Weak pelvic floor muscles


There are several types of urinary incontinence, but the most common is stress incontinence. Stress Incontinence is when you have bladder leakage that occurs with any increased abdominal pressure such as laughing, coughing, sneezing or exercising. Weak pelvic floor muscles or a weak or damaged sphincter causes stress urinary incontinence. According to EMedicineHealth.com, stress incontinence affects up to 60 percent of women.

Symptoms & Causes

Causes: Stress incontinence is the most common type of bladder control problem in younger and middle-aged women, often related to pregnancy and childbirth or menopause.

According to emedicinehealth.com:

Stress incontinence is most commonly caused when the urethra (the tube from the bladder to the outside of the body) is hypermobile because of problems with the muscles of the pelvis. A less common cause of stress incontinence is a muscle defect in the urethra known as intrinsic sphincter deficiency. The sphincter is a muscle that closes off the urethra and prevents urine from leaving the bladder and passing through the urethra to the outside of the body. If this muscle is damaged or deficient, urine can leak out of the bladder. Obviously, some people may have both.

Symptoms: This type of incontinence often occurs during physical activity, for example, when sneezing, laughing or standing up from a seated position. When abdominal muscles contract, there is an increase in intra-abdominal pressure and urine leaks out of the body.

Risk Factors & Complications

Stress incontinence is more common among women, but gender and age are not the only factors. According to the Urology Care Foundation, risk factors of getting urinary incontinence include:

  • Pregnancy and childbirth
  • Overweight or obesity
  • Smoking
  • Chronic coughing
  • Nerve injuries to the lower back
  • Pelvic surgery
  • Caucasian or Hispanic race

Treatment Options

Many people think urinary incontinence is just part of getting older. It’s not. And it can be treated, or even cured.

Urinary incontinence can affect a person’s emotional, psychological and social life – it is not just a medical issue. Those who have urinary incontinence are hesitant to do daily activities, not wanting to stray too far from a toilet.

Below are the best ways to treat stress incontinence.

Absorbent pads or diapers

Absorbent products may be used to manage any form of incontinence. However, these products are NOT A TREATMENT for incontinence; for some individuals, urinary incontinence products are a temporary strategy until they address and resolve the underlying cause of their incontinence. Most people find the use of pads, diapers and bladder supports to be extremely inconvenient, expensive and impacts their quality of life.

Risks when using absorbent products include irritation around the groin area and an increased risk of urinary tract infections.

Product options include:

  • Depends® Adult Underwear
  • Tena Serenity®
  • Poise® Impressa®
  • Always Discreet®

Behavioral Techniques

Depending on the severity, type or underlying cause of incontinence, your doctor may recommend these treatments first to help strengthen and train your pelvic floor and bladder.

  • Bladder Training: Training the bladder to hold out for longer and longer periods between bathroom visits.
  • Fluid Management: Having a reasonable fluid intake, drinking less, avoiding coffee, tea, caffeinated sodas and alcohol.
  • Double Voiding: Urinating twice – once you urinate you wait a few minutes and urinate again to release any residual urine.
  • Scheduled Trips to the Restroom: Urinating every two to four hours instead of waiting for the urge to go to the bathroom.

Physical Therapy

Patients typically attend in-office appointments 2-3 times per week for a duration of 12 weeks. Treatment requires manual digital manipulation of the external and internal tissues of the pelvis, vagina and/or rectum. This type of therapy is fairly intimate and can be uncomfortable for some patients.

Therapists will often utilize bladder training, biofeedback, pelvic floor muscle exercises and electrical muscle stimulation.

Pelvic Floor Muscle Exercises (Kegel Exercises)

Many physicians recommend Pelvic Floor Exercises (Kegels) as a first line treatment for Stress and Urge bladder leakage. The goal of pelvic floor muscle training is to strengthen weak urinary sphincter and pelvic floor muscles – the muscles that control urination and defecation.

The Problem with Kegel Exercises

Research has shown that over half of women who attempt Kegel exercises do them incorrectly by overusing their abdominal, buttock or leg muscles resulting in no improvement in pelvic floor muscle strength. In addition, if you already have very weak pelvic floor muscles, you may not be able to contract them effectively.

Finally, according to Dr. Arnold Kegel, “Muscles that have lost tone, texture and function can be restored to use by active exercise against progressive resistance since muscles increase in strength in direct proportion to the demands placed upon them.” Simply put, you need to perform your exercises with active resistance—something to squeeze against.

