Urinary Incontinence Part 1

Hey ladies! Let’s talk incontinence.

Urinary incontinence to be more exact. There are a whole slew of mechanisms that can cause women to start leaking urine but it all comes back to three root causes: pelvic floor muscle weakness, excessive muscle length, and muscle tightness. Now, those three things may seem like drastically different problems however, both muscle tightness AND excessive muscle length CAN cause muscle weakness. Sounds weird, I know but let me break it down for you. 

There is this relationship inherent in all muscles throughout your body, called the length-tension relationship. From this relationship, there is an ideal muscle length to produce the optimal force or power to perform an action. But how does this relate to my pelvic floor, you ask. Well, just like the muscles in your arms, your pelvic floor has to be able to contract and relax appropriately to allow passage of urine, or bowel movement, prevent internal organs from falling out of your body, and assist with maintaining intra-abdominal pressure. If these tissues are not working at their optimal length, the result can be constipation, pelvic organ prolapse, as well as fecal and urinary incontinence. 

Now, for whatever reason (and we’ll get into that next time), you are having urinary incontinence. When a pelvic physical therapist, like me 😊, assesses your internal tissues, they may find your pelvic floor muscles are weak, but they may also be tight. So, according to the length-tension relationship, if your pelvic floor muscles are TIGHT, or in a shortened state, they are not at their optimal length to perform the contractions required to maintain your continence. On the other hand, if your pelvic floor muscles are OVERSTRETCHED, or in a elongated state, they are still not at their optimal length to perform the required contractions. 

Anatomy overview: Your pelvic floor muscles work as a sling within your pelvis, like I said before, to maintain your internal organs within your body, maintaining fecal and urinary continence, and assist with maintaining intra-abdominal pressure in conjunction with your diaphragm. Around every opening within your pelvic floor (urethra, vaginal opening, and anus) muscles sit to contract when preventing urine or feces from exiting your body, as well as to relax to pass urine or have a bowel movement when you have deemed the timing appropriate. Check out an anatomy textbook or google pelvic floor muscles to see how these tissues interact with each other. 

So we’re back again to these pelvic floor muscles. If these pelvic floor muscles are too WEAK to contract and provide optimal force to prevent urine from exiting your body, you will be dealing with incontinence in some manner. But Lauren, you also said if your muscles are too tight you can have the same issue. Yes, yes I did and that still holds true. With pelvic floor muscle TIGHTNESS, the muscles are still unable to contract and provide that optimal force to prevent urine from leaking. Now, there is a concept where muscle tightness surrounding the anus can lead to constipation and fecal incontinence, but that is a concept for another day. And what about overstretched muscles? Well, if the muscles are TOO STRETCHED OUT, they still aren’t contracting appropriately.

Phew, that was a lot of information. I’ll let all of this sink in for a little while and next time we’ll discuss different scenarios that may lead to urinary incontinence, as well as a plea for those that have been provided kegels to reduce their incontinence symptoms without an internal assessment by a pelvic physical therapist.

If you have questions or concerns, please feel free to call the office at 904-516-8121 or email me at Lauren@vighettiPT.com and we can discuss next steps.