Oh no, I am having stress incontinence! What natural treatments can I do?

Stress incontinence treatment

Stress Incontinence: Natural and conservative treatment options to improve your urinary control!

We often work with women and men who experience stress urinary incontinence and are looking for natural treatments, rather than medications or surgery.  The age, backgrounds and lifestyle of these patients vary wildly and, no, not everyone is experiencing the urinary leakage because they had a baby (this is obvious for men, but it can be assumed women only experience stress incontinence due to childbirth).  The good news is that there are natural and safe options you can undertake to improve your stress incontinence, that do not involve surgery nor medications.  This article will review your options:

Stress Incontinence Basic Overview:

When speaking of stress urinary incontinence we are talking specifically about the involuntary loss of urine that occurs with some activities that put pressure on your bladder and urinary control system.  Most often you hear about leaking happening with laughing, coughing and sneezing because these activities cause a large increase in intra-abdominal pressure.  When you have increased intra-abdominal pressure, the bladder control mechanisms must be able to tolerate and respond to this intra-abdominal pressure to avoid leaking urine.  With stress incontinence, the system is overwhelmed and urine readily escapes.  We commonly treat individuals who experience stress incontinence with activities such as walking, getting up from a chair, moving in and out of a car and bending over to pick something up.  Regardless of whether your stress incontinence occurs with higher level activities (jumping, running, jumping jacks) or more benign daily activities (walking, changing positions, bending over), all of the suggestions in this article can help you.

Female vs Male Stress Urinary Incontinence, Key Differences:

Female Stress Urinary Incontinence

Stress incontinence is something that can occur in young, female athletes who’ve never had a baby.  All the athletic moves such as jumping and quick directional changes can place a lot of force through the abdomen and genitourinary system and for some young athletes, their body cannot manage this.  It is common when we work with women that their stress incontinence dates back to their youth.  They often remember losing urine when having a fun laughing attack in their youth or when playing their high school sports, for example.  Following pregnancy, a woman’s pelvis and pelvic floor muscles change and an unfortunate consequence for many women is stress urinary incontinence.  Many women have heard of or know friends who have undergone surgery for their stress incontinence, but most women we know would prefer to avoid surgery and instead are looking for natural treatments for their stress incontinence.  This article details the research proven, natural treatments.  For an overview regarding stress urinary incontinence in women, here’s an article: https://www.nafc.org/female-stress-incontinence

Male Stress Urinary Incontinence

In men, the most common reason for their stress urinary incontinence is having a prostate procedure, usually a prostatectomy but also following a TURP (transurethral resection of the prostate).  Post-prostatectomy incontinence rates vary in research, but can be as much as 80% of men.  About 6-8% of men who have a prostatectomy will experience longstanding stress incontinence, but rest assured that there are things you can do to help this, including physical therapy.  Research shows that about 30-40% of men will experience stress incontinence following TURP, but typically it will resolve.  Unfortunately, for 0.5-1.0% of men following TURP, their stress incontinence does not go away, after 6 months.

How the prostatectomy or TURP causes urinary incontinence:

Why does a prostatectomy cause stress incontinence?  It is because your anatomy is changed because the radical prostatectomy removed a number of your urinary control mechanisms and may also damage some of the nerves.  The prostate itself provides a degree of urinary control, so its removal compromises your ability to control your urine.  Normally, you have urinary sphincters that are muscular bands at the base of the bladder & prostate.  These sphincters are important and keep you from unexpectedly losing urine.  They remain shut, tightly, to prevent urine from leaking.  When you pee, these sphincters relax and dilate so that your urine flows.  With a prostatectomy the prostate is removed and your sphincters are also part of the process.   Surgically, the bladder is connected to the urethra (in the area where the prostate used to be).  Anecdotally, our patients sometimes tell us that they do perceive their urethra to be shorter after their prostate has been removed.  Just about all men have some amount of urinary leakage immediately following their procedure, but with physical therapy and specific strengthening exercises you can improve urinary control.

I don’t want to leak urine all the time!  What are my natural, conservative treatment options for stress incontinence?

There are numerous things you can do to help your stress urinary incontinence.

  1. Bladder retraining and fluid intake balance

When we are talking about stress incontinence natural treatments one of the first places to start is to look at bladder retraining, behavioral changes and fluid intake.  A physical therapist can help you learn how to retrain your bladder and can troubleshoot and advise you on your fluid intake.  We often find that individuals are scared to lose urine so they unnecessarily empty their urine prematurely, which can in the long-run not work in their favor.  Ideally, your bladder is strong and able to fill and hold a normal amount of urine, without experiencing bladder spasms, urgency and frequency.  We also see people have vast problems with their fluid intake.  Some people avoiding drinking, so they are dehydrated.  Other people sip and drink water all day long, which for some people makes it hard to hold your urine.   In some cases fluids like caffeine can worsen bladder control.  A PT can help you figure out what would be the most strategic fluid intake for your circumstances.

  1. Weight Loss is a great natural treatment option for stress incontinence

Yes, losing weight is shown to reduce stress incontinence!  Do you have an extra 5-10 pounds on you (Or more?).  Extra weight places more strain and pressure through the bladder, urethra and pelvic floor.  Losing even 5 pounds can have a beneficial effect on your stress incontinence.  While losing weight can feel like a challenge, the rewards it brings are totally worth it. And, if you are serious about implementing natural treatments for your stress incontinence, this one is a big one to accomplish!

