It’s not just an issue for elderly women, or pregnant or recently pregnant women, either. Urinary incontinence (UI) affects roughly one in four women in the United States. That includes new and expectant mothers as well as young female athletes, all of whom find themselves with inadequate bladder control. Whether your patient suffers with stress urinary incontinence, urgency urinary incontinence, or mixed incontinence, education is a first step in providing support and helping them onto a road of recovery.

Many women with UI feel embarrassed and may simply believe they must “live with it.” Most would never think of physical therapy as a treatment option. But it can be extremely effective, and women can often remedy UI with targeted physical therapy. Here are four vital point you will want to discuss with your UI patient:

Explain What is Happening. Clarify that UI occurs when the muscles and/or nerves that control the storage and release of urine are damaged or dysfunctional. SUI develops when the pelvic floor muscles are weak, or if pressure in the abdomen causes the urethra to shift. In UUI, damaged nerves may be sending bad information to the muscles surrounding the bladder, telling them to contract (and force urine through the urethra) at inappropriate times.

Assure your patient that there are many causes for UI, including pregnancy and delivery, age-related loss of pelvic muscle tone, obesity, menopause, an anatomical predisposition, or a history of heavy lifting or participating in high-impact sports.

Explain pelvic floor muscle training (PFMT), also known as Kegel exercises. Make clear to the patient that exercising the pelvic floor muscles can reduce or cure UI—if done correctly. Provide direction about how to focus on the correct muscles, explaining that to properly identify the PFMs, the patient should pinch, squeeze, and brace the muscles in the genital area as if trying to stop the flow of urine.

Explain how biofeedback can be helpful. In some cases, PFMT is combined with biofeedback, to help patients track when the bladder and urethral muscles contract. Explain to your patient that biofeedback is a procedure that uses electrical sensors to provide information (feedback) about various bodily functions. Clarify that biofeedback can help patients make subtle changes—relaxing specific muscles while engaging others. The information helps track when the bladder and urethral muscles contract, which can help control them more effectively.

Explain the importance of keeping a bladder diary. Tell your patient that you will want them to keep a “bladder diary,” in which they are to record fluid intake and every urination, intentional or otherwise. Explain that the diary often reveals patterns, which can help you devise a program of bladder training to use the bathroom at regular timed intervals and make fewer trips to the toilet by “teaching” the bladder to hold more urine. RM

Gail O’Neill, PT, is a licensed physical therapist with Armonk Physical Therapy & Sports Training, specializing in women’s health and orthopedics. With degrees in both physical therapy and biology, O’Neill has practiced for 30 years in New York and Connecticut.