With more than 1 in 2 women suffering from urinary incontinence, it’s no question that understanding urinary incontinence is important to overcoming symptoms. Welcome to Your Guide to Urinary Incontinence by Flyte, where you will learn what type of urinary incontinence you may have, the causes of urinary incontinence, if it is considered normal to have incontinence at certain stages of life, and what conservative treatment options are available to help you treat your incontinence and lead a more confident life.

Table of Contents

1. Types of Urinary Incontinence.

2. Common Causes of Urinary Incontinence

3. When is Urinary Incontinence Normal?

4. Conservative Treatment Options for Urinary Incontinence

Types of Urinary Incontinence

There are several different types of urinary incontinence. The following three are the most common.     

• Stress Urinary Incontinence (SUI): Involuntary loss of urine with activities that cause an increase in intra-abdominal pressure. For example, when coughing, laughing, sneezing, lifting, or exercising.
• Urgency Urinary Incontinence (UUI):A strong and usually sudden urge to urinate followed by involuntary loss of urine. For example, leaking on the way to the bathroom.
• Overactive bladder (OAB): According to the Mayo Clinic, symptoms may include feeling a sudden and difficult to control urge to urinate, urge incontinence, frequent urination usually over 8x in 24 hours, and waking up more than 2x at night to urinate. OAB and UUI can present together or separately.

• Mixed Urinary Incontinence (MUI): A combination of urgency urinary incontinence and stress urinary incontinence.

Take the Flyte Urinary Incontinence Quiz to find out what type of urinary incontinence you have – stress, urgency, or mixed?

Common Causes of Urinary Incontinence

There is no single cause of urinary incontinence. Your urinary incontinence may be driven by a certain issue, or it may be multifactorial, requiring specialized care to get to the root cause. Either way, understanding some of the potential causes of urinary incontinence equips you with the knowledge of what treatment options may be best for you.

Weak Pelvic Floor Muscles

The pelvic floor is a term describing a group of muscles and connective tissues, attaching from your pubic bone to your tailbone and between your two sit bones to create a “sling” or “hammock.” Your pelvic floor has several important functions including stabilization of your spine, hips, and pelvis, support of your abdominal and pelvic organs, control of the urethral and anal sphincters, sexual function, and circulation.

If your pelvic floor muscles are too weak, they cannot sufficiently contract and close the urethral sphincter (the tube that carries urine from your bladder to the outside) to prevent urine from escaping. Multiple factors can cause weak pelvic floor muscles including strain from pregnancy and childbirth, nerve irritation, normal muscle decline with aging, surgery, and more.

Pelvic floor muscle training is recognized as a first-line treatment for stress urinary incontinence caused by weak pelvic floor muscles. Many women are not familiar with where their pelvic floor muscles are or how they function. Understanding pelvic floor anatomy is the first step in understanding why urinary incontinence and pelvic floor dysfunction happens. Watch Flyte’s Demystifying the Pelvic Floor Video to learn more.

Overactive or Chronically Tight Pelvic Floor Muscles

Your pelvic floor muscles may be tight or “overactive,” which surprisingly can also cause pelvic floor muscle weakness. Overactive pelvic floor muscles mean your pelvic floor is working in overdrive. Potential reasons for overactive pelvic floor muscles include compensation for other muscle weakness in the core/pelvis, stabilization for hypermobility in the spine, hip, or pelvis, and chronic stress that results in unconscious tensioning of the perineal or perianal region.

Overactive or tight pelvic floor muscles can cause urinary incontinence. So how do you know if you have an overactive pelvic floor?

To determine if you have overactive or tight pelvic floor, ask yourself these questions:

1. Do I have pain with tampons, intercourse, or during a pelvic exam?
2. Do I struggle to start or empty my bladder or bowels?
3. When I try to do a Kegel, do I feel any movement in my vagina, anus, or between my sit-bones?

If you answered yes to any of these questions, you may have an overactive or tight pelvic floor. Learning how to relax and stretch these muscles may be beneficial prior to beginning a pelvic floor strengthening program. Always consult with your healthcare provider and consider seeing a pelvic floor physical therapist if you suspect that you may have an overactive pelvic floor.

Connect with Flyte’s Ask A (Pelvic) PT to ask questions and receive general guidance (not medical advice) to help you learn if Flyte is right for your incontinence symptoms or if you may benefit from learning to relax your pelvic floor muscles first. Still unsure? Learn more about whether you should Kegel or Not Kegel.

