It’s time to tackle another taboo topic! If you’ve been here for a while, you know that I think “taboo topics” simply shouldn’t exist when it comes to women’s health. Understanding your pelvic floor, your pregnant and postpartum body, and your overall wellness will improve your quality of life without fail! Nothing is off limits here, because I want you to feel empowered, not ashamed.
If you’re dealing with urinary incontinence, you’re definitely not alone. This problem is common, but it’s not “normal,” and there are ways to treat it that will improve your daily life. No shame – let’s talk about it!
Urinary dysfunction can show up in a few different ways. Today, we’re focusing on stress incontinence, which is defined as urinary leakage that occurs due to activity or pelvic floor pressure. This commonly occurs when you exercise, run, lift, or jump, but can also happen in everyday life when you cough, sneeze, or laugh.
This differs from urge incontinence, which is categorized by a strong and sudden urge to pee, and a difficult time holding it in when that urge shows up. Some women experience symptoms of both, which is called mixed incontinence.
On an anatomical level, there are a few different reasons why stress incontinence occurs in women. Here’s why stress incontinence could be showing up for you:
Due to aging, pregnancy, or other factors, PF muscles can weaken. The pelvic floor muscles play an important role in the stress continence control system to help with both the passage and prevention of urine through the urethra. When your pelvic floor muscles contract, they tighten the urethral opening to prevent the passage of urine.
On the flip side, when your pelvic floor muscles relax, they allow the urethra to remain open and therefore urine can pass. If these pelvic floor muscles weaken and they’re no longer strong enough to hold in urine during forceful events like sneezing, coughing, or jumping, stress incontinence occurs. Head to my blog to learn more about 5 potential signs of pelvic floor weakness.
Sometimes, PF muscles are strong enough when you isolate and contract them, but you’re unable to coordinate when and how they should contract. When you cough or sneeze, your pelvic floor reflexively should contract to help narrow and support the urethra.
However, sometimes you can lose this coordination for a variety of reasons (including childbirth). In these situations, you may not be reflexively contracting your pelvic floor when you sneeze or cough postpartum even though you know how to voluntarily contract these muscles when asked.
This is why I frequently instruct women how to gently perform a gentle pelvic floor contraction (kegel) right before and during a cough or sneeze to retrain their mind-body connection.
Image used with permission from Pelvic Guru®, LLC www.pelvicglobal.com
Your core is a pressure management system, like a can of soda. Your diaphragm is the top, your pelvic floor is the bottom, your abdominals are the front and sides, and your back muscles are the back.
When you inhale, your diaphragm contracts and lowers, your ribcage expands 360 degrees along with 360 expansion of your abdominals and back muscles, and your pelvic floor lowers. On an inhale, your intra-abdominal pressure (IAP) naturally increases which causes increased pressure on your pelvic floor, abdominals and back. The increased IAP is distributed equally amongst the muscles that make up your “soda can.”
Aside from inhaling, other activities can cause an increase in IAP, like holding your breath, jumping, running, coughing, sneezing, or bearing down (forceful pushing down into the pelvic floor).
If one part of your soda can system is not functioning properly and cannot expand to accommodate the increased pressure, this puts an uneven distribution of force on the remaining areas. For instance, if you have really tight lower back muscles, they will have trouble expanding with increased IAP. That poor muscle function increases the load on the pelvic floor and abdominals.
If you put too much pressure down into the pelvic floor when you jump, cough, or sneeze, it can cause stress incontinence because the increased load is beyond the capacity of the pelvic floor muscles.
To avoid developing common pelvic floor or core dysfunctions like diastasis, prolapse, and incontinence, you need to maintain proper IAP by avoiding things such as: holding your breath or bearing down.
If you’re concerned that you’re “too young” to be experiencing these symptoms, I promise you’re not alone. According to research, incontinence affects 25% of young women, 44-57% of middle-aged women, and 75% of older women. Stress incontinence can occur at any time for a number of reasons, but there are a few factors that increase your risk of developing it. They include:
If stress incontinence is showing up in your life, you may feel embarrassed or frustrated. I want you to know that you have options! Discuss them with your provider or physical therapist to find a care plan that’s right for you.
This is always going to be my number one treatment option for stress incontinence. As we’ve already discussed, many cases of incontinence are due to muscular dysfunction or lack of training, which we can definitely fix in PT. Physical therapy is the most conservative treatment option available, and it will help you figure out the best strategy for you to manage your stress incontinence.
At your first pelvic floor physical therapy appointment, your pelvic floor PT will customize your treatment plan based on your evaluation. Your plan may include pelvic floor exercises, biofeedback, pessary devices, bladder retraining, or some combination of these tools. Even if you do end up needing additional treatment options, I always recommend PT as the starting point. It will almost always be a part of your recovery plan! Find a provider close to you to get started, and remember that there’s no shame in getting treated so that you can enjoy your life with reduced symptoms – or no symptoms at all!
There are a few pharmacological treatments available for stress incontinence. Your provider can help you determine which, if any, are right for you! Which medication you take is dependent on what’s causing your stress incontinence. Some medicines are formulated to help your urethra contract and close when needed, while others are topically applied to increase blood flow to the necessary receptors.
Sometimes, surgery is necessary to correct stress incontinence. A few of the more common surgeries for stress incontinence include:
You can read more about the procedures here.
However, there are risks associated with every surgery, and these procedures aren’t always a guaranteed success – especially if you never address the reason why the incontinence occurred in the first place. If you have a weak pelvic floor and never strengthen it, then your incontinence is likely to return after surgery. That’s why I always recommend pelvic floor physical therapy as your first line of defense!
If you’re experiencing any symptoms of stress incontinence, I always recommend an in-person, individualized exam by a pelvic floor PT, however accessibility to providers can be extremely difficult due to barriers such as: insurance, distance to providers, provider waitlists and childcare.
My Movement Through Early Postpartum course teaches you how to connect with your pelvic floor to build strength AND mobility — both of which are needed to manage stress incontinence. The course provides you with educational videos covering various “taboo” topics such as incontinence as well as daily movement you can perform to re-connect, re-train and re-build your pelvic floor, core and full body regardless of how many weeks/months/years you are postpartum. You can experience urinary functionality again, so don’t lose hope!