A lot of us have been there. You are in the middle of a conversation or workout class and before you know it, you feel a little wet. In a place you don’t really want to be. Yes, I am talking about leaking pee with a sneeze, when you laugh or cough, during your run, crushing double-unders at the gym. Whether you are younger or older, any gender, prenatal or postpartum, or as healthy as can be. But here is the thing, just because a lot of us experience this (up to 55% of women)¹, DOES NOT mean this is normal. 

In fact, leaking urine (of any amount and with any activity or trigger) is the exact opposite of what our body is designed to do. And here is where an understanding of the pelvic floor muscles comes into play. The pelvic floor is actually a group of small muscles that make up a bowl in the bottom of the pelvis, and they are designed to function in the following ways:

• Support – give integrity to the pelvis to hold up reproductive, urologic, and intestinal organs such as the bladder, bowel (rectum/colon), uterus, prostate
• Stabilize – assist the deep core made up of the abdominals, multifidi, diaphragm, and pelvic floor muscles to help your hips, pelvis, and spine 
• Sphincter – the pelvic floor muscles contract and squeeze to hold in pee or poop, or they relax and lengthen to allow pee and poop to exit your body
• Sexual Activity – very quick contractions of the pelvic floor muscles brings in a lot of blood flow to assist arousal, erection, and orgasm
• Sump-pump – regular contraction of the muscles allow blood flow to move in and out of your pelvis (have you ever heard of pumping your ankles to get the blood pumping up your legs? Same idea here)

Stress urinary incontinence (SUI) is the formal name for leaking urine while sneezing, laughing, running, etc. The most obvious role that plays a part of this is the sphincter role due to the contraction and relaxation of the pelvic floor. However, other roles like stabilization and support can simultaneously contribute to SUI. And because the pelvic floor muscles work so closely with other muscles in your body, there are many other things to consider when finding the “root cause” of your leaking. Some examples:

• Posture
• Breathing strategies
• Muscle coordination (especially around the deep core)
• Muscle weakness (pelvic floor or elsewhere)
• Muscle tension (pelvic floor or elsewhere)
• Clenching or guarding tendencies
• Diastasis recti (abdominal separation most commonly from pregnancy)

Aside from the physical mechanisms contributing to SUI, some risk factors for developing SUI can include but are not limited to:

• Pregnancy/childbirth
• Heavy weightlifting
• Prior orthopedic injuries (from your head to your toes)
• Frequent abdominal exercises
• Stress/anxiety
• Trauma or chronic pain
• Childhood bladder or bowel habits
• Chronic constipation or straining 
• Pelvic organ prolapse
• Menopause

Here is the good news, you CAN do something about this to keep your pants dry and boost your confidence.  To help you get started, try a few of these simple steps at home: 

• Diaphragmatic breathing: try 3 to 5 breaths into the belly while inhaling through the nose, and let that breath out slowly through the nose or mouth while exhaling
• Posture: imagine a string attached to the top of your head, and it is pulling you up towards the ceiling. Stack your ribcage over your pelvis and breathe here for a minute or two. 
• Pelvic floor stretches: hold child’s pose, happy baby, or deep squat for 2 minutes to relax your pelvic floor (and probably your shoulders and jaw while your at it)
• Note any clenching around your belly or pelvis. Extra tension can put too much pressure down on the pelvic floor, leaving it susceptible to giving way (aka leaking). 

However, the importance of seeing a trained pelvic floor physical therapist cannot be emphasized enough. A pelvic floor PT is able to listen to your story, understand it, piece together the contributing factors, and assess what physical root cause(s) make the difference between leaking and no leaking. Your PT may also recommend other providers to help you meet your goals and suggest a few lifestyle modifications that help you take control of your body. Contact us at Regenerative Edge Physical Therapy & Wellness today to begin your treatment plan with a specialist.

References:

1. Guin G et al. Int J Reprod Contracept Obstet Gynecol. 2018 Jun;7(6):2115-2119