( This post was originally published here.)
Many of my clients have questions about urinary incontinence (aka. leaking, sneezy pees) which affects 1 out of 3 women.
Here I answer 8 common questions about leaking:
1) What is urinary incontinence?
Any amount of urine that leaks out (even a few drops) when you don’t want it to = incontinence. The most common types of incontinence are:
Stress Incontinence: The leakage of urine when you increase pressure in your abdomen, which puts force down on your bladder such as sneezing (sneezy pees), coughing, lifting, or exercising.
Urge Incontinence: The leakage of urine that happens with a sudden, uncontrollable need to urinate. Also known as an ‘overactive bladder,’ since individuals with urge incontinence may feel the need to urinate frequently.
Mixed Incontinence: A combination of both Stress and Urge incontinence.
2) How did I develop incontinence?
It's often due to weakening (which can mean these muscles can be loose OR tense) or poor timing of your pelvic floor muscles. Certain specific or on-going events can cause these muscles to be compromised;
3) How can pelvic floor physiotherapy help with urinary incontinence?
Pelvic health physiotherapy is 80% effective for treating urinary incontinence. Physiotherapy involving an internal pelvic floor exam and treatment should be the first recommendation to resolve urge and stress incontinence before surgery is considered. Pelvic health physiotherapists have taken specialized training to complete an internal evaluation and design a treatment program that's tailored to your needs. Physiotherapy can save you money by allowing for fewer use of pads, decreasing your use of medications for incontinence and giving you the confidence to return to the activities you enjoy.
4) How would you assess my pelvic floor?
I take a detailed history by asking about your goals for physiotherapy, your symptoms, daily fluid intake, any previous pregnancies/births/surgeries/injuries or other medical conditions as well as any other treatments you have tried for your symptoms. Education is provided about where your pelvic floor muscles are located using a pelvic floor anatomical model and I explain how your posture affects the activation of these muscles.
Your pelvic floor muscles attach from your pubic bone to the tail bone (front to back) and sitz bones (side to side). They act as a trampoline and have many jobs including supporting your bladder/uterus/rectum (and your baby when pregnant), stabilizing your low back/pelvis, and closing the openings where urine and stools come out.
An external exam is then carried out which looks at your posture, tension in muscles that are connected to your pelvic including glutes, inner thighs and your outer core including whether an abdominal separation (diastasis) is present. The next step is an internal pelvic exam (with your informed consent) involving observation, and palpation (feeling) of the soft tissue and muscles outside and inside the vagina and rectum. Pelvic floor physiotherapists internally assess your pelvic floor muscle tension, strength and endurance as well as pelvic organ placement and these muscles work together with your other. Now that you and I have an idea of how your pelvic floor muscles are working, I then will guide you on trying to connect these muscles with your other core four muscles: transversus abdominis, diaphragm and multifidus. Often times we begin with just connecting the pelvic floor and diaphragm as that can be quite challenging on its own. Afterwards I explain the outcomes of the external and internal assessment, how these findings may be affecting your symptoms and goals, and discuss a tailored treatment plan to attain your goals.
5) What does pelvic health physiotherapy treatment involve?
Education about the anatomy of the pelvic floor muscles and how they work together with three other deep core muscles (diaphragm, transversus abdominis and multifidus) to help resolve your incontinence;
Education about the causes that can be driving your symptoms;
Advice about foods and drinks to avoid that may cause an irritation of the bladder;
Advice about how to modify behaviours that may aggravate your symptoms;
Strategies to decrease urinary urgency and frequency;
Manual external soft tissue release techniques for muscles connected to your pelvic including adductors, glutes, outer abdominals;
Manual scar release techniques (cesarean, vaginal or other related external surgical scars);
Techniques to help you find your pelvic floor muscles and to learn to use them correctly, which may include strengthening and/or releasing these muscles;
Progression of exercises to challenge core engagement with functional movements such as lunges and squats.
6) I thought incontinence was a normal part of having children and aging?
Most women are surprised to hear that although leaking is common, it doesn't need to be considered your 'new normal'. 50% of women at some point in their life will experience urinary incontinence and 33% will develop regular occurrences. 3.3 million Canadians experience incontinence and only 1 in 12 people seek out treatment because they're embarrassed to talk about it or don’t know that help is available BUT now you know that pelvic health physiotherapy is 80% effective for treating urinary incontinence.
7) Why hasn't years of doing kegel exercises helped my leaking?
The truth is, 30-50% of women are doing kegels (pelvic floor muscle training) incorrectly. Also, it's important to know that kegels are not always the answer to incontinence, even when performed correctly. Pelvic floor muscles can be tight (just like any other muscle in our body), which can cause incontinence. The only way to know if your pelvic floor is tight or weak or both, is to have an internal assessment by a trained Pelvic Health Physiotherapist who can guide you through an exercise and treatment program suited to your individual needs. Also getting your deep core four muscles to "talk to each other" (aka. activate together) can often be more efficient to achieving your goal of getting rid of incontinence versus just doing kegels alone.
8) What can I do to help myself?
Maintaining a healthy and strong pelvic floor is very important for staying in control and remaining continent for life. Some strategies to help you improve and keep your pelvic floor muscles strong and healthy are:
Avoid constipation. Repeated straining is similar to mini childbirth for your pelvic floor, which can cause these muscles to become weak over time;
Drink plenty of water. Take your weight in pounds, divide by 2 then divide by 8 and this will give you the amount of water in cups (250 ml) you should drink daily. Increasing this amount by 2-4 cups is recommended if you are breastfeeding, exercising or during exposure to extreme heat. Women are surprised to hear that drinking less water makes your urine more concentrated and can increase certain types of incontinence and cause you to have increased frequency and urgency of urinating;
Learn to wait until your bladder is full before using the washroom. For many people this means using the toilet about 6-8 times a day. Avoid making toilet trips "just in case";
Learn to engage your pelvic floor muscles before you cough, sneeze or lift heavy items;
Practice releasing (or lengthening) your pelvic floor muscles not just engaging/lifting.
Exercise your pelvic floor. Ask your Pelvic Health Physiotherapist how to do these exercises correctly. Internal exams are the gold standard for knowing if you're exercising your pelvic floor muscles correctly. Your physiotherapist will show you how to connect your deep core four muscles: pelvic floor, transversus abdominis, diaphragm and multifidus which will give you a more balanced core activation and ultimately help your leaking often times more efficiently than just kegels.
Remember, it is never too early or too late to get your pelvic floor assessed by a physiotherapist. As a pelvic health physiotherapist at Holistic Health Physiotherapy, I not only assess and treat incontinence but also pelvic pain, low back pain/pelvic girdle pain, pelvic organ prolapse, diastasis recti plus help prepare you for pregnancy and for childbirth.
For more answers to YOUR questions about leaking - check out a video I did with Chana Ross, also a pelvic health physiotherapist where we talk all things related to incontinence.
If you found these answers helpful please share with others. Feel free to connect with me by email or on Facebook, Instagram or Twitter to stay up to date on new info about all things pelvic floor and core during bump, birth and beyond stages of life!
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