Urinary incontinence, or involuntary loss of bladder control, isn't something that just happens to older woman. In fact, the condition affects men and women alike, young and old. More than 17 million Americans have urinary incontinence, and the experience can leave them feeling ashamed, socially isolated, and depressed, yet only 15 percent seek treatment.*  According to the American Physical Therapy Association (APTA), those who experience incontinence need not feel this way, as proper preventive measures and treatment can help patients manage, if not alleviate, this often debilitating condition.

"While bladder control problems occur twice as often in women, men also experience incontinence, particularly after prostate surgery or lower back injuries," says physical therapist Karen Red, PT, who focuses on bowel, bladder, and sexual dysfunction at the Mechanicsburg Office of First Choice Rehab. She notes that structural or nerve damage from surgery or injury may result in chronic incontinence, or long-term difficulty controlling urination.

Red also works with incontinence patients as young as 6, who present with the symptoms as a result of poor muscle development in childhood, constipation, pediatric surgery or while participating in highly intense athletics such as track and field.

Ms. Red also notes that the number of people with urinary incontinence is most likely much higher than reported. "Patients often think that because of age or medical history, incontinence is something they have to learn to live with, but in reality that couldn't be further from the truth," she says. "Health care professionals need to be aware of the role that physical therapists play in treating incontinence so that their patients know about alternatives to diapers, medication, or surgery."

Types of Incontinence

According to Red, one of the two most common types of incontinence is stress incontinence (a sudden involuntary loss of urine when moving in a certain way, such as when exercising, sneezing, laughing or coughing) that may result from pregnancy, childbirth, menopause, or pelvic surgery. "During pregnancy and childbirth, weakened pelvic floor muscles and poor ligament support at the bladder can lead to stress incontinence which may or  may not resolve itself," said Red. "Similarly, women going through menopause experience incontinence because the reduction in estrogen can contribute to weakened vaginal tissues," she added.

Other contributors to stress incontinence may include:

• Pelvic surgery, such as hysterectomy
• Constipation
• Obesity
• Chronic cough that may be associated with pulmonary diseases
• Urinary tract abnormalities
• Certain over-the-counter cold medications

The causes of urge incontinence (when the bladder muscle contracts at the wrong time, causing leakage with the urge to urinate) can be less clear-cut, notes Red. Possible causes are urinary tract infection, kidney stones, constipation, neurological disorders (such as Parkinson disease or multiple sclerosis), bladder irritants such as chocolate, caffeine, or nicotine and poor bladder support problems caused by pelvic floor weakness. "To effectively treat or manage bladder control problems, it is essential to first get a proper diagnosis," cautions Red.

Squeeze Before You Sneeze!

Physical therapists use a variety of methods to help patients correct pelvic floor weakness. They evaluate the extent of incontinence, identify treatment goals and make sure patients understand how treatment works. Kegel exercises, or pelvic floor muscle exercises that involve contracting, holding, and releasing pelvic floor muscles, are the most effective weapon in the fight against stress incontinence, notes Red. "Identifying the correct muscles is imperative. Studies have shown that the ability to isolate the pelvic floor muscle is not a skill we are born with. For many it is as difficult as learning to "wiggle your ears." Once the motor learning is established, the exercises can be done during daily activities, such as while sitting at your desk, driving, or watching television.

Physical therapists can also offer tips on lifestyle changes that will help make the bladder less irritable -- including lifting and moving correctly, avoiding common bladder irritants, keeping a bladder diary, and exercising correctly, such as avoiding improper sit-up techniques.

Ms. Red summarizes, "The bottom line is that incontinence is a treatable condition. It is often a symptom of other underlying conditions which can be addressed in a comprehensive pelvic floor program."

* Both statistics from National Association for Continence (NAFC)