  1. Pelvic floor muscle training with a pelvic physical therapist

When an individual experiences stress incontinence your pelvic floor muscles typically are not functioning properly.  Research has shown that pelvic floor muscle training can improve your symptoms.  It has also shown to help for pelvic organ prolapse symptoms, which is a condition common to women, and something that contributes to stress incontinence.  Training your muscles does take time, research seems to show it takes 3-6 months of consistent work to get the benefits you are looking for.  So, the trick is to be consistent and make the commitment to doing your exercises.  Training these muscles is the ultimate natural treatment for stress incontinence.  Seriously, if you have stress incontinence these muscles are always dysfunctional and you must address this.

What exercises should I be doing to train my pelvic floor muscles? 

Working with a pelvic health therapist you will learn a wide variety of exercises clinically shown to help improve urinary control.  Exercise is nature’s gift, as it is a natural treatment for stress incontinence that has no unpleasant side effects, like you would experience with pharmaceuticals and surgery.  There is not one exercise to do and, definitely, doing a “kegel” is not what we are talking about.  Stress incontinence occurs when your bladder control is overwhelmed by abdominal pressure that is generated through your movements.  We will assess the symphony of muscular coordination that should be occurring.  We also look at your movement patterns and see if your strategies are optimal for promoting bladder control.  When we help you train your pelvic floor muscles we also coordinate your breathing, abdominal wall, pelvic floor, glutes/hips and thighs and we address speed and timing.

Why we do NOT recommend you do Kegels:

We don’t recommend that you just try to work on Kegels or pelvic floor muscle training on your own at home; stress incontinence is a bigger problem than just getting a kegel to be stronger.  In fact, most people we see who have stress incontinence cannot perform a kegel properly.  They do it all wrong and in some cases can worsen the problem!  They are often bearing down on the muscles, even when they think and perceive they are correctly tightening the muscles.  Other times the muscles are already too stiff and tight, so kegels can worsen your stress incontinence.  Another problem we see is the lack of correct coordination between your abdominal wall and breathing with your pelvic floor muscles.  Additionally, in men, we see a tendency to recruit the wrong muscles when they do kegels such that they are unlikely to get much benefit to help their incontinence.  We also see, in both women and men, a tendency to “cheat” using your glutes and thighs, which does you no good and, in fact, can give you a false perception that you are helping yourself.  We also see people who commonly have a problem in their abdominal wall that can contribute to your stress incontinence.  This problem, a diastasis recti abdominus (DRA), is a widening of your linea alba that causes a disruption in your body’s ability to transfer load through your trunk, thus rendering it easier to lose your urine.  Before we begin pelvic floor muscle training, we assess you for a DRA and if this is a problem you have, then we treat that as well.    Working with a pelvic health PT will give you the best chance of improving your stress incontinence and we can teach you what to be doing at home so you can add these things to your workouts.

  1. Pessary, an option for women.

A pessary is a small item that is custom fitted by your physician for your anatomy and is inserted in your vagina.  Pessaries come in many different shapes and sizes to help correct your anatomy when you have a pelvic organ prolapse.  Combining a pessary with behavioral changes and pelvic floor muscle training, as described above, was found to have better improvement than only wearing a pessary.  Put another way, a pessary all by itself might not eradicate your stress incontinence, but if you also work on improving your pelvic floor awareness, strength and coordination while making some behavioral changes, you have a better chance of meeting your goals.  Just as most women are comfortable using a tampon, a pessary is something a woman can learn to insert and remove by herself.  Getting fitted for a pessary happens at your doctor’s office, preferably a urogynecologist who is specially trained in measuring your prolapse and fitting you for a pessary.  In one study, 73% of women who were given a pessary were happy enough with it to continue wearing this after one year.   If you have a pessary, usually there are regular follow ups with your physician to ensure everything is going all right with it.  How often you have a follow up depends on your physician’s preferences and your body, menopausal status and other considerations.  Sometimes follow up checks for your pessary would be every 3 months, other times it could be every 6 months or once a year.  Based on my experience as a pelvic health PT, I find that pessaries are under-utilized and not well known.  They are, in fact, an excellent natural treatment for stress incontinence and most women, can adapt well to wearing one.  You don’t even feel it, once it is inside you and fitted well.

  1. Address and improve your constipation

Improving urinary control can happen when you get your bowels regulated.  Individuals who have extreme constipation may face stool impaction and this has been shown to worsen urinary control.  Additionally, straining to have a BM is a strain on your pelvic floor muscles, the exact muscles that are needed to be in tip-top shape to maintain continence.   For any person I am working with who presents with issues related to stress incontinence, I always assess and help them with their bowel regularity.  Getting your bowel movements optimized is a natural treatment for stress incontinence and, for some people, can be an “easy win” towards getting their urinary control improved.

There is hope! You can improve your stress incontinence if you undertake the above tips!

The bottom line is that stress incontinence, although a frustrating and common condition in both women and men (following prostate surgeries), is not normal and can be improved with targeted efforts.  By implementing a combination of efforts listed in this article you can improve your constipation.  Do you need to lose a few pounds?  Cut back on your caffeine?  Retrain your pelvic floor, breathing and core muscles? Improve your constipation?  Get a pessary?  These are many natural treatments for stress incontinence that can help you, so please do not assume you are stuck with this problem.  Dr. Maureen O’Keefe, DPT offers expert and customized care specific to your body, your movement patterns, your muscular dysfunction and your bladder.  If you feel you would benefit from expert, directed guidance to help you improve your stress incontinence, call us today at 616-516-4334.  We always enjoy answering your questions and helping you determine your next best steps!


Dr. Maureen O’Keefe, DPT