As I stated in a previous blog, leaking urine during daily activities is not something you have to live with the rest of your life. Many of us think that because we have had children, we have to learn to live with stress incontinence. Some of us may develop leaking when trying to return to high impact activities like jumping, running, and playing sports. Stress incontinence may be common, but common does not equal permanent. It is important to understand why the leaking is occurring so that we can manage it appropriately and get back to doing what we love doing.
There are many causes of urinary leakage. If you recently had a baby or have had multiple children, you had a drastic change in abdominal muscle strength just due to stretching of the muscles with pregnancy, and a change in pelvic floor function due to pregnancy postural and weight changes. On top of that a vaginal delivery stretches the pelvic floor in order for the baby to pass through the birth canal.
What if you recently have not had a baby, but experience leaking? This can happen too. Sometimes our daily habits can contribute to leaking. If you have a habit of urinating every time you feel an urge, versus truly having a full bladder, you can train your bladder into thinking it always needs to be empty (even when partially full). Or maybe it's just the opposite for you. What if you have a job that limits your ability to use the bathroom as frequently as you need to and so your bladder is filled to capacity. Your bladder may leak with even the slightest jolt of movement or start to overflow.
Having weak pelvic floor muscles can also contribute to leaking if we try to do strenuous activities like jumping or running. You may need to train your pelvic floor muscles to handle this kind of stress.
Some of us may actually have pelvic floor muscles which are overworking and never relax. Your muscles may be holding quite a bit of tension so when you actually try to urinate you are not completely emptying your bladder because you don’t relax well. This can lead to leaking later in the day when you do activities which require more stress on your pelvic floor like running or jumping.
One other thing to consider is that there are women who are dealing with pelvic organ prolapse. The easiest way to understand this is to say that the ligaments that support your pelvic organs start to get stretched out over time secondary to heavy lifting, pregnancy, labor and childbirth, and aging. If you have pelvic organ prolapse, your organs are not supported as well and can drop into your pelvic floor muscles and put more pressure on them.
So what can you do to prevent leaking? It kind of depends on the cause. Some basic things to try include:
Diaphragmatic breathing. Taking relaxed breaths into the lower ribs and belly improves diaphragm and pelvic floor lengthening. This helps the pelvic floor relax fully and contract stronger.
Kegels. You should be doing a mix of short quick squeezes (muscle contractions) and longer holds that push the muscle to near fatigue. The last few reps should be very difficult. Each squeeze should be a full activation and a full release or we end up creating a shortened muscle that can’t work efficiently. Everyone will start at a different number of reps but an example would be 2 sets of 5 quick contractions followed by 4 reps of 4 second holds. If this is too easy for you you’ll want to add reps or length of the holds. If it’s too difficult, decrease the reps and holding time. Do these laying, sitting and standing 1x/day.
Kegels don’t work for everyone. If you have overactive pelvic floor muscles (too much tension) kegels could actually make your symptoms worse. You may need to work on relaxing your pelvic floor muscles before you can work on strengthening them. Talk to your OB, gynecologist, midwife, or pelvic health therapist if you notice kegels make your symptoms worse.
Wear perineal support after delivery or talk to your pelvic health provider about a pessary if you have prolapse. This is something simple such as a thick pad and snug underwear. You just want to gently support the muscles into an optimal position after having been stretched during pushing.
A pessary is a device inserted into the vagina to help hold up and support your pelvic organs if you are experiencing prolapse.
Track when you are leaking. If it’s only with coughing and sneezing then it may be as simple as addressing muscle function. If you leak when you have a strong urge to pee then there may be some habit changes that can benefit you (i.e. don’t keep ignoring the urge because you’re busy, or cut down the amount of coffee or soda you drink).
Find a Pelvic Health PT for a treatment plan specific to you. A pelvic health therapist can evaluate the status of your pelvic muscles and determine a treatment approach ideal for you which will eventually transition to training your pelvic floor muscles to tolerate jumping and running activities.