Understanding Incontinence: The Different Types and How Pelvic Floor Physical Therapy Can Help

Bladder health and pelvic floor function are closely connected. The bladder is a muscular organ that fills with urine throughout the day. While it’s filling, the pelvic floor muscles — a group of muscles at the base of the pelvis — remain contracted to keep urine from leaking. When it’s time to urinate, the bladder contracts, and the pelvic floor muscles must relax in order to fully empty. This coordination is essential for healthy bladder function.

Many people feel the urge to urinate before their bladder is actually full. This can become problematic if it leads to frequent trips to the bathroom or behaviors like "just in case" peeing, which can actually train the bladder to hold less over time. It’s also important to avoid hovering over the toilet, as this prevents full pelvic floor relaxation and can lead to incomplete emptying. Likewise, straining to urinate puts unnecessary pressure on the pelvic organs and should be avoided.

Typical healthy voiding patterns include urinating 5–8 times in a 24-hour period, ideally at intervals of 2–4 hours. It's also normal to get up once occasionally or not at all during the night to urinate. If your habits fall outside these ranges, it may be worth discussing with a healthcare provider or pelvic floor physical therapist.

There are several types of incontinence, each with different causes:

• Stress incontinence occurs when physical stress (like coughing, sneezing, or exercising) increases pressure on the bladder and leads to leakage, often due to weakened pelvic floor muscles.

• Urge incontinence is caused by involuntary bladder contractions, leading to a sudden, intense urge to urinate — sometimes before reaching a bathroom.

• Overflow incontinence happens when the bladder doesn’t empty properly, often due to a blockage in the urethra. This can result in frequent dribbling or leaks.

• Neurogenic incontinence stems from damage or dysfunction in the nervous system that affects bladder control — for example, in conditions like multiple sclerosis or spinal cord injury.

• Overactive bladder (OAB) refers to a frequent, urgent need to urinate, often with urge incontinence, even when the bladder isn’t full.

• Urinary retention, or the inability to empty the bladder, is a serious condition that can be a medical emergency if left untreated.

• Painful bladder syndrome (interstitial cystitis) involves chronic pain or discomfort in the bladder, often worsening as it fills and sometimes persisting even after emptying.

  
  

Pelvic floor physical therapy can play a significant role in managing many of these conditions by retraining the muscles, improving bladder habits, and restoring better control.