by Poppy Sundeen

No one knows exactly how many millions of American women suffer from urinary incontinence. That’s because an estimated half of them never ask their doctors for help, perhaps out of embarrassment or in the belief that nothing can be done.

Ellen Mitchell (not her real name) waited a year before she asked for help dealing with a problem that grew increasingly difficult. “I’d go to the bathroom before I left the house to buy groceries,”Mitchell says. “Then I’d have to go again at the store, and when I got back home, I’d race to the bathroom before unloading the groceries from the car.” Eventually, the problem interfered with her work as well as her home life. Mitchell suffered from urge incontinence, one of the most common forms of the disorder. In her case, it was compounded by nerve damage sustained during childbirth. Still, her symptoms were similar to those of countless other urge incontinence sufferers: sudden, strong urges to urinate, sometimes with loss of control. An even more common form, stress incontinence, is marked by urine leakage when the patient coughs, sneezes or laughs.

When Mitchell finally began looking for an answer, she found not one but many. “The first doctor suggested surgery,” she relates, “but I decided to look for other alternatives before accepting what seemed to be a drastic measure.” Another doctor prescribed medication that proved less than effective for Mitchell. Eventually, she saw a urologist who suggested an idea that sounded too good to be true: physical therapy.

Mitchell’s doctor put her in touch with Selena Escalante, M.P.T., a physical therapist at the Arlington Memorial Rehabilitation Center. Escalante is one of a few physical therapists trained in a new program that uses exercises, often in concert with biofeedback, to treat urinary incontinence.

“I got involved after taking an American Physical Therapy Association course on the subject,” says Escalante, who holds a master’s degree in physical therapy. “The goal of the course was to share techniques for assessing and treating pelvic floor muscle weakness.”

Pelvic floor muscles play an important role in both urge and stress incontinence. Strengthening the muscles through exercise can reduce or eliminate leakage and accidents.

“Our program begins by measuring pelvic floor muscle strength,” explains Escalante. “That way, we have a benchmark to measure our progress.” The patient then begins a program of weekly sessions at the Arlington Memorial Rehabilitation Center, supplemented by daily home exercise.

“Biofeedback is often helpful, because it tells patients whether they’re doing the exercises correctly,” Escalante adds. In Mitchell’s case, one biofeedback session was sufficient to correct a mistake in her exercise technique.

Along with exercise, Escalante’s program includes behavioral changes. “I tell my patients to avoid caffeine and alcohol,” she says, “because both substances can irritate the bladder.” She also asks her patients to increase their water intake.

At first, Mitchell was puzzled by the idea of drinking more water. She thought it might make things worse, not better. Then she learned that drinking water dilutes urine, and the weaker the urine, the less likely it is to trigger a bladder contraction.

Ellen Mitchell followed the program to the letter. “I had to give it my best shot,” she says, “to be sure I was doing everything I could to solve my problems without surgery.” Her diligence paid off. After just three months of working with Escalante, Mitchell no longer suffered the embarrassment and disruption of uncontrollable urges.

“Orthopedists have long viewed physical therapy as an important tool in helping their patients,” notes Escalante. “As word of this program spreads, I hope to see more gynecologists and urologists look to physical therapy as well.”