by Istvan “Ish” Takacs, PT, DPT – “The PT in the Saddle”
As a Physical Therapist I would like to drop some of the formalities and would like to educate the reader/rider/cyclist (i.e. you) on this topic. I know for a fact that urinary incontinence [UT] is underreported. Many scientific and anecdotal reports confirm this, and I have seen and heard it first hand during races and group rides. We may dwell on factors why some riders chose to announce that they just wet themselves in future blogs.
When a cyclist Google’s this medical term he or she will find official and unofficial definitions. Chances are he or she just had his or her first episode of UT prior to firing up the search engines. Here is my definition: “Urinary incontinence is when urine leaves your body without your permission”. This may happen due to several factors and the medical community wisely divided them into different categories which can help one identifying the proper provider in search of a solution.
This type of incontinence has little to do with losing control over your bladder/bowel while stressing over your next bike purchase, and has nothing to do with the pressure of selecting between a 110mm and 120mm handlebar stem.
“Stress” refers to actual pressure on human tissue in reference to other human tissue. More specifically, whenever outside pressure on the bladder exceeds the amount of force that muscles holding the bladder shut can exert.
Episodes such as the following can cause stress incontinence:
Can Physical Therapy help? Absolutely.
This is a tricky one…
It happens whenever the urge to urinate arrives and the person has little to no time before the urine is released. Have you ever rode behind a car who turns it’s right blinkers on and proceeds to turn to the right within seconds? Yeah…both situations will leave you using explicit language.
To explain, we require a small anatomy lesson without using long and scientific words. Essentially, your bladder is covered in a muscle called the detrusor muscle. It has highly specialized smooth muscle that is under voluntary and involuntary nervous control. This is very useful in terms of survival because your brain will make you go wee-wee* in order to save you from an exploding bladder.
Occasionally, damage or “faulty” wiring to your nerves can fire up these nerves hence releasing the urge to go and/or urine itself. Other factors may include an over-activation of the autonomic (involuntary) due to stress, medication, bladder irritants (like coffee, alcohol, and Coca-Cola…I know cyclist don’t drink any one these) and actual damage to the muscle tissue resulting in spasms over and around the bladder.
Triggers may include:
*Interestingly enough this will not happen when you hold many bowel movements, and may end up with severe diverticulitis. You can also lose the urge for #2 completely but this is another story for another day.
Can Physical Therapy help? You bet.
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Overflow of incontinence proves to be more common in men with prostate gland enlargements or benign prostatic hyperplasia (BPH), following prostate surgeries, a blocked urethra, and other traumas to the bladder.
In this case, the bladder cannot hold as much urine as the body is producing and/or the bladder cannot empty fully. This will leave residual urine, a hesitant and poor flow coupled with increased frequency to void. This may open up avenues to further unpleasant complications.
Currently, BPH is not well understood, and research has identified some factors which may contribute to the development such as older age, increased levels of testosterone, and a traditional western diet. Luckily, cycling is not one of them.
Can Physical Therapy help? This will vary case by case depending on the severity of the surgical intervention
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Functional incontinence will rarely happen to a “normal” human being who is not crazy enough to put on spandex and lycra bibs and ride a bicycle around for hours solo, or in a group. Most sane (i.e non-cyclist) people without a mobility problem, a physical disability or actual dementia will be able to make the conscious choice to leave their fellow human beings and spend some alone time in the appropriate restroom.
Most people also don’t have to deal with wrestling genitals out of cycling bibs…
Humor aside, functional incontinence happens when a client has an accident because they are unable to remove clothing or make it to the bathroom on time due to some physical or mental barrier. Difficulties such as the above may leave patients frustrated to say the least.
Common factory may include
Can Physical Therapy help? Yes. The therapist will guide the patient through Activities of Daily Living training (ADLs training) which will address strategies to remedy possible challenges.