Tag Archives: incontinence

bladder control during pregnancy

Bladder Control During Pregnancy


Aside from a growing belly, you may notice other changes in your body now that you are pregnant. One thing you may notice is the loss of urine when you are not trying to urinate. Loss of bladder control, also called incontinence, is common during pregnancy and after childbirth. Needing to run to the bathroom often or leaking urine can make you feel embarrassed. Do not feel shy about asking for physical therapy for incontinence. They can help you understand and manage bladder control, and make sure there are not other conditions causing your incontinence. Here is some information to help you learn more.

Urine is stored in your bladder, which is an organ located in the pelvis. The muscles of the pelvis help keep your bladder in place. When you urinate, urine travels from your bladder and out of your body through a tube called the urethra. Ring-like muscles (sphincter muscles) keep the urethra closed so urine does not pass until you are ready to urinate. Muscles at the end of the urethra (sphincter muscles) and in the pelvic floor also help to hold back urine.

The weight of a baby in your belly and the act of giving birth will put pressure on your bladder and may cause your pelvic muscles to stretch and weaken. This causes your bladder to sag, and your urethra to stretch. Nerves can also be damaged. It is this damage to muscles and nerves that can cause bladder control problems to persist.

pregnant woman

The good news is that incontinence may go away once your pelvic muscles heal, usually 6 weeks or so after giving birth. But you can take steps after childbirth to minimize bladder control problems by doing exercises to strengthen your pelvic floor muscles. Kegel exercises are one type of pelvic floor muscle exercise.

Kegel exercises do not require equipment and can be done anywhere—while sitting at your desk, standing in line at the bank, or even lying down in bed. They are done by squeezing your sphincter muscles in the same way you would when stopping urine flow. After 6-8 weeks of doing the exercises, you may find that you have fewer leaks.

Talk to your doctor to learn more about how to correctly do Kegel exercises. Following pregnancy, if Kegel exercises do not control the incontinence, your doctor may discuss other treatments or refer you to a specialist who can help.

Here are some general steps for doing Kegel exercises from the American Pregnancy Association:

• Squeeze your pelvic floor muscles as if you were trying to stop the flow of urine. Do not squeeze the muscles in your belly, legs, or buttocks.
• Hold for 5-10 seconds, then relax.
• Repeat 10-20 times.
• Try to do at least 3 sets per day.

If incontinence is still bothersome, talk to your doctor about other options, such as wearing absorbent pads or briefs. With support from your healthcare team, you will be able to manage incontinence, as well as other bodily changes that come with pregnancy.

by Marjorie Montemayor-Quellenberg, MA

American Congress of Obstetricians and Gynecologists

Office on Women’s Health

Health Canada

Women’s Health Matters

Kegel exercises. American Pregnancy Association website. Available at: http://americanpregnancy.org/labor-and-birth/kegel-exercises. Updated Aug. 2015. Accessed Feb. 10, 2016.

Treatments of common complaints in pregnant women. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 1, 2016. Accessed February 10, 2016.

Urinary incontinence fact sheet. Office on Women’s Health website. Available at: http://www.womenshealth.gov/publications/our-publications/fact-sheet/urinary-incontinence.html. Updated July 16, 2012. Accessed February 10, 2016.

Urinary incontinence in women. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 9, 2015. Accessed February 10, 2016.

What I need to know about bladder control for women. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/urinary-incontinence-women/Pages/ez.aspx. Updated June 2012. Accessed February 10, 2016.

3/5/2013 DynaMed’s Systematic Literature Surveillance: http://www.ebscohost.com/dynamed: Boyle R, Hay-Smith EJ, Cody JD, et al. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2012;10:CD007471.

