Incontinence in Women

Debi Schneider and Stephanie Hemker, 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.

What are some misconceptions women have regarding incontinence?

A lot of people will ask if they’re the only person that leaks when they cough or laugh. Or they’ll also say that they think it’s normal because on TV there are a lot of commercials that have normalized incontinence. Or some people will say, “I’ve had four kids. I just thought it was normal that I would have pain with intercourse or that I would have leakage.” But that’s actually not true, and we’re here to give them some more information and help them get their life back.

Talk about how pelvic floor dysfunction can cause incontinence.

The pelvic floor is a group of muscles that sit in the lower pelvis. They aid in urination, defecation, and sexual function. They also help to support the pelvis, the hips, and the low back. Sometimes patients come with issues where their pelvic floor is weak. These patients may complain of urine leakage when they cough, laugh, sneeze, jump, or exercise.

What kind of treatments are used to help strengthen pelvic floor muscles?

The whole focus of incontinence, whether it’s postpartum or with aging, is to learn where those muscles are and how to contract them. We try to tell people to imagine the pelvic floor muscles as being a sling that 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. We focus on and teach them where this sling of muscles is.

We cater a program to the specific needs of the patient. Depending on what we find with their alignment, we may do some corrections to that. We may do some soft tissue work or massage-type techniques to those muscles. I may have the patient do exercises where they are coordinating their pelvic floor muscles with their core muscles with their breathing patterns.

Then, there’s also something called biofeedback, which uses an electrode inserted into the vagina or rectum and gives a readout onto a computer as to what the muscles are doing. It’s similar to an EKG with the EKG 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 giving us a picture of how the muscles are responding. Then, we teach them to watch the screen and show them that the dial will go up higher with a higher level of contraction. It’s a good technique.