Hormonal Changes

Hormonal changes – common during pregnancy, postpartum, perimenopause, and following hysterectomy – can contribute to symptoms of urinary incontinence. Hormones play an integral role in keeping the muscle and connective tissues that support the urethra healthy. With significant changes in level of hormones such as estrogen, women may notice the onset of urinary incontinence symptoms or a worsening of existing incontinence symptoms.

Nerve Changes

Several different nerves play a crucial role in connecting the nervous system, including the brain and spinal cord, to muscles such as the bladder, pelvic floor muscles, and surrounding pelvic muscles. An injury to the spine or a neurological condition can impact this communication. The result? Changes in your bowel and bladder function, including onset or worsening of urinary incontinence.

Bladder Habits

Another way the nervous system plays a role in continence is through bladder habits. Certain bladder habits can increase the incidence of urinary leakage, especially urinary frequency and urgency urinary incontinence. Examples include:

1. Urinating “Just-In-Case": This habit teaches the bladder that it needs to empty before it is full. As a result, the bladder may begin cueing you that it needs to empty more often than necessary. One way to tell if this may be impacting you is if you feel the urge to urinate but when you do urinate, your stream of urine only lasts a couple of seconds instead of the recommended 8-20 seconds (8-10 seconds is about a half full bladder; 16-20 seconds is approximately a full bladder).
2. Building Associations within the Environment: An example of this is what we call “key in the door” syndrome. Let’s say you are feeling the urge to urinate while driving home but feel in control of your bladder. However, once you get out of the car, walk up to the house, and place your key into the front door lock? Suddenly the urge to urinate has increased ten-fold and you’re not sure if you will make it to the toilet in time. These behavioral associations teach the brain and in consequence the bladder to respond to certain environmental triggers.
3. Pushing Out Your Pee: While urinating, you should be breathing normally and relaxing your pelvic floor muscles to allow urine to leave your body through the urethra. Your bladder is a muscle that pushes the pee out for you, so if you are “power peeing” you are actually weakening your pelvic floor muscles.
4. Hovering Over the Toilet: Keeping your bottom off the toilet seat while urinating causes your pelvic floor muscles to tighten. When your pelvic floor muscles are tight, they close the urethra, and your bladder cannot empty correctly. Many women who “power pee” often must push out their urine due to pelvic floor tightness closing off the urethra. If you find you struggle with starting your flow of urine, you may need to work on pelvic floor relaxation.
5. Consuming Bladder Irritants: Certain foods and drinks may irritate the bladder more than others. Learn more about common bladder irritants that may be worsening your leaks.

Poorly Managed Abdominal Pressure

Stress urinary incontinence can be caused by poor management of the pressure within the abdomen and pelvis. Even with a strong and capable pelvic floor, if the pressure from above is too much, incontinence will result. For example, a large and violent sneeze that causes you to bend over and exert a lot of force may lead to more urinary incontinence than a gentle, quiet sneeze.

When the deep muscles in your abdomen and pelvis are not functioning harmoniously, incontinence can result during routine activities. This dysfunction in the pelvic floor, along with excessive, mis-managed pressure in the abdomen, can give rise to symptoms of pelvic organ prolapse, potentially exacerbating urinary incontinence.

Proper breathing plays a pivotal role in managing intra-abdominal pressure, offering a valuable strategy for improving urinary incontinence by promoting stability in the lumbopelvic region. The images below are an example breathing exercise to help promote lumbopelvic stability.

Constipation

Constipation is defined as having three or fewer bowel movements a week or difficulty passing hard stools. Constipation is often associated with excessive breath holding, straining, and pushing, leading to increased pressure into the pelvis and pelvic floor. This can increase pressure on the bladder and lead to an onset or worsening of incontinence and to pelvic organ prolapse.

Addressing constipation is important in managing incontinence symptoms. Constipation is also often associated with dehydration or not drinking enough water. Dehydration makes urine more concentrated, irritating the bladder lining, and worsening incontinence or urgency symptoms.

When is Urinary Incontinence Normal?

Many women operate under the assumption that incontinence is just part of being a woman in a certain stage of life. As a result, many women do not seek out solutions to their symptoms and allow their incontinence to continue or worsen over time. Urinary incontinence is very common but is never normal.

