Part 3 – Healthy Living for Life – Incontinence – a not-so-normal part of aging (Full Version)

– My next guest is a physical therapist who can help people with incontinence gain control Welcome Tara Phelps

– Thank you – First of all, I was hoping that you could help us understand how we can control incontinence through physical therapy – So, it depends what kind of incontinence you have There's two different kinds of urine incontinence There's stress incontinence, which is urine leakage with coughing, laughing, sneezing, any increase in abdominal pressure

That urine incontinence responds very well to muscle retraining and strengthening the correct muscles Then there's urge incontinence and that is urine incontinence when you're rushing to the bathroom and you can't make it there in time With that urine incontinence, we look a lot at bladder behavior, bladder habits, and develop a bladder retraining program Then there's mixed incontinence and that's a little bit of both, that is the most common and typically what I see in physical therapy – So, can you tell us a little bit more about the specific types of physical therapy that you would use to treat these different types of incontinence? – So, one of the first things I have people do when they come in is I'll have them fill out a bowel and bladder diary and a food log and look at the things that they're eating and drinking throughout the day

I check for bladder irritants, teach people to decrease the amount of caffeine, carbonation, alcohol intake I talk a lot about dehydration, making sure they have enough water A lot of people are under the impression if they decrease how much water they're drinking, then they'll have to go to the bathroom less That actually makes things worse because it concentrates everything in your bladder Avoiding constipation is a big thing to focus on and then we work on retraining the right muscles and strengthening the correct muscles

So, I'll develop an individualized strengthening program for the patient If those options don't work, we can use biofeedback That is a computer system that the patient is hooked up to and I'll have them contract and relax those muscles and there's graphs and audio tones and pictures So they get the feedback if they're using the muscles correctly If none of those options work and the people need a little more help, we can use electrical simulation and that just delivers electricity current to those muscles to facilitate a muscle contraction

– So I wanna go back to the muscle exercises or the training that you do Can you tell us a little bit more specifically of what types of therapies or activities do you do to help with that? – To strengthen those muscles, those are your kegel exercises that everyone talks about And most people who try kegels on their own cannot do it correctly and this is because these pelvic floor muscles are at the bottom of your pelvis There's a lot of stuff on top of them You have all your internal organs and they're kinda buried

So, I use the analogy, like if you're gonna work your biceps, you can see it, you can feel it and you know it's working Your pelvic floor muscles, you can't see those If they haven't worked for a long time, then you might not be able to feel them So, a trick that people can try is if they stop their flow of urine That uses those same muscles

I let people try that one time Don't get in the habit of doing that because that can cause other problems, but it is those muscles So, you squeeze those muscles and then you can relax them If you are squeezing in your abdominals, you're not using the right muscles or if you're squeezing your glutes together, you're not using the right muscles So, I tell people if you're doing a kegel, no one should be able to know

So if you're bouncing in your seat, you're using the wrong muscles – [Host] It's silent and nobody knows what you're doing – Yes – So, if somebody can't do kegels, is there other types of muscle training that can be done to help them? – Mmhmm So, sometimes we tie in a few muscles that are close to those other muscles

So you can use some of the hip muscles Sometimes if they can't work the pelvic floor muscles on their own, then we can focus on the abdominals Most people can figure out how to use these muscles That's when we'll use the biofeedback system So, that computer system to help retrain those muscles or the electrical stimulation

If they have something else going on that is limiting their ability to control those muscles on their own – I wanted to go back to the biofeedback therapy Earlier, we had talked with Dr Bubbers about fecal incontinence So I wanted to ask you, does biofeedback therapy, is that something that you could use for fecal incontinence? – Yes, so the exact same way that we treat urine incontinence, we can treat fecal incontinence

It's using a similar group of muscles, just a few different ones with the fecal incontinence, but it works the exact same way – And I kinda wanted to shift gears a little bit and talk about women who are post-menopausal Do hormones or actually the lack thereof play a role in incontinence? – Yes So, when someone goes through menopause, their estrogen levels decrease When this happens, the tissue properties and the properties of those muscles are a little bit impaired

So they can become thinner and as they become thinner, they can become weaker and not work quite so well – So, do you use physical therapy there? Would that be more of a different type of therapy for those situations? – Yes, this is, physical therapy is very common after childbirth or when someone goes through menopause Some of these issues happen because of a life event like that, other times it's just a normal part of aging Things become weaker So, physical therapy is very common after menopause

– Tara, I only have about a minute left and so, I wanted to ask you, because this is really an important issue that a lot of people don't know how to talk about or maybe are uncomfortable talking about, what would be your take-home message for anybody who might be having an incontinence problem? What would be the message you'd like to share with them about this? – So, my big goal is to raise awareness with people and know that there's something that can be done to help you and there's people out there that want to help you I would recommend before someone comes to a physical therapist to go to their doctor first and get screened Incontinence can be due to other issues or something else going on, medication side effect or a neurological condition – [Host] Okay, perfect Thank you so much Tara for this excellent information

– Thank you – We're about outta time for this week I wanna thank my guests for helping us get a handle on incontinence and to encourage you to seek help from a professional because incontinence doesn't have to ruin or run your life Please tune in next week and until then, stay fit, stay well and stay healthy for life with Healthy Living For Life – [Narrator] Healthy Living For Life is brought to you by Mountain-Pacific Quality Health

We'd love to hear from you If you have suggestions for future programs, visit our website at MPQHForg or call us at 406-443-4020 You can also catch us on YouTube by visiting our website and clicking on the YouTube icon Special thanks to Fire Tower Coffee House and Roasters

Production facilities provided by Video Express Productions


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