By Dr. Renee Bullis, PT, DPT. Renee is one of our contributors and we are lucky to have her expertise to share. Remember to consult your own physician or medical professional for any medical needs!
Do you accidentally pee when you cough or sneeze? What about right when you get home from the store and pull into the garage? Do you immediately have to run in and use the bathroom for fear of leaking? What about when you run, jump, or work out? Have you made every excuse to not get on the trampoline with your kids because it’s inevitable you’ll have a little, or a lot of, dribble? What about if you get a case of the giggle fits?
As a pelvic floor physical therapist (PT), I want every woman to know that leaking urine is not something you just have to live with! Yes, even if you’ve had multiple babies or have been through menopause.
Let’s explore the Who, What, When, Where, Why, and How with all things incontinence.
Incontinence can affect women throughout their lifespan, which includes childhood and high school, pregnancy, postpartum, and during or after menopause. It affects couch potatoes to elite athletes and everyone in between. Depending on your age and other risk factors, there is a fairly decent chance that your girlfriend sitting next to you has experienced leaking urine at some point in her life. In fact, one study showed that 25% of young women and 44-57% of middle-aged and postmenopausal women experience incontinence (1). Another study showed that 49% of women who exercise at the gym or attend gym classes, with at least one risk factor for stress urinary incontinence, experience stress urinary incontinence (2).
Incontinence refers to any unwanted or accidental leaking of urine, feces, or gas. Urinary incontinence is specific to accidental leaking of urine, which could feel like just a few drops or feel like your whole bladder empties accidentally. A few of the most common types of incontinence are stress, urge, and mixed incontinence.
When does leaking happen? It can happen with increases in intra-abdominal pressure – like with a cough, sneeze, laugh, or even things like running, lifting, and abdominal exercises. Leaking can also happen with a really strong urge. Certain times of a woman’s life also bring significant changes in hormones and the pelvic floor, which can both affect continence. Some of these times include pregnancy, childbirth, postpartum, menopause, and undergoing certain surgeries, such as pelvic or abdominal surgeries.
Where does it occur? Well, this seems a bit silly. Other than leaking happening in your pants, let’s keep the theme of this post and describe “the where” in relation to pelvic anatomy. Your bladder empties urine through the urethra which sits in front of your vagina. Your bladder sits in your pelvic cavity, along with your other pelvic organs – uterus, ovaries, and rectum – and with other ligaments and connective tissue. Below the organs is your pelvic floor. Think of your pelvic floor as a hammock of muscles supporting your pelvic organs, including your bladder.
There can be several reasons why leaking happens, but let’s focus on the pelvic floor today. If your pelvic floor is weak, overactive, lacks coordination, or has poor activation patterns, it may not be working effectively or efficiently. This can lead to incontinence. Your pelvic floor has fast-twitch and slow-twitch muscle fibers, and we want to train both. We want your pelvic floor to help prevent leaking when you cough (fast-twitch fibers), as well as being able to hold when you get a super-strong urge with no bathroom in sight (slow-twitch fibers). Pelvic floor contractions, AKA Kegels, can be used to help strengthen the pelvic floor. But – and a big “but” here – not everyone needs to do Kegels! Also, just doing Kegels laying on your back might not make a big difference for you. This is where a pelvic floor PT can help determine what you need.
How do we stop leaking? Pelvic floor PT can be an effective tool in improving continence. Not only will we assess pelvic floor function that could be contributing to your incontinence, but we will also discuss other contributing factors, such as bladder and bowel habits (fun fact: your bladder is very trainable!). We will assess other muscles and your movement patterns that also could be contributing to your symptoms. Our bodies are really good at compensating without us being aware, and we can help identify those compensation patterns and assess if they could be contributing to symptoms or putting you at risk for injury in the future.
Many women feel embarrassed by their incontinence and end up avoiding different activities, like exercising or even doing certain activities with their kids. As pelvic floor PTs, we want to help you feel confident in whatever you do.
So please reach out to one today!
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