Women, Incontinence and Low Back Pain

   Recent research has led to an apparent relationship between low back pain and urinary incontinence. Pelvic floor impairments can contribute to hip, pelvis and low back pain and urinary incontinence. In a study where women reported a combination of low back pain and some type of pelvic floor dysfunction (e.g. urinary incontinence, difficulty emptying, sexual dysfunction and/or constipation) 82% indicated that their symptoms initially began with either low back pain or pelvic girdle pain. The treatment of one of these components often impacts the other.
   There are two kinds of muscles in our body; muscles that stabilize the bones and joints prior to any motion occurring and muscles that move the bones and joints. Optimal function requires proper timing of muscles action, proper endurance and strength of muscles. A weakened pelvic floor raises the risk of incontinence and chronic back pain due to poor core muscle stability.
   Stress incontinence is most in women under 60 years old, and especially in post partum women. Most do not know this is a very treatable condition. It is defined as leakage with sneezing, coughing, laughing, or exercising or physical exertion.

Statistics
Incontinence affects 40% of women and 10% of men.
Hysterectomy raises risk of incontinence by 40%, and more if cervix was removed.
Childbirth more than doubles the risk for developing stress or urge incontinence (often after menopause).
Approximately one third of constipation issues are from pelvic floor problems.

Risk Factors
Childbirth (Contributing factors include difficult labor, contractions less than 30 minutes or more than 2 hours, use of forceps and episiotomy.)
Hysterectomy (The cervix serves as a muscle attachment for a portion of the pelvic floor muscles.)
Menopause (Tight seal of the sphincters may be impaired with decreased estrogen.)
Age (Incidence increase with age, especially with one or more of the factors above.)

Treatment
   Many people feel their condition is inevitable, but there are treatment options available. Physical therapy for the pelvic floor has proven effective for the treatment of incontinence and is available in some hospitals and physician offices. Medications can be effective, but may have unwanted side-effects for some people. Surgical procedures are generally recommended when other treatment approaches do not resolve the problems.

WNH Services
Specialists in gynecology, surgery and family medicine
Surgical services
Non-invasive therapy
   In 2007, WNH launched a program for the treatment of the above conditions. The process begins with evaluation from a physical therapist trained in the treatment of pelvic floor dysfunctions. Recommended treatment may include one or more of the following: instruction in an appropriate home program; patient education and behavioral instructions; biofeedback to assist in re-training the pelvic floor; theraputic electrical stimulation; and, manual therapy.

Resources
Simon Foundation for Continence
National Association for Continence
National Vulvodynia Association
Topic: pelvic pain or incontinence
Healthline