Urinary incontinence is ranked in the top three negative impactors on quality of life, right behind stroke and Alzheimer’s. Up to 40% of adults over sixty-five years of age are full-time users of absorbent incontinence pads due to urinary incontinence. Furthermore, a 2016 study found that only 3% of conversations about incontinence were initiated by healthcare providers.

Treating urinary incontinence is important for overall physical and mental wellness. Being informed on the types of urinary incontinence, the various causes, and treatment options are great first steps to improving your quality of life quickly and effectively.

Stress urinary incontinence is the most common type of urinary incontinence and specifically, is most common in postpartum, athletic, and peri- and post-menopausal women.

Physical and hormonal changes during pregnancy and postpartum may lead to the onset of urinary incontinence or worsening of previously present urinary incontinence. Learn more about urinary incontinence during pregnancy and postpartum and what you can do to help.

Significant changes in hormones during perimenopause can contribute to urinary incontinence onset or worsening of previously present incontinence. There are many factors that may lead to incontinence during this phase of life. Learn more about urinary incontinence during menopause, genitourinary syndrome of menopause, how to interpret a bladder diary to interpret your symptoms, and at-home tips to improve your symptoms.

Increased, repetitive loading through high-impact activities shows up as increased incidence of urinary incontinence in athletes. Athletes have a 177% higher risk of urinary incontinence compared to inactive women. Often, the athlete’s choice of sport isn’t necessarily the issue but instead, the underlying physical inadequacies that lead to onset or worsening or urinary incontinence. Learn more about how to stop leaking urine with activities such as running and 3 at-home tips to reduce leaking urine with athletic and everyday activities.

Conservative Treatment Options for Urinary Incontinence

Once you’ve identified what type of urinary incontinence symptoms you have and what the root causes may be, it’s time to explore your treatment options. Below are some of the conservative treatment options available for women with urinary incontinence, as recommended by professional organizations including the American Urological Association and the American Physical Therapy Association Academy of Pelvic Health. However, always consult with your healthcare provider about what the best individual choice is for you. Your doctor or pelvic floor physical therapist may recommend further diagnostics or evaluation to understand the root cause of your incontinence symptoms.

For some women, one of the above conservative treatment options is enough to fully eliminate their incontinence symptoms. For others, one of the above options may begin to improve their quality of life, but to fully address their urinary incontinence, a combination of treatment options may be needed. To better understand the above conservative treatment options, see a brief summary of each below:

Flyte: Mechanotherapy for the Pelvic Floor

Flyte is the only FDA-cleared in-home pelvic floor device that delivers transvaginal mechanotherapy to treat urinary incontinence and strengthens pelvic floor muscles in the fastest in-home treatment available for stress and mixed urinary incontinence 5 minutes a day for 6 weeks). Simple to use and backed by two published clinical studies showing results comparable to surgical results, Flyte uses the transvaginal mechanotherapy to promote cellular healing and structural changes that lead to improved pelvic floor muscle strength and tone. Learn more about Flyte and how it works.

Behavioral Therapies

Behavioral therapies include bladder drills, fluid management, and lifestyle changes to address incontinence symptoms. Bladder drills (also known as urge suppression techniques) are actionable techniques to retrain the brain-bladder connection to reduce urinary leakage, frequency, and/or urgency.

• Bladder Drills/Urge Suppression Techniques

• Stop what you are doing. When the urgency sensation comes on quickly, stop what you are doing, sit down and focus on your breathing. Try not to rush to the toilet. 
• Relax. Take a few deep breaths. This will help with the strong urge to urinate until it starts to calm down. 
• Distract yourself. Think of something besides having to go to the bathroom. (e.g. try alphabetizing the months of the year)
• Kegels. Squeeze your pelvic floor muscles. Squeeze and lift and let go quickly 5-10x or until the urge passes. Continue breathing normally.
• Pressure. You can place pressure on the perineum with your hand, or a towel, sit down, or sit on your heel to help control the urge to urinate. 
• Heel raises. If you are unable to sit down, while standing go up and down on your toes, lifting your heels, several times until the urge passes. 

Additionally, making changes to fluid management or to your lifestyle can be helpful; keeping a bladder diary can help you determine what changes to prioritize.

