Can physical therapy help urinary incontinence?
Yes, and it’s often the most effective first-line treatment. Pelvic floor physical therapy involves working with a specialized therapist who assesses your pelvic floor muscles and develops a targeted program to improve their strength, coordination, and endurance. For many women, it reduces or eliminates incontinence without medication or surgery.
How it works
Kegel exercises are only a small part of pelvic floor physical therapy. Your muscles need strength, but they also need to relax and lengthen, coordinate with each other, and hold up over time. The best physical therapists work on all of that.
A specialized therapist will also look at the surrounding structures (hips, thighs, and core) because they all affect how your pelvic floor works. Many patients improve a lot with changes to breathing, posture, and bracing alone. Your therapist may use biofeedback to show you which muscles to engage, develop a personalized program for your specific patterns, and progress your exercises as you improve.
What to expect
Your first visit typically lasts about an hour and includes a detailed discussion of your symptoms and goals, an external and internal assessment of your pelvic floor muscles, education about your anatomy, and initial exercises to start at home.
Follow-up sessions (usually weekly or biweekly) involve progress assessment, advancing your exercise program as muscles strengthen, behavioral strategies for managing urgency, and techniques for using your pelvic floor muscles during activities that trigger leaking.
The evidence
Studies show that pelvic floor therapy roughly halves the number of incontinence episodes for many women, and about half of women with stress-predominant incontinence are satisfied with their results a year after starting. It also helps manage urgency and urge incontinence through muscle coordination and urgency-suppression techniques, and it carries very little risk.
Whether your leaking is stress-related (with coughing, sneezing, or exercise), urgency-related (a sudden, hard-to-defer urge), or a mix of both, pelvic floor therapy is a reasonable place to start, and it stays useful even if you later add medication or surgery.
Dr. Stewart’s perspective
“Pelvic floor physical therapy is one of the most underutilized treatments in medicine. It’s my first recommendation for nearly every type of incontinence, and it’s an investment in your pelvic floor regardless of what other treatments we pursue.”
References
- ACOG Committee on Practice Bulletins—Gynecology, American Urogynecologic Society, Kenton KS, et al. Urinary Incontinence in Women (ACOG Practice Bulletin No. 155). Obstetrics & Gynecology. 2015. doi:10.1097/AOG.0000000000001148
- Bo K, Frawley HC, Haylen BT, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. International Urogynecology Journal. 2017. doi:10.1007/s00192-016-3123-4
- Nygaard IE, Heit M. Stress Urinary Incontinence. Obstetrics & Gynecology. 2004. doi:10.1097/01.AOG.0000137874.84862.94
- Wallace SL, Miller LD, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Current Opinion in Obstetrics and Gynecology. 2019. doi:10.1097/GCO.0000000000000584
- Sanses TVD, Zillioux J, High RA, et al. Evidence-Informed, Interdisciplinary, Multidimensional Action Plan to Advance Overactive Bladder Research and Treatment Initiatives: Directives From State-of-the-Science Conference on Overactive Bladder and Cognitive Impairment. Urogynecology. 2023. doi:10.1097/SPV.0000000000001274
← Learn more about Urinary Incontinence