You’re not the only one who leaks urine when you cough, sneeze, jump or laugh!
Sadly, this is an all-too-common symptom of a condition known as stress incontinence.
What is stress incontinence?
Stress Incontinence is the involuntary loss of urine with activities that cause pressure (stress) on the bladder, such as coughing, sneezing, running, and jumping.
Leaking occurs when the downward pressure from the bladder is greater than the strength of your pelvic floor.
It is the most common form of incontinence in women under the age of 60, and it occurs in approximately 44% of female athletes.
One study estimates that 47% of women who regularly exercise report some degree of incontinence (Joy et al, 2018), and this number is likely much higher than the likelihood of underreporting.
Needless to say, this is a common problem, ladies!
What causes stress incontinence?
The onset of stress incontinence is often seen after pregnancy and childbirth, but there are other conditions that can also increase the risk including:
- Hormonal changes after pregnancy
- Chronic coughing
- Poor postural habits
- Abdominal or pelvic surgery including hysterectomy
- Repeated stress or high impact activities (running, jumping, heavy lifting)
The first thing you need to understand is that NO amount of leaking is normal.
We may laugh about the common experience of “pee-sneezing” or tease about not being about to go to the trampoline park, but incontinence makes many women feel sad, isolated, and embarrassed.
It’s NOT a normal part of life and aging, and it is certainly not something you should continue to deal with!
Should I be concerned?
Incontinence is a symptom – think of it as the warning lights on your car dashboard.
It is an indicator of something not working well in the system as a whole. This is why it is so helpful to work with a pelvic floor therapist to help get to the root of why you are having these issues.
Despite the fact that nearly 25 million Americans deal with some degree of incontinence, the NAFC reports only 1 in 12 actually seek treatment.
My goal is that we begin to change that!
So let’s talk about why this happens…
The pelvic floor consists of a group of muscles that run from your pubic bone to your tailbone in a “hammock” at the base of the pelvis.
They serve to support bladder and bowel function, assist in sexual health, and provide support to your pelvic organs.
The pelvic floor is also an incredibly important part of your core, working with your deep abdominal muscles and diaphragm.
The first and second layers of the pelvic floor serve to close and squeeze the openings, providing sphincteric support and preventing leaking.
The deeper layers provide support by lifting and keeping your pelvic organs in place, avoiding bladder, uterus, and bowel prolapse.
So how does the pelvic floor become dysfunctional?
Your Breathing May Be the Culprit!
In fact, I wrote an entire blog post about the role of the pelvic floor and breathing, which you can read here.
Do I just need to “strengthen my core”?
Another reason you may be experiencing stress incontinence is over-engaging your core.
That’s right – too much abdominal muscle activity can lead to leaking!
In a culture with tummy control leggings and Spanx, we are led to believe that it is a good thing to “hold in your belly.”
Postpartum belly binders resembling an 18th-century corset are marketed to help you “bounce back” and flatten your tummy.
When you are bombarded with these ideas and pressure, it is a normal response to think the tighter you can hold your belly in, the better off you’ll be.
Upper abdominal “gripping” is a common culprit, as is over-working the pelvic floor. This decreases your ability to breathe well and creates an imbalance in your abdominal muscles, making it difficult for you to recruit your lower Transverse Abdominis (deep core).
This weakness not only affects how your core functions, but it leads to the appearance of a lower belly “pooch”.
Muscle engagement and activation is a delicate balance – you want to recruit just what you need to work, but your muscles should also be able to fully relax.
Letting go can lead to immediate improvements, even though that seems counterintuitive!
Women have been misled to think that they need to hold a kegel the whole time they run or jump rope, and that creates a pelvic floor that is tight (hypertonic) and exhausted!
Consider this same idea in another context.
Imagine holding your arm in a bent position and tightening your bicep for 10 minutes or performing 200 biceps curls. How would those muscles feel afterward?
What about Kegels?
I don’t want to underemphasize the importance of strengthening the pelvic floor, but this is much more complicated than just doing Kegels.
When women are given written or verbal instructions on performing a pelvic floor contraction (aka kegel), most of them are not able to perform the contraction correctly.
So how do I make my pelvic floor work the way it should?
Internal assessment allows pelvic floor therapists to accurately assess and teach you how to work with your body and your breath.
Many women will find they are actually “bearing down” rather than “lifting and squeezing”, which leads to incontinence.
We also need to address any increased muscle tone or hypertonicity that we see.
The ability to fully relax and lengthen is just as important as being able to contract your pelvic floor muscles.
For more information on the idea of relaxing the pelvic floor, check out my post on Overactive Bladder.
Teaching clients how to proactively engage the pelvic floor prior to coughing and sneezing can be incredibly effective in eliminating leaking.
The pelvic floor muscles consist of both slow and fast-twitch fibers, meaning we need to train with short, quick contractions, as well as longer endurance, holds (10 seconds).
A Pelvic Floor Therapist will perform a strength assessment, rating your ability to squeeze, lift and hold, and testing how many quick contractions you can perform in 10 seconds.
What many clients find most challenging is fully relaxing (lengthening) after each contraction. I can’t overemphasize how important this is!
It’s so much easier to train a muscle that can move through its entire length!
How we use these muscles matters as well. When properly functioning, the pelvic floor has the ability to anticipate and respond to varying levels of pressure.
For example, the strength of contraction needed to stand from a chair differs greatly from the contraction needed for running or jumping.
We can help you train with different levels of intensity and speed and also help “re-train” this anticipatory control.
In terms of coordination, we teach you how to work with your breath, “timing” the exhale, and pelvic floor contraction with impact during a high-impact activity like jumping.
What role does posture play?
Many women are so surprised to learn that their leaking actually has more to do with their posture and poor alignment during activities that increase pressure. This goes back to my discussion about the “pressure canister”.
Some important cues to remember:
- Keep your ribcage over your pelvis. To have the best ability to engage your core, you need good alignment and connection between your diaphragm and your pelvic floor.
- Are you maintaining a neutral pelvis? Are you allowing your pelvis to “spill forward” in an anterior tilt or are you finding yourself in a “tucked under” posterior pelvic tilt?
- Don’t allow your chin to pop up and forward. Imagine a string pulling your hair straight up from the crown of your head.
These subtle changes help your ribs, spine, and pelvis remain in optimal positioning so they can all do their jobs!
So you’re telling me it doesn’t have to be this way?
That’s exactly right!
Yes, this is a difficult subject to talk about for many women, and yes, there are numerous potential causes of stress incontinence.
But there is strong evidence to support a treatment approach that considers the role of your breathing, posture, and pelvic floor muscles TOGETHER in order to avoid urinary leaking.
Remember, urinary leaking is extremely common, but no amount of leaking is normal, no matter who has told you otherwise!
You owe it to yourself to explore your options for treatment and get back to a life without having to hold back a cough, sneeze, or laugh!