Last reviewed February 2016 by Michael Woods, MD Last Updated: 2/10/2016

EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.

physical therapy during pregnancy

Physical Therapy for the Pregnant and Postpartum Woman


If you are encountering problems during your pregnancy, don’t stress. Many women are able to find pain relief by going to physical therapy during pregnancy. A licensed physical therapist, specifically trained in women’s health, can evaluate and address the physical issues affecting you. Some of the techniques a PT would use in alleviating these discomforts are postural awareness/education, individualized stretching and strengthening programs, soft tissue mobilization/myofascial release (types of massage), breathing exercises, bladder education and pelvic floor strengthening. A PT can also assist you in implementing an exercise regimen that is safe and easy to take part in no matter what your level of fitness. All of this is performed in concurrence with your OB/GYN’s care.

Musculoskeletal complaints of the Pregnant Woman:
• Postural stresses (accentuated lordosis)
• Pelvic girdle instability pain
• Back pain or SI joint dysfunction
• Round ligament pain
• Nerve entrapment syndromes: carpal tunnel, tarsal tunnel, thoracic outlet syndromes
• Neck pain
• Foot or Ankle pain (especially overuse of the gastrocnemius muscles due to COG shifted anterior)
• Tendinitis: lateral epicondylitis and trochanteric bursitis
• Circulatory problems:
• Lower leg cramps
• Edema in lower extremities
• Groin / coccyx pain
• Urinary complaints (due to reduced bladder capacity as the fetus pushes on the bladder ): stress or urge incontinence

Musculoskeletal complaints of Postpartum Woman (effects of hormonal laxity):
• Diastasis Recti
• Symphysis pubis separation
• C-section scar or episiotomy scar adhesions/pain
• Pelvic floor Dysfunction: pain with sexual activity
• Postural stresses: nursing, holding and carrying baby
• Low back pain or SI joint dysfunction
• Urinary complaints (due to weakness of the pelvic floor muscles / trauma during labor and delivery)
• Stress Incontinence
• Urge incontinence


Goals and benefits of exercise for the Pregnant Woman:
• Promotes good posture
• Increases or maintenance of aerobic fitness
• Improves muscle tone
• Improves sleep
• Prevents low back pain
• Reduces risk of gestational diabetes
• Improves physiological and psychological health
• Prepares mom for labor and delivery

Goals and benefits of exercise for the Postpartum Woman:
• Faster recovery from labor and delivery
• Increases endurance for taking care of self and baby

Make the right choice today. Ask your doctor how physical therapy can help you!

This information about physical therapy during pregnancy was written by by Rachna Mehta, PT, DPT, CIMT – Hamilton Physical Therapy Services, L.P. in Hamilton, NJ. Hamilton Physical Therapy Services is a well established provider of rehabilitation services in Mercer County since 1978. They take pride in offering personal and compassionate care with a patient-centered approach helping transform lives, one life at a time. For more information click here.

Pediatric Incontinence

Treating Pediatric Incontinence with Physical Therapy



Bed wetting is almost as common as asthma, but it is often not discussed, even with doctors.
The pelvic floor is made up of muscles and other tissues that form a sling from the pubic bone to the tailbone. They help to support the abdominal and pelvic organs and assist with the control of bladder and bowel activity.

Pelvic floor dysfunction refers to a wide range of problems that occur when these muscles are weak and/or in spasm. The tissue surrounding the pelvic floor organs may have increased sensitivity and irritation or decreased sensitivity, causing the resulting dysfunction seen in children.

Although millions of children suffer from pelvic floor dysfunction, most don’t get the help they need. Typically, children are toilet trained by age 4 with only very occasional accidents. After age 4 childhood bowel and bladder dysfunction is considered a major medical problem and greatly affects quality of life for the whole family. Every day, five million American children wake up not knowing if their bed will be wet or dry. Many of these children feel embarrassed and ashamed. Bed wetting is almost as common as asthma, but it is often not discussed, even with doctors, because of its embarrassing nature.

