Wednesday, January 18, 2012

Embarrassing Health Questions Answered: What To Do about Urinary Leakage

Women are often embarrassed to admit or
ask questions about their bladder problems.
Physical therapy can help, which is
good news you can use.
This week's guest post is by physiotherapist and yoga expert Shelly Prosko. Visit Shelly at

It is a fact that 53% of women between the ages of 20-80 years old experience urinary incontinence (the inability to control the bladder) at some point in their lives (Culligan & Heit, 2000). Less than half of these women do not even mention it to their physician (Burgio, 1994) perhaps because they are too embarrassed, or simply because they think it is normal to experience ‘a bit of leakage’ when they sneeze or laugh.  Or, that it is normal after pregnancy or with age.  Or, that is normal because their mom, sister, and best friend all experience a ‘bit of leakage’ too.  

But it is not normal.   

Yes, it is common, but not normal.  Urinary incontinence can be prevented and treated in most cases.

The two main types of urinary incontinence are stress and urge.  It is important to know the difference between the two, and know which one you may have, in order to treat it accurately. However, it is common to have a combination of the two as well. 

Stress incontinence is what occurs when the pelvic floor muscles (PFM’s) have become too weak to stop the flow of urine during actions that put pressure or stress on the bladder, such as coughing, sneezing, laughing, twisting, or lifting.  Pelvic floor weakness can result from the muscles being overstretched during childbirth or even from low estrogen levels, such as during menstruation or menopause. 

Urge incontinence is when there is a sudden ‘urge’ to urinate with an inability to control the bladder.  This happens when the pelvic floor muscles are chronically tense to the point of fatigue, and consequently give out at inappropriate times.  If the PFM’s are consistently tense, without knowing how to relax, release, and control them, other problems in addition to urge incontinence can arise like low back pain, irritable bowel syndrome, interstitial cystitis, and painful intercourse. 

Many people believe that the popular Kegel exercises which consist of ‘squeezing’ the PFM’s will solve the leakage problems. However, this is not necessarily the case.  If your incontinence is due to chronically tensed PFM’s that are fatiguing (urge incontinence), then simply performing Kegel exercises may actually be worsening your problem. Learning how to release your PFM’s in conjunction with diaphragmatic breathing would be more beneficial for someone with urge incontinence. If your incontinence is PFM weakness due to being overstretched or inadequately activated, then correctly prescribed Kegel exercises can help.  But Kegel exercises do not address all of the muscles that are important for a healthy pelvic floor. Kegels are still only a small part of the overall treatment of this dysfunction.  

Treatment of incontinence may begin by learning how to activate, release, and control the PFM’s.  PFM training with a physical therapist has been recommended for women suffering from stress urinary incontinence and for prevention of urinary incontinence during pregnancy and after delivery (Britnell, et al 2005). Successful physiotherapy treatment protocols also include hip adductor and deep abdominal muscle strengthening, lumbar or core stability training, and prescription of exercises that address postural mal-alignment or hip tightness that may be contributing to pelvic floor weakness.  Education regarding bladder irritants in the diet can also be included in your treatment plan.

Yoga and Pilates have also been shown to improve both types of incontinence due to their ability to address the above areas. 

A physical therapist trained in this area will be able to help diagnose which type of incontinence you may have, and help develop an appropriate treatment plan.  Treatment need not be invasive and usually consists of 4 to 6 visits.  The assessment typically consists of a series of questions followed by a physical examination of postural alignment, hip, pelvis and abdominal strength and flexibility testing.  Although incontinence is common, it can be treated.  So whether you are a new mom or a retiree, you can still continue to enjoy a healthy lifestyle knowing you have confidence in controlling your bladder.

Ask your OB/gyn or midwife about physical therapy if you are suffering from urinary leakage. You can, in many states in the US, also go directly to your local physical therapist without a doctor's referral to receive evaluation and care for women's health issues such as incontinence.

About the Author
Shelly Prosko, RPT, PYT-C, CPI

Shelly is a Registered Physiotherapist, Yoga Therapist and a Certified Pilates Instructor. She received her Physiotherapy degree at the University of Saskatchewan, Canada in 1998, her Yoga Therapist training through Professional Yoga Therapy Studies in North Carolina ( and her Pilates certification through Professional Health and Fitness Institute in Maryland (

She has treated a wide variety of musculoskeletal, neurological and cardiorespiratory conditions while working in private orthopaedic clinics and long term care facilities across Canada and the United States. Shelly was the physiotherapist and clinic manager at The Morris Center For Sports Medicine in Watkinsville, Georgia for 7 years. In 2006, she relocated to Alberta and continued to work in the private orthopaedic clinic setting and was actively involved in the occupational rehabilitation programs at CBI Health.

In 2009, Shelly settled in the Okanagan and continues to follow her passions at Sun City Physiotherapy by offering private Physio-Yoga Therapy sessions and by incorporating Yoga Therapy and Pilates into her physiotherapy treatments ( She also teaches specialty Physio-Yoga Therapy classes in the community. She believes that bridging the gap between Western and Eastern healthcare philosophies is essential in order to achieve optimal health. Consequently, her treatments are individually based and are a unique blend of both approaches.

In addition to her many skills as a health care practitioner, Shelly is also an accomplished figure skater and has traveled the world with many professional ice shows. She is also passionate about music, dance, acting, trapeze, and spending quality time with her family and friends.


  1. Thank you for mentioning about incontinence and treatment of incontinence

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