Hi friends! Osteoarthritis of the hip affects about 14% of the population, but did you know that almost half of patients with hip osteoarthritis have some form of urinary incontinence (Martines, 2022; Tamaki, 2014)? Let’s talk about why.
The pelvic floor muscles have several rolls including supporting the pelvic organs, working as part of the core to stabilize, controlling urine and poop, and sexual function. When the pelvic floor muscles aren’t working properly, we can have urinary incontinence. Remember, urinary incontinence is ANY involuntary loss of urine (Martines, 2022).
The function of the obturator internus (hip muscle) is to rotate the hip externally (or away from the middle of our bodies). The pelvic floor muscles and the obturator internus (hip muscle) share fascial connections (Martines, 2022). This means that these muscles can impact the way the other functions, either for the better or for worse. Other muscle groups, like the hip adductors and the hip flexors, that attach to the pelvis also play a role in pelvic floor muscle function.
With hip osteoarthritis, we often see a limitation in the hip range of motion and strength of the hip muscles. This loss in strength can be cause by muscle atrophy (Martines, 2022). This means that, as the obturator internus muscle loses strength and flexibility due to hip osteoarthritis, the pelvic floor muscles can have a harder time performing its functions and therefore we can have urinary incontinence.
With a hip replacement, the hip muscles often regain their strength and range of motion (Martines, 2022). This improvement helps to improve the relationship between the pelvic floor muscles and the obturator internus muscles and can decrease the amount of leakage that we experience.
We also know that osteoarthritis can cause individuals to walk more slowly. Researchers have found a link between a slower walking speed and urinary incontinence, and improving walking speed can improve urinary incontinence (Martines, 2022). With a hip replacement, the improvement in hip strength and range of motion with a hip replacement often allow individuals to walk faster.
It's important to note that there are different surgical techniques for a hip replacement. The anterior approach to hip replacement can spare these muscles and may improve incontinence (Martines, 2022). Improvements in continence were noted at 3 and 6 months after surgery (Martines, 2022).The posterior approach to hip replacement sections the obturator which can compromise muscle strength and may even lead to urinary incontinence and overactive bladder symptoms (Martines, 2022).
Keep in mind there can be several reasons for urinary incontinence and hip dysfunction is only one possibility. This means that a hip replacement alone may not be the only treatment for urinary incontinence, and a hip replacement may not resolve everyone’s urinary incontinence. If you are experiencing urinary incontinence, discuss this with your providers. A pelvic floor physical therapist or occupational therapist can be a great resource. A skilled therapist will perform a thourough evaluation, looking at the pelvic floor and beyond, to address pelvic floor tightness, improve posture and body mechanics, and improve any areas of tightness or weakness. A therapist will develop a treatment plan individualized to you and your specific needs for the most success. You can ask your provider for a referral to one near your, or find one at www.mypfm.com/find-a-pt.
Ready to learn more about pelvic health? Here are some helpful resources:
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For providers, check out myPFM Academy to learn more so you can better help your clients. With two membership options, you have access to courses, a growing library of patient handouts, hundreds of custom sharable images and infographics, and multilingual resources. At myPFM Academy you’ll find courses like:
The Hip and Urinary Incontinence: A look beyond the pelvic floor at what keeps us dry with Lauren Trosch, PT, DPT, OCS
Sexual Considerations after a Total Hip Replacement with Dr. Kelli Wilson, PT, DPT, OCS, FAAOMPT (Oct 2023)
Written by Emily Reul, PT, DPT
References
Martines GA et al. Urinary incontinence, overactive bladder, and quality of life in women submitted to total hip replacement. Neurourol Urodyn. 2022;41(3):830-840.
Tamaki T, Oinuma K, Shiratsuchi H, Akita K, Satoshi I. Hip dysfunction-related urinary incontinence: a prospective anaylsis of 189 female patients undergoing total hip atrhtoplasty. Int J Urol. 2014;21(7):729-31.
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