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Pelvic Floor Weakness: Urinary Incontinence Treatment for Bladder

  • Urinary incontinence in a very common malady that affects approximately one in four women over the age of 18. Most women suffer silently, as this is a condition many find difficult to discuss; they end up wearing pads and avoiding activity that causes leakage. This is unfortunate since most people suffering with this condition can be helped without resorting to drugs or surgery.
  • There are approximately 25 million adult Americans suffering from some form of urinary incontinence, 75-80 % of those are women.
  • There are three types of urinary incontinence: Stress Urinary Incontinence, Urgency Urinary Incontinence also called Overactive Bladder (OAB), and Mixed Urinary Incontinence which is a combination of stress and urgency.
  • Stress Urinary Incontinence, the most common form, affects an estimated 15 million adult women in the U.S. Fortunately, this form is the most responsive to conservative care. It is due to weakness in the pelvic floor that often can be successfully treated with chiropractic and exercise.
  • Urine is stored in the bladder and travels out of the body through the urethra. There are a series of muscles associated with the pelvic floor that determine if the smooth muscle sphincters are strong enough to hold the urine from leaking when increased pressure is placed on the bladder. Pressure on the bladder is increased when you cough, sneeze, laugh, lift, exercise, etc. You can illustrate bladder function by placing water in a balloon and pinching the opening of the balloon with your fingers. Now place pressure on the balloon, if water leaks out it indicates that you’re not holding the opening tightly enough.
  • Childbirth, weight gain, trauma, and other conditions that stretch the pelvic floor can cause incontinence. Stress incontinence can also be caused by joint dysfunction that causes interference with the nerves supplying muscles of the pelvis. If there is joint dysfunction, it must be treated with chiropractic prior to successful rehabilitation of the muscles of the pelvic floor.
  • Urge Incontinence or Overactive Bladder (OAB) is due to bladder spasms that cause great urgency to void and can create more significant quality of life issues. OAB usually requires medical treatment, but conservative care is often helpful.


  • Dr. Fowler has seen significant improvement in stress incontinence with Directional Non-Force Technique (DNFT) Chiropractic. In women with incontinence, I often find a unique lumbar (low back) misalignment i.e. a forward shift of the lowest lumbar vertebra (just above the pelvis). This can compromise the neurological control of bladder function. Treating this gently and effectively is best performed using DNFT analysis and correction.
  • Dr. Fowler attended a Dynamic Neuromuscular Stabilization (DNS) course on Women’s Health in Toronto this Spring and learned the most current strategies for stabilizing/strengthening the pelvic floor to help women with bladder incontinence.
  • Improving function of the pelvic floor is always important in stress incontinence. However, performing the pelvic floor strengthening “Kegel” exercise by itself is often unsuccessful since there are tight fibers interspersed throughout the weak fibers of the pelvic floor. When you perform the Kegel (pulling the pelvic floor muscles up towards the abdomen), you tighten all the fibers including the fibers that are already tight. This can perpetuate incontinence as the muscles are attached to the bony pelvis, which can’t move, and the sphincter muscles which can. This effect pulls open the sphincter muscles weakening their function.
  • The pelvic floor muscles are slings of muscle that create the bottom of the “core”. All power to the extremities comes through the core, so the entire core must work well for the pelvic floor to remain strong. The pelvic floor and diaphragm have to work synergistically with the abdominal and back muscles for the core to function optimally. This includes retraining breathing, so it is diaphragmatic based and not chest breathing.
  • So, for rehab exercises to correct pelvic floor weakness, we must first address the tightness by teaching patients how to relax the pelvic floor through postural modifications and deep pelvic breathing techniques. Then there is intermittent activation and relaxation of the pelvic floor in varying degrees of contraction and postures to develop control.
  • The first strategy is to evaluate and treat the bony pelvis and lumbar spine to normalize the nerve supply to the pelvic muscles, bladder and sphincters. Next, we facilitate muscle activation through Dynamic Neuromuscular Stabilization (DNS); this is a system of techniques developed in Eastern Europe to integrate nerve and muscle function. It’s more successful to rehabilitate muscles and joints if they are neurologically activated.
  • The pelvic floor is a common area of weakness in the core and properly addressed can add quality to lives through resolving incontinence along with improving sexual function for both men and women.
  • If you have urgency incontinence, it can help to clean up your diet to minimize or eliminate items that can irritate the bladder and trigger spasms, e.g. caffeine, alcohol, nicotine, and artificial sweeteners.
  • Herbs are sometimes helpful and you can find lists on Web M.D. but it is recommended that you seek the professional help of a Naturopath, Holistic Doctor, or a Physician that specializes in complementary medicine to help you make the best choices.
  • Weight loss can help with stress incontinence. Studies show that reducing Body Mass Index (BMI), which is a rough estimate of a person’s body fat based on height and weight, as little as 5% can result in a significant reduction in stress incontinence; there was no change in overactive bladder symptoms with a decrease in BMI.

You can see that urinary incontinence is a treatable condition. If you or someone you know is bothered with this and wants to address it, give us a call so we can help.

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