There are devices available including over-the-counter devices (no prescription required) to assist you in identifying the correct muscles and providing active resistance.


Biofeedback is a technique that provides you with real-time information about activity in the bladder and pelvic muscles to help you learn to contract these muscles properly. Sensors are placed internally and/or externally within or around the vagina or rectum. Many trained specialists, such as physical therapists, occupational therapists, and nurses provide these services. Patients typically require 2-3 in-office visits per week to learn how to isolate and contract the pelvic floor muscles while using biofeedback to guide performance. In addition, there are biofeedback products available for home use.

Medical devices

Medical devices can be used to help build and strengthen pelvic floor muscles, treating incontinence at the source instead of just managing the result. According to the Mayo Clinic, “gentle electrical stimulation can be effective for stress incontinence and urge incontinence.”

Electrical Muscle Stimulation

The use of electrical muscle stimulation for urinary and fecal incontinence spans a 30 year period and has gained popularity as it is an effective, safe, non-invasive treatment of stress, urge, mixed urinary incontinence and fecal incontinence.

Electrical stimulation resolves incontinence by treating the underlying problem – it strengthens weak pelvic floor muscles and can calm an over-active detrusor muscle without the use of medications or surgery. Muscle stimulation is a first-line treatment option that should be used prior to more invasive options.

Muscle stimulation causes a contraction of the pelvic floor muscles to strengthen them (resolving stress incontinence) and can also calm an overactive detrusor muscle (resolving urge incontinence). This therapy is very valuable when a person is too weak to contract their muscles on their own and also helps you to isolate the pelvic floor muscles.

Electrical muscle stimulation can be done in your doctor or therapist’s office or in the privacy of your home with an over-the-counter (no prescription necessary) muscle stimulation device.

While there are many options available to manage urinary incontinence, most people don’t realize there are products that can cure it.

Dr. Holly L. Thacker, Dr. Lynn Pattimakiel, Dr. Lynn Simpson and Mary Clarkin, CNP of the Cleveland Clinic’s Center for Specialized Women’s Health have been prescribing two medical devices, the InTone and ApexM, to their patients at Cleveland Clinic and are seeing significant improvement with incontinence.

ApexM & InTone from InControl Medical

A recent clinical study shows a 90% improvement in daily incontinence occurrences over a 12-week period. The InTone (doctor prescribed) and ApexM (over-the-counter version of InTone) devices treat stress incontinence by strengthening the pelvic floor muscles that allow you to squeeze your urethra, stopping any unwanted leakage. Both devices are used intravaginally and can be done in the privacy of your own home. Learn more about InControl Medical ApexM here.


It is not recommended by the American College of Physicians (ACP) for those with stress incontinence to seek drug treatment.

Bulking Agents

Another way to prevent leakage from stress incontinence is to inject synthetic bulking agents into the tissues around the urethra boosting the size of the urethra lining and creates resistance against the flow of urine from the bladder.

Injections must be repeated every 12 to 18 months and are only helpful against stress incontinence. Potential side effects include pain at injection site and or damage to the urethra.

Note: Bulking Agents treat Stress Urinary Incontinence only and do nothing to strengthen the pelvic floor muscles.


According to the Cleveland Clinic, approximately 11 percent of patients seeking treatment for urinary incontinence will undergo surgery.

Sling Procedure

Sling surgery for stress urinary incontinence is often done as an outpatient procedure. One option for stress incontinence is to place the bladder in a “sling” – a piece of tissue or synthetic material is used to create a sling around the bladder neck and urethra in order to provide support to keep the urethra closed in order to prevent leaks. As with any surgical procedure, please discuss thoroughly with your physician the benefits and possible complications that may exist.

Note: Does nothing to strengthen the pelvic floor muscles. 

Bladder neck suspension

This procedure will support your bladder neck and urethra. The bladder neck is an area of muscle where the bladder connects to the urethra. The surgery involves an abdominal incision, so it can be done during general or spinal anesthesia.

Prolapse surgery

If a woman has mixed incontinence as well as a pelvic organ prolapse, surgery may include a combination of sling and prolapse surgery.

Artificial urinary sphincter

For men, a small, fluid-filled ring is implanted around the bladder neck to keep the urinary sphincter shut until you’re ready to urinate. When you do urinate, you press a valve implanted under your skin that causes the ring to deflate and allows urine to flow.