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Urinary Incontinence Under the Radar: Part 2

Welcome back for Part 2! November is Bladder Health Awareness month, and Femina PT would like to shine light on something that tends to go understated, unaddressed, brushed off as “normal”: urinary incontinence. In this blog series we’ve been addressing the various effects that urinary incontinence has on an individual’s life, and how conservative physical therapy treatment can help combat them. If you missed last week’s article, you can find it here.

Last week, we went over a lot of statistics. Urinary incontinence is without a doubt a healthcare crisis and places an enormous burden on the individual and their family members. Urinary incontinence, and the related sequelae, is expensive, isolating, and poses the risk of delirium, falls, pressure ulcers, and abuse.

The secondary effects that urinary incontinence has on an individual are significant and multifactorial. This includes the psychological burden as well as the physical symptoms.

Mental wellbeing:

There are different types of urinary incontinence: stress/activity-related, urge, mixed, functional and others. No matter how it goes down, it leads to psychological consequences including but not limited to: shame, insecurity, loss of social life, isolation, and depression. To make matters worse, the added stress can worsen urinary incontinence and contribute to the vicious cycle of declining mental health. One study found that having moderate to severe anxiety and depression increases the prevalence of urinary incontinence (2).

Physical well-being:

Urge and stress urinary incontinence are positively related to falls. There is a positive correlation between a low scoring “timed up and go test” (a test that physical therapists use to assess fall risk) and symptoms of urinary incontinence in women, with the average age of 84.3 years. Other studies found a two-fold increase in risk of falls with urinary incontinence. Urinary incontinence and frequent urination at night (called nocturia) can contribute to abnormal daytime sleepiness and increased risk for falls. Additionally, urinary symptoms increase rushing to the bathroom, which negatively affects balance and spatial awareness of obstacles on the floor -- further increasing fall risk.

The social isolation many resort to due to the shame surrounding these symptoms may lead to cardiovascular decline, possibly worsening the comorbidities that typically present in addition to urinary incontinence. This may lead the provider to overlook the urinary incontinence. Comorbidities are prioritized and urinary incontinence continues to worsen, further increasing risk for falls, morbidity, and the cycle continues.

How can pelvic floor physical therapy help?

Research explored the relationship between pelvic floor physical therapy (PFPT) on urinary incontinence compared to no treatment. The systematic review found that women with stress urinary incontinence who had pelvic floor muscle training versus no treatment for urinary incontinence were 8x more likely to report being cured. For women with any type of urinary incontinence, they were 5x more likely. Researchers also looked at quality of life measurements, and found that women with any type of urinary incontinence who received pelvic floor muscle training (PFMT) were more likely to report improvement in urinary symptoms, and improvement in quality of life. Women in the treatment group also reported better sexual outcomes. Researchers suggested that pelvic floor muscle training should be considered in first-line conservative management for women with urinary incontinence.

In physical therapy, you regain control of your life, learn about your own anatomy and how to manage your own symptoms so that you don’t need to continue to rely on your provider - you are given tools to help yourself.

Does conservative treatment last?

Yes! A study found that pelvic floor muscle rehabilitation for urinary incontinence remains effective for up to 5 years after an average of just 8 sessions in older women.

We hope you tell all your friends and family to think about the current and future health of your bladder this month of November. If you or anyone you know is experiencing similar bladder symptoms, see a medical provider and ask if physical therapy is a safe option for you. We recommend that if you are having urinary incontinence, see a pelvic floor physical therapist (@RITA PLEASE LINK TO CONTACT US PAGE ON FEMINA) so you can receive a thorough evaluation and receive a tailored program specific to your individual clinical presentation.


Debus G, Kästner R. Psychosomatic Aspects of Urinary Incontinence in Women. Geburtshilfe Frauenheilkd. 2015 Feb;75(2):165-169. doi: 10.1055/s-0034-1396257. PMID: 25797959; PMCID: PMC4361165.
Felde, G., Engeland, A. & Hunskaar, S. Urinary incontinence associated with anxiety and depression: the impact of psychotropic drugs in a cross-sectional study from the Norwegian HUNT study. BMC Psychiatry 20, 521 (2020). https://doi.org/10.1186/s12888-020-02922-4
​​Eliasson K, Elfving B, Nordgren B, Mattsson E. Urinary incontinence in women with low back pain. Man Ther. 2008 Jun;13(3):206-12. doi: 10.1016/j.math.2006.12.006. Epub 2007 Mar 23. PMID: 17363318.
Dumoulin C, Cacciari LP, Hay‐Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews 2018, Issue 10. Art. No.: CD005654. DOI: 10.1002/14651858.CD005654.pub4. Accessed 27 October 2022.
Simard C, Tu LM. Long-term efficacy of pelvic floor muscle rehabilitation for older women with urinary incontinence. J Obstet Gynaecol Can. 2010 Dec;32(12):1163-1166. doi: 10.1016/S1701-2163(16)34740-5. PMID: 21176328..
Lane GI, Hagan K, Erekson E, Minassian VA, Grodstein F, Bynum J. Patient-Provider Discussions About Urinary Incontinence Among Older Women.
Wilson, Leslie PhD; Brown, Jeanette S. MD; Shin, Grace P. PharmD; Luc, Kim-Oanh PharmD; Subak, Leslee L. MD. Annual Direct Cost of Urinary Incontinence. Obstetrics & Gynecology: September 2001 - Volume 98 - Issue 3 - p 398-406J Gerontol A Biol Sci Med Sci. 2021 Feb 25;76(3):463-469. doi: 10.1093/gerona/glaa107. PMID: 32353111; PMCID: PMC7907491.
Viktrup, Lars, et al. "Stress urinary incontinence in active elderly women." Southern Medical Journal, vol. 98, no. 1, Jan. 2005, pp. 79+. Gale Academic OneFile

