There are a variety of treatment options for urinary incontinence, ranging from behavioral therapy to surgical interventions

Various Therapies

Behavioral Therapy: The purpose of this therapy is to increase the holding capacity of the bladder. By increasing the capacity of the bladder you gain more bladder control. This therapy typically involves 1) patient education, 2) fluid and dietary management (avoiding bladder irritants such as caffeine), 3) bladder retraining, and 4) urination log. Behavioral therapy may be a simple, effective, and non-invasive treatment that can work for some people. Others might need to include additional therapies.

Physical Therapy: This therapy is a hands-on technique provided by a licensed, qualified pelvic floor physical therapist and is often combined with behavioral therapy. Pelvic floor muscle training is the individualized instruction of relaxation and contraction of the pelvic floor muscles. This has been commonly referred to as “Kegels.” This term is outdated and does not adequately describe what muscles need to contract or relax for a given individual.

It is important to understand that doing pelvic floor contractions (Kegels) without the guidance and instruction by a trained therapist is a contraindication and can do more harm that good.

Overall, physical therapy is a durable, simple, and effective long-term solution to managing SUI; however, the success of physical therapy to treat SUI is almost entirely dependent on how committed the client is to doing the prescribed exercises on a routine basis. SUI can re-emerge if clients stop doing the prescribed exercises. On the bright side, starting effective physical therapy before SUI begins is the best way to prevent SUI.

Pharmacological: There are a plethora of prescription medications that have been used to treat SUI with varying success. Examples include α-adrenergic agonists, Imipramine, Duloxetine, β-Adrenergic Antagonists, and hormonal treatments. Prescription medication can be helpful, but is not considered a first-line treatment because this solution is neither 100% effective, cost-effective, permanent, and may come with unintended and unwanted side-effects.

Surgical: This form of therapy is the most invasive and expensive, but may be the last and only option for those struggling with SUI that has been unchanged by other therapies. There are over 200 different types of surgical corrective surgical techniques to address SUI. Most surgeries aim to stabilize and support the urethra and bladder neck and/or increased compression of the urethra or bladder neck. Multiple surgeries tend to be less effective and can increase post-surgical complications; the success of the surgery is also highly dependent on the surgeons expertise and comfort with the type of surgical technique.

Pelvic Floor Muscle Training

The most common initial treatment for pelvic floor dysfunction is pelvic floor muscle training (PFMT) by a licensed physical therapist.  Treatment protocols vary, but typically include several weeks of manual therapy and a home exercise program. Evidence concludes that PFMT should include a minimum of 8 weeks of instruction and guidance from a licensed physical therapist to adequately address long-term SUI.

Pelvic floor muscle training is almost entirely dependent on the client’s commitment to use the prescribed exercises on a regular basis.

There is a discrepancy in the research about the success of pelvic floor muscle training to treat pelvic floor dysfunction, particularly SUI.  The literature shows that PFMT started in pregnancy is successful at preventing postpartum SUI, whereas beginning PFMT in the postpartum period is only successful at reducing or eliminating SUI symptoms in the first year postpartum.

The discrepancy within successful outcomes of PFMT is due to a disposition of those patients who were originally placed in the PFMT group to stop performing their prescribed home exercises after the first postpartum year because of a decrease or complete elimination of symptoms. Conversely, the participants who were advised not to do PFMT reported introducing and using various forms of PFMT in the 12-year period because of the impact SUI has on daily life.

The Right Pelvic Training

The research shows that PFMT introduced and described briefly by a provider other than a physical therapist, such as a nurse or obstetrician in a single postpartum visit, is inadequate. As noted above, providers who are not specifically trained and physically examining the client while they try to contract the pelvic floor muscles is a contraindication and should not be attempted.

Clear instruction is particularly necessary in the postpartum period after trauma to the neural, muscular, and fascial components of the pelvis. Most postpartum people are unable to correctly engage and contract their pelvic floor. The common problems include incorrectly contracting other muscles (gluteal muscles, rectus abdominus) or making other errors like holding their breath, pelvic tilts, or straining.

Safe Pelvic Training

The SOWH and Orthopedic Section of the American Physical Therapy Association recommend that antenatal treatment begin with clients presenting current pelvic symptoms and/or have a higher risk of developing pelvic dysfunction following delivery.

The Section on Women’s Health (SOWH) and the Orthopedic Section of the American Physical Therapy Association (2017) conducted a survey of 105 sources to create a clinical practice guideline for the management of pelvic girdle pain in pregnancy.  The guideline standardizes the definition of PFMT to include any use or combination of joint manipulation, joint mobilization, soft tissue mobilization/manipulation, myofascial release, muscle energy, and muscle-assisted range of motion.

The recommendation recognizes that there is “little to no reported evidence of adverse effects in the healthy antepartum population” who engage in pelvic floor physical therapy. SOWH supports and recommends “internal pelvic muscle examination and intervention in the management of antepartum, peripartum, and postpartum women with pelvic dysfunctions.”