Bladder Diary

A bladder diary helps you identify patterns in your day that may be contributing to your incontinence symptoms. Factors that are often considered include food and drink intake, timing of food and drink intake, time in between urinating, number of times urination occurs during the day, how long it takes to urinate, presence and intensity of a urinary urge, and timing and amount of any urinary incontinence.

Download Flyte’s Bladder Diary here. Fill it out on three separate days and read the interpretation guide to help you determine what changes you can begin making in your habits to reduce your incontinence symptoms.

Pelvic Floor Physical Therapy

A pelvic floor physical therapist is a physical therapist with additional certifications and training to evaluate and treat pelvic health conditions, including all types of urinary incontinence. A pelvic floor physical therapist (PT) is highly specialized to use conservative physical therapy interventions such as hands-on manual therapy, therapeutic exercises, coordination training, and more to address your individual symptom presentation and help you reach your goals.

If you are comfortable and your pelvic floor PT believes it would be beneficial to your plan of care, they may suggest performing an internal examination of your pelvic floor muscles for further information on how to best treat your condition.

Flyte has Doctors of Physical Therapy specialized in pelvic health staffing their complimentary Ask A (Pelvic) PT Service. Flyte’s pelvic floor physical therapists do not offer individualized medical advice but do provide general information on pelvic floor health. When you schedule a call with Flyte’s pelvic floor physical therapists, you can...

• Ask questions about your pelvic health symptoms
• Receive general education about pelvic health (ex: what may indicate a tight pelvic floor versus a weak one, does increasing fluid intake help with incontinence, etc.)
• Receive education, tips, and tricks about improving pelvic health
• Get pointed to validated sources of information regarding your specific pelvic health condition, questions, or concerns
• Ask questions about Flyte and get screened to learn if Flyte may be right for you
• Receive a recommendation to the appropriate specialist or healthcare provider in your area, if appropriate

Transcutaneous or Posterior Tibial Nerve Stimulation (TTNS/PTNS) and Sacral Neuromodulation

Transcutaneous or Posterior Tibial Nerve Stimulation (TTNS/PTNS) is the use of electrical stimulation, delivered through surface-level self-adhesive electrodes, along the posterior tibial nerve to inhibit reflex bladder contractions. The electrodes are placed along the inside of your foot/ankle and lower leg. This technique stimulates the nerves that play a role in bladder control and is a form of neuromodulation. Additional non-invasive electrical stimulation options can be available in-clinic. Your doctor may also recommend other types of neuromodulation treatments, such as implanted sacral neuromodulation. While not effective for stress urinary incontinence, neuromodulation may be recommended for urgency urinary incontinence, and fecal incontinence. 

Medication (Pharmacological Intervention)

There are currently no FDA approved medications to treat stress urinary incontinence in the United States.

In other cases, medication may be helpful in addressing your symptoms of overactive bladder, urinary urgency, or frequency. Be sure to talk to your doctor about side effects, a timeline for when you should be able to wean off the medication, and what needs to be done to lower or discontinue medication use in the future. If appropriate, a topical estrogen cream may be prescribed to help address the impact of hormonal changes, such as during perimenopause or postpartum.

Continence Pessary

A pessary is a small, easily removable device that is placed into the vagina to lift the bladder or close off the urethral sphincter to reduce urinary incontinence.

At-Home Kegels

Pelvic floor muscle strengthening exercises, or Kegels, is a first-line treatment for stress urinary incontinence. Many women who do Kegel exercises are uncertain about whether they are doing them correctly, including the frequency and position for optimal effectiveness. Without validation that the Kegels are being performed effectively, staying compliant with these exercises is difficult.

Take the time to learn how to properly perform a Kegel. As with any exercise, quality is more important than quantity. If you are performing Kegels consistently at home and not noticing much change in your symptoms within 8-12 weeks, ask your doctor about Flyte for a more effective way to strengthen your pelvic floor muscles in just 6 weeks.

 

Your Guide to Urinary Incontinence empowers you to combat your urinary incontinence symptoms. Advocate for yourself and seek out conservative options to treat the root cause of your issue. You should always feel that you are heard and supported by your healthcare providers. If this is not the case, remember that you are part of your own patient care team and you can always seek out a second opinion to further understand your options.

Easily connect with a pelvic floor physical therapist by scheduling a call for support and guidance.

 

References available from Flyte by Pelvital upon request.