- Welcome, my friends to the Bob and Brad podcast.
My name is Mike Kenitz,
and today I'm interviewing physical therapist Sarah Haag.
She is an expert in urinary incontinence
and bladder control.
She is also the part owner
in Entropy Physiotherapy and Wellness,
and the author of the book
"Understanding and Treating Incontinence."
So without further ado, here is Sarah.
All right, so we're gonna start talking
about urinary incontinence.
So first question is what causes urinary incontinence?
- Great question.
There's actually a lot of different things
that can cause urinary incontinence.
Some people have the misconception
that it's just a weak pelvic floor,
but it can be a little bit more complicated than that.
So it might be easier to talk
about how do we stay continent?
And basically to stay dry, what we need is we need
some sort of closure on our urethra,
which is that tube that goes from our bladder
to the outside world.
So that can be our urinary sphincters, our pelvic floor,
our pelvic floor muscles, helping keep that closed.
But then also it requires our bladder,
which actually has a smooth muscle around it,
to kind of stay relaxed.
So we have a little bit of tension down here
and our bladder's kind of relaxing.
And then as that bladder fills up,
eventually we'll have a little stretch
and that's kind of what gives us the urge
to go to the bathroom.
So when our bladders stretch, stretch, stretch,
at a certain amount of fluid in there,
makes us feel like we gotta go to the bathroom.
When we go to the bathroom and we relax the pelvic floor
and that bladder muscle, the detrusor,
squeezes everything out.
So that's when everything's working together.
They kind of work together but are doing opposite things.
One's relaxing while the other one's working.
Incontinence happens when the pressure
on the inside of the bladder
and or our intra-abdominal cavity,
which is basically everything below our breathing diaphragm
down to our pelvic floor.
So if the pressure in there becomes higher than our ability
to close that urethra or keep it squeezed shut,
that's when we have a leak.
So it's kinda like this imbalance in the equation.
So what causes incontinence?
Sometimes it is some weakness in the pelvic floor,
sometimes it's that the, like, the urethra or the bladder
has become hypermobile and so it doesn't stay supported
and in the right spot.
For men, one of the things that might happen
is that if they have prostate cancer,
an issue that causes the prostate to be removed,
they actually lose some of their urethra
and perhaps some of their sphincter.
So now that's one of those contributing factors
to their incontinence.
Going up higher to the bladder,
it can also be overactive bladder.
So you know, some people say they just have a small bladder
or they feel like they have to go to the bathroom
all the time.
That's actually that bladder muscle,
again which is a smooth muscle
which really we don't have direct control over,
but we can kind of condition it and train it.
Maybe that's squeezing too much all the time.
And that's in a person
where their neurological system is intact.
Excuse me.
There's a lot of other reasons
involving more of, like, the neurology of bladder function
that could cause urinary incontinence.
- So it's not one thing, basically.
It could be many causes, right?
- Could be many causes.
And actually something I'll talk to my patients about
is sometimes it's a bunch of little things
that added up to the incontinence.
So if they have an empty bladder, they can run a 5K.
If they have a cup of coffee,
which might make their bladder a little twitchy,
'cause it makes some people's bladders irritated,
and they have a slightly weak pelvic floor,
and they go running, now they leak.
So sometimes it's a couple of different things
feeding into that episode of incontinence.
- Is coffee 'cause of the caffeine
or why does that cause problems?
- Great question.
So there isn't tons of really strong, like, research
on irritants for bladders.
We just know for some people caffeine.
Some other common ones are carbonation,
artificial sweeteners, citrus juices.
For some people it really makes their bladder wanna empty.
- Cool. - But I will say
in my clinical practice, this is not across the board.
So if you're like, wow, I go to the bathroom all the time,
but I love my coffee, what do I do?
I'll have people do a voiding log.
So we can, kind of, look at when are your issues happening,
and how much do we think is the coffee having to do with it.
Because I had one person get way better
when they drank as much coffee as they wanted.
(soothing music)