Dysfunctional elimination in children occurs when the pelvic floor muscles are not working together with the bladder and /or bowel and the normal voiding or emptying reflexes can be disrupted. This can lead to a chronic abnormal pattern of elimination which does not allow the bladder or bowel to empty completely. Some children experience difficulty urinating or controlling their bladder function, frequent bladder infections, constipation, not urinating enough during the day, or sensing bladder fullness. Children may periodically have leakage during the day or wake up wet in the morning or both. This can be embarrassing and uncomfortable.

If your child has experienced any of the above symptoms they may have been seen by a physician or specialist, who is now recommending therapy to relax and retrain the pelvic floor muscles. Therapy can provide the tools your family needs to take control of your child’s bladder and bowel functions.

If any of the below problems sound familiar, then PT can help:
• Urinary incontinence (loss of urine)
• Urinary urgency (constant/strong need to urinate)
• Urinary frequency (urinating over 8 times in a 24 hour period)
• Urinary retention (not fully emptying your bladder)
• Bed-wetting (nocturnal enuresis)
• Fecal urgency, frequency and/or retention
• Bowel incontinence, pain with defecation, inability to empty bowels
• Excessive gas, abdominal bloating
• Constipation, diarrhea with/out soiling/staining

How do we treat pediatric incontinence?
We meet with a child and their parent/s or guardian about pediatric incontinence we  get a thorough knowledge of history and current problems. We then do a physical examination, looking at the muscles of the abdomen, legs, back and others we feel applicable to the specific problem. This exam is with an adult present and over clothing. Finally, we consult with the referring physician to develop an individualized treatment plan. Treatment is one-on-one, hands on, with the child dressed and lasts about one hour-in comfortable, private treatment rooms. We work with each child and family member very closely and modify our treatment according to what works best for each individual. We incorporate a holistic approach, looking at diet, sleep patterns, and other behavioral issues that could be contributing to the current problem.

What exactly do we do?
Treatment includes:
• Biofeedback-surface electromyography (external electrodes or “stickers”)
• Behavioral and diet modification
• Soft tissue mobilization, myofascial release and deep tissue massage if needed
• Hot and cold therapy
• Stretching and strengthening of pelvic floor and surrounding muscles as appropriate
• Relaxation techniques.
• Scheduled bladder retraining
• Pelvic floor muscle re-education


Medical research has shown that proper pelvic floor muscle training and biofeedback drastically improves voiding dysfunctions in children.

We use animated biofeedback used a computer program with images of dolphins or space shuttle to get children to activate and relax the pelvic floor muscles.

Your child is not alone
• 20% of pediatrician visits are for incontinence problems
• 15% of visits to gastrointestinal doctors are for lower bowel dysfunction
• 3% of visits to pediatricians are for constipation
• 5 million children complain of nocturnal enuresis (nighttime bedwetting)

Common Myths
Myth: Decreasing my child’s fluid intake will decrease their incontinence?
Fact: Decreasing fluids can actually lead to dehydration, which can actually increase incontinence.

Myth: Once my child has been diagnosed with incontinence, nothing can be done about it?
Fact: Incontinence can almost always be successfully resolved, treated or managed. Physical Therapy can help!

Myth: All children gain control of their bladder and bowels at the same age?
Fact: Children develop control at different ages depending on their physical and cognitive development, as well as their environment. It is typical for a child to develop bladder and/or bowel control between two and five years of age.

It might reassure you to know that around 19% of school-aged children wet the bed. It’s really one of the most common of all childhood problems. To give you an idea, in a class of 30 children:

Aged 5 years: 5 wet the bed at least twice a week
Aged 7 years: 2 wet the bed at least twice a week
Aged 12 years: 1 wets the bed at least twice a week
Aged 15 years: 1 child in every two classes wets the bed at least twice a week.

1. Maintain adequate fluid intake
2. Practice prompted voiding
3. Practice bladder retraining
4. Limit intake of colas, root beer and other dark soft drinks
5. Limit caffeine intake
6. Avoid constipation
7. Exercise on a regular basis
8. Drink fluids throughout the day and limit fluids at night (2 hours before bed)
9. Keep a bladder diary