The Truth Behind Incontinence Devices: Why You Still Leak
What is Urinary Incontinence?
Simply put, incontinence is the involuntary loss of urine. This can range from leaking a few drops of urine to a complete emptying of the bladder, when you don’t intend to. It can occur at any age and is far more common than one may think. It is estimated that as much as 50% of adult women experience urinary incontinence at some point. While common, it is important to remember that no amount of leakage, at any age, is ever normal!
Before we can understand incontinence, it’s important to understand what the pelvic floor is…
The pelvic floor is a group of muscles that lie between sit bones and run from your pubic bone to your tailbone. They collectively form an important part of your “core” and are responsible for opening and closing the urethra, anus, and vagina (in females). They also support the organs within the pelvis, such as the bladder, uterus, and rectum, and play a role in sexual function. These muscles are, for the most part, under volitional control. This means you can contract them (aka a kegel) and relax them, on command. The pelvic floor muscles need to be able to move through their full range of motion and perform these functions in response to demands that are put on our bodies, such as running, jumping, lifting, pregnancy, etc. Leakage occurs when there is more pressure or force put down on the pelvic floor, than the pelvic floor muscles can produce to maintain closure of the urethral opening. It’s like playing a game of tug-of-war where one team has 10 people and the other team has only 3 people. The team with fewer people simply can’t produce as much force to equal out the pressure and fight back.
Incontinence devices & how they work
Incontinence devices promise to work by eliciting contractions of your pelvic floor muscles and therefore strengthening your muscles in order to rid you of bladder leakage forever. Here are a few popular products that you may have seen advertised and specifics about how they work:
The Emsella chair. This is a chair that uses electromagnetic fields to elicit a deep PFM contraction that is said to be equivalent to doing over 11,000 kegels in 30 min. According to the company, you can sit on their chair, fully dressed, and have the device do the work for you. Sounds effortless and simple enough to use. Now consider this question: Would you do 11,000 bicep curls if you had shoulder pain? Of course not! If it were that simple, incontinence would not be as prevalent as we’ve pointed out.
Innovo shorts. These shorts utilize electric current that is passed through sensors to engage the pelvic floor muscles and glutes. The website advertises that if you use their product for 30 minutes, you will “complete 180 perfect kegels.” But who is there to determine if you’re doing a perfect kegel? Any well trained pelvic floor therapist will tell you that if you’re doing a “perfect kegel” your glutes should NOT be working!
Kegel exercisers. These devices are intended to be inserted vaginally and typically connect to your smartphone to provide some type of visual reading on the kegels you are doing. Some websites advertise this product generally for “pelvic floor disorders” but this implies that anyone with any type of pelvic floor disorder would benefit from using this. In fact, there are a large number of individuals with pelvic floor disorders (including bladder leakage as a symptom) who should stay away from doing kegels, as this activity can actually worsen their condition.
* One last note on the devices that utilize electric current is that these devices are not deemed safe for just anyone. Those who are pregnant or who have certain cardiac issues should not be using a product like this. Individuals who have had certain types of cancers should also be cautioned and their individual risk evaluated by a physician prior to using electric stimulation. The companies selling these products wouldn’t have the medical knowledge to screen for who is appropriate to use these. and because they are available for purchase directly to the consumer, it can pose a very real risk to one’s health.
Why you still leak
So why don’t these devices work? Why do people still complain of bladder leakage, even after a faithful attempt at using these magical fixes? Here are two important reasons why…
It is because your pelvic floor muscles are just one part of a much larger system. They do not work in isolation. In fact, nothing in your body works in isolation. First and foremost, your posture needs to be such that your ribcage is stacked over your pelvis. Your pelvic floor muscles need to then coordinate with the rest of your core muscles and your respiratory diaphragm, to function optimally. You can sit and do all of the kegels in the world (or have them done for you) but it still wont coordinate your muscles within your system.
Leakage is not necessarily caused by pelvic floor weakness. Bladder leakage can often be the result of pelvic floor tension, poor coordination, and hip weakness. Recent research compared those with and without bladder leakage and found no significant difference in pelvic floor strength, but a clinically significant difference in the strength of hip muscles. It’s therefore far more complicated and requires a thorough assessment by a trained professional, to understand the underlying cause.
One key to bladder leakage is managing pressure within your system. This comes down to how you are breathing with different tasks. When you inhale, your pelvic floor descends and lengthens as your diaphragm contracts. When you exhale, your pelvic floor rises back to its resting position and your diaphragm relaxes. Sounds simple, but this concept can be difficult for patients to implement early on.
How pelvic floor therapy helps
Pelvic floor therapy is critical to understanding why you’re leaking and to help you gain control over your bladder and pelvic floor function. Two people can have urinary incontinence with very different reasons underlying this symptom, therefore, a cookie-cutter approach is not ideal. Additionally, a pelvic floor therapist should consider your whole body as a system and assess how your pelvic floor is responding to the demands on the system. Then, and only then, can an appropriate treatment protocol be devised. Pelvic floor therapy should also be functional. Your day to day doesn’t consist of you lying around, so why would it be appropriate to sit around and do kegels? If you’re having symptoms with running, jumping, or picking up your kids, you need a program that addresses your pelvic floor function with those specific tasks. So save yourself time and money with incontinence devices and get yourself formally assessed by a specialist who can ensure you are safely and effectively making progress towards your goals!
