Urinary Incontinence: What It Is and How to Treat It

Treatments for Urinary Incontinence

I have been working with this condition for many years, and my experience has taught me to give great importance to the behavioral aspect of what, beyond being a clinical problem, is above all a source of distress for those who suffer from it. Understandably, people try to avoid embarrassing situations by emptying their bladder frequently, even without feeling the urge. Unfortunately, this habit reduces the bladder’s “holding capacity,” which may then trigger urgency and leakage, even with increasingly smaller amounts of urine. Another common behavior described by patients is the tendency to push when emptying the bladder. This, too, has the opposite effect and often leads to the need to use the bathroom again after a short time. The same issue applies to bowel movements, especially in people suffering from constipation. Spending too much time on the toilet and straining excessively does not help proper function and is often the origin of hemorrhoids, prolapse, and incontinence. Managing physical effort is another key aspect I address during the first consultation. Often, people exert themselves while holding their breath (instead of exhaling, which would be more appropriate), and they primarily use the rectus abdominis muscles (the “six-pack,” so to speak) instead of the obliques or the transverse abdominis. This pattern causes a significant increase in intra-abdominal pressure and places stress on the organs and intervertebral discs. Therefore, the first step—even before evaluating the pelvic floor’s weakness—is to correct the improper behaviors that people with long-standing incontinence often develop and that contribute to maintaining the problem. Treatment then involves helping the patient become aware of pelvic floor contractions and strengthening these muscles through exercises that are as closely related as possible to their daily activities. Typically, I select a few targeted exercises (4–5 at most), focusing on breathing and contraction of the pelvic floor. These are first practiced in easier, supportive positions and then progressed by adding load or integrating the contractions into the person’s sports or physical activities. This kind of program has shown excellent results: with just a few well-structured exercises, patients often experience a significant reduction in their symptoms from the very first sessions.