Urine Trouble?

Women who leak shouldn’t suffer in silence. That’s what Assistant Professor of Physical Therapy Stacie Bertram is fighting for in her research on female stress urinary incontinence.

“I certainly have had friends and family members who have struggled on and off with incontinence over the years,” Bertram said. “I think it's a silent, mini epidemic in women. Nobody wants to talk about it.”

And yet, nailing down the cause of female stress urinary incontinence can be difficult. Vaginal deliveries, being overweight, being involved in high weight-bearing activities, and even your diet are all thought to be associated.

“There are foods and drinks we love dearly that are bladder irritants,” Bertram said. “Some of them are coffee, red wine, chocolate and cheese. It's all the good things in life.”

However, the jury’s still out on whether certain factors have an impact.

“From a physical therapy point of view, there's some preliminary evidence out there that says people who have weaker hip muscles and abdominal muscles, core strength muscles, seem to report more incidences of incontinence. That's still being evaluated and examined. That's the research that I'm doing right now – looking at mechanical factors that might be associated with stress urinary incontinence in young women,” Bertram said.

As part of the multi-year study, Bertram and her graduate students spent this year looking at women ages 18 to 35. They zeroed in on things like core strength, recreational activity, height and weight, all to see if they could begin to make clinical predictions.

“Let's say you're a runner and you hurt yourself,” Bertram said. “You go in and see a physical therapist. What would be really helpful is if we had clinical prediction rules, where I'm doing an examination of them, and I notice they have weaker core strength.

“Then I examine their lower quarter, their hip, their knee, their ankle, and I notice, ‘Wow, they have an imbalance in their hip strength and mobility.’ Wouldn’t it be nice if the combination of that data would cue the physical therapist to ask if they had any problems with stress urinary incontinence.”

Because one of the greatest difficulties with this area of research is overcoming stigma and under-reporting, any tools that could help identify women early and get them the assistance they need would be a huge benefit to the field.

Board certified women's health specialist Dr. Janet Forinash ’08 was in the first graduating class of Bradley’s Doctor of Physical Therapy program, and now specializes in lymphedema, breast cancer rehab and pelvic floor. Of her pelvic floor patients, she says about 50% have some stress urinary incontinence.

It was in one of Bertram’s classes at Bradley that Forinash discovered the passion for women’s health that drives her career forward.

“I got to do a project where we had to create our own clinic,” she said. “I chose to do a women's health clinic, and it opened my mind to what I was really interested in.”

Now, Forinash finds herself flexing her physical therapy muscles even outside the clinic.

“Once people know you're a pelvic floor therapist, you may get a little more information from friends, family, things like that, where people feel more comfortable talking to you about those kinds of things. Just last week I went to a boutique – I don't even know how this came up with the person who was running the desk, but I ended up giving them my card before I left.”

--Jenevieve Rowley-Davis

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