These problems are devastating, and so are the secondary effects of urinary incontinence. Stay informed by signing up for our newsletter so you won't miss out!

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Heather has affected my life in the MOST POSITIVE way and I am forever grateful. My husband refers to her as the "sex doctor" so you can only imagine how happy he is with my therapy outcome.

After the birth of my son I suffered from "Vaginismus", however, at the time I just thought I was broken. My "broken vagina" affected me physically but it was an emotional struggle as well. Many women in my life also suffered with pain from sex after their babies were born so I knew I wasn't alone. They told me they "just got used to it" but I couldn't see myself living that way.

Sex wasn't just painful, it was literally impossible - IT DIDNT FIT!

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Before I was referred to Heather Jeffcoat I was living in a nightmare. I had been married to my husband for three years and I was suffering from Vaginismus. That all changed when I visited my OBGYN and she said she knew of someone with a great success rate. To be honest I was hesitant at first because my first doctor had already told me that all I needed to do was order dilators from the internet and I should overcome my problem. She was wrong because I had followed the book on how to use the dilators with absolutely no advancements in my condition. However, that all changed when I went in for my first visit and Heather took the time to explain my condition and how we were going to work together to overcome it.

I remember leaving her office with a glimmer of hope that I could live a normal life. As my sessions continued I began to see immediate results. With only four sessions and a strict dedication to my home programs I was cured of Vaginismus. In the beginning of this process I was made aware that my health insurance company might not cover the costs, which was disappointing but today I can say one hundred percent that it was the best money I ever spent. Now thanks to Heather I am finally enjoying my life to the fullest with my husband. Thank you Heather, I can’t begin to tell you how much I appreciate all that you have done for me. I will never forget it. Those who are suffering from these types of conditions don’t be afraid because she makes you feel so comfortable and the end result is worth it. Good luck to you all and I hope you experience the success I have.
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Heather's unique physical therapy program literally changed my life! After years of struggling with vaginismus, a condition that made it impossible for me to have intercourse and very difficult to use tampons without pain, a gynecologist referred me to Heather. I was nervous for my first appointment, but Heather's professional and friendly demeanor put me at ease. She did a great job explaining each technique she was using to help my muscles relax. Heather uses a combination of internal and external stretches and exercises to relax the pelvic floor and build muscle strength. Her specially developed home program helped me quickly recover from an issue that seemed insurmountable before meeting Heather. She was optimistic about my progress and incredibly encouraging. Less than 6 months after my first session, I was able to have pain-free sex for the first time in my life! If you are suffering from vaginismus or any other pelvic floor issues, I highly recommend making an appointment with Heather and reading her book!

-- Amanda W., 2/15/16 via Yelp!

Testimonial by R.H.

No one could tell me why I was having pain during sex--sharp pain, not just uncomfortable, pain. I was referred to Heather Jeffcoat after researching several different options. I had seen a specialist who told me physical therapy would not help and my only option was surgery. I really didn't want to go that route, so when we got a referral, I decided to try it--it can't hurt, I thought. I am so glad I did. She diagnosed the problem right away, which was a relief in itself.

To know why I was having pain eased my mind immensely. And to hear that she could fix it without surgery was another relief. She said she could fix the problem in 6 weeks. I think it was actually 4 for me. She was very methodical, and treated me as an intelligent human being capable of participating in my own recovery. I would absolutely recommend her to anyone. She did not try to prolong my session numbers, she worked hard to accommodate my schedule (and the fact that I had to bring a baby to sessions), and she was completely honest the entire time. It is so hard to find someone with these characteristics, much less a professional who is so good at what she does. She has my highest respect.

-- R.H.

Testimonial by S.P., Age 26

I would like to start off by thanking Heather Jeffcoat for educating me and curing me of Vaginismus. I had been married for almost three years before I was referred to Heather. I never knew about Vaginismus until almost three years into my marriage. I knew something was wrong when I went on my honeymoon and came back a Virgin. I had always imagined how magical my first night would be but boy was I wrong.

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