I didn’t know why or if it happened to others as well. There would be times when it was worse and times when it was better. Only when I started my life as a physical therapist and learnt about the pelvic floor did I get a chance to fix it once and for all.
What I experienced as a child was called stress urinary incontinence (stress UI). Basically this means that a physical “stress” to the body (like coughing, laughing, jumping, running) causes leaking. What I experienced later was called urge urinary incontinence. This is frequently referred to as the “key-in-the door” phenomenon where you might link a specific place/smell/action/sight/sound to leaking. Having both types is referred to as mixed urinary incontinence.
Having gone through both has made me a better clinician to treat urinary incontinence (UI). Today I treat across the gender spectrum and from children to older folks with all forms of bladder issues, including UI, urinary urgency/frequency, bladder prolapse (cystocele), painful bladder (interstitial cystitis), overactive bladder, incomplete bladder emptying, urethral pain, and more.
Here, I focus specifically on stress urinary incontinence - why it happens and what you can do.
Why do I leak?
UI in general is present in 25-45% of the population and is three times more likely to occur in females than males. Stress UI is the most common type of the three forms of UI across all age groups. Although vaginal delivery can increase your chances of leaking, people who have C-sections also experience UI. This is because the several months of pregnancy cause shifts in hormones, posture, muscle strength/flexibility, and more. Studies show that 35-67% of women having UI during pregnancy. Also, urinary tract infections, constipation, genetics, age, and obesity can increase the risk of UI.
It’s clear that some factors, such as age and genetics, we cannot control. With age, we naturally lose muscle mass, the very muscles that serve a huge supportive role in the pelvic floor, as explained in Intro to Pelvic Floor. Generally speaking, weakness in the pelvic floor muscles is a prime factor for stress UI, however tightness can also cause leaking! This is why kegels are not always the answer to incontinence (more on this later). In theory, the heavier we are, due to obesity or pregnancy, the more pressure we exert on our pelvic floor. This stretches the muscles and weakens their supportive function. If you are constipated, you may be straining and pushing on the toilet, which can further lengthen the tissues of the pelvic floor. Refer to our Constipation blog post for more on how you can help with this.
What can I do about it?
Young female athletes to elderly men with prostate dysfunction experience stress UI. Whether you plan to get pregnant or not, we are all going to age. So strengthening and stretching the muscles of the pelvic floor is relevant regardless of age or sex.
As a general rule of thumb, UI that is caused by pelvic floor muscle dysfunction can be due to weakness, lack of coordination, and/or tightness. You should always check with your pelvic floor physical therapist on whether to strengthen or lengthen your pelvic floor muscles and whether you are doing it correctly or not. Many times, I will retrain people’s pelvic floor muscles, because, while they might think they are doing a pelvic floor contraction (AKA a “kegel,”) they are actually squeezing their inner thighs or glutes. This is a coordination problem, not necessarily a strength problem. Other times, I will find that the person needs to do just the opposite of kegels (reverse kegels AKA relaxation and muscle lengthening) because their UI is caused by tightness, not weakness. Once you and your physical therapist determine that your UI is a specific result of weakness of the pelvic floor muscles and you learn how to do kegels correctly, it’s great practice to perform 3 sets of 12 kegels, 3-4x/week for long-term health. Remember, all people (regardless of gender) have pelvic floor muscles, so understanding them is equally important to all, not just females.
It’s also great to contract your pelvic floor muscles before and during a cough or sneeze to prevent unwanted leaking.
Incontinence can strongly interfere with your life. Some of my patients will admit that they don’t drink half as much water as they should because of their peeing issues. Don’t even get me started on how harmful lack of water intake is (a blog for another day!). Other patients will admit how embarrassing it is to take multiple bathroom breaks during long car rides because of their incontinence. In addition, studies have shown that stress UI can hinder people from wanting regular physical exercise due to fear of leaking.
The bottom line is, when it comes to stress UI, there is a lot you can do about it. Seeing a pelvic floor physical therapist has proven benefits to help you decrease leaking and improve the overall quality of your life. Speaking from personal experience, incorporating pelvic floor work in my daily exercise routine has put away any thought of UI for me!
There it is folks - our second post in our 3-Part Pelvic Series on Peeing! Coming up next week are issues people face with… PROCREATION.