbirth.

Why should women tell their doctor if they have incontinence?

A lot of women suffer from incontinence starting at a very young age but have difficulty talking to their doctor. If more women realized that incontinence is also a muscular controlled function, we could really aid in helping them. We've seen some excellent results even to the point where people no longer needed to do additional surgery.

Why does childbirth cause incontinence?

Pregnancy is a very natural process, but in the process of having a child, the muscles of the pelvis are stretched beyond belief. In that case, the muscles are no longer what we would consider normal. Our job is to re-educate those muscles to assist the mothers to not only be continent but also recover from that delivery more readily. We would like to do that pre-pregnancy or pre-delivery, but we don't always get that opportunity. So, we usually see the patients postpartum.

Why can women develop incontinence as they age?

The aging process of the entire body is fascinating. You can see some people who are 90 years old and look like they're 70, some people who are 70 and look like they're about 110. It's about taking care of your body in general. With pelvic floor health, it's the same thing. The muscles lose their ability to contract, especially if we're not exercising. Exercise is imperative to maintaining not only overall general health but also pelvic floor health. You need to start strengthening this when you're a teenager or certainly in your 20s, continue that throughout your entire life and it will stay as strong as the rest of your body if you are an exerciser.

How can women exercise those pelvic floor muscles?

When we address the muscular issues of the pelvic floor, we try to tell people to imagine the pelvic floor muscles as being a sling that basically is there to support your internal organs. They're also there to function to prevent leakage from the urethra, which is what's going to be emptying the bladder. This sling of muscles is deep and a lot of people think they're doing the exercises correctly when they tighten their stomach or hip muscles. These muscles are stretched to a level that they haven't been stretched to before. It's difficult to contract them again, so women develop incontinence. What we're going to do is focus on this sling of muscles and teach them where those muscles are. We have talked about how women have said, "I had no idea," because they are so concentrated on using their abdominal muscles or their gluteal muscles—anything but the pelvic floor muscles. Unless you're taught properly where those muscles are, you're not sure how to use those. The whole focus of incontinence, whether it's postpartum or with aging, is to learn where those muscles are and how to contract them. 

How do you teach women to exercise the correct muscles?

We use different techniques. We do an examination. We do biofeedback. Biofeedback is a technique where we actually use a machine that shows you what the muscles are doing. I often explain that it's similar to an EKG. An EKG is showing you what the heart muscle is doing. Our screen is showing you what the pelvic floor muscles are doing. It's not creating any type of current but is showing us a picture of how the muscles are responding. We teach them by watching this screen. As they're able to have a higher level of contraction, the dial is going to go up higher. It's a good technique. 

What kind of success rate do you see after treatment?

We're all just very, very blessed to see almost a 100% success rate. It doesn't mean that they're 100% "cured," but they're 100% better. Their lives have changed. They can go out to dinner with their spouses or their friends without worrying about where every bathroom is. They can cough and sneeze without worrying. They can go back to actually exercising without leaking as well. Their quality of life has improved immensely even though they might not be 100%. We had one patient, a beautiful woman, who came in very distraught because her life revolved around her bladder...where she could go, who she could be with, and it was always very embarrassing because she felt like there was an odor and her life had stopped. Within a very short period of time, and after making dietary changes and some muscular strengthening improvements, she was about 75% improved. Not only was it gratifying for us, but it was amazingly satisfying for her to be able to resume a more normal life.