Lots of women we know as patients and friends talk about bladder leakage. It’s become so popular to talk about that it’s even considered normal in some circles. To quote a friend, ‘What’s a little pee among friends?’ In her world, leaking with exercise is a common occurrence and something to manage rather than treat. Bladder leakage may be common but it is never normal! Whether you are leaking when you jump or run, can’t hold it when you have a strong urge to go or a combination of the two (mixed incontinence), physical therapy can help. In many cases, urinary incontinence can be improved with exercise and behavioral changes.
Stress urinary incontinence (SUI) is involuntary urine leakage that occurs during an increase in intra-abdominal pressure, such as during exercise or with cough or sneeze. Most of us have heard about or even tried Kegel exercises, but staying dry (continence) is about more than the pelvic floor. Structural integrity, muscle strength and coordination are all components of continence. Believe it or not, your respiratory diaphragm, abdominal muscles and pelvic floor all work together to keep you dry and stabilize your trunk throughout the day and during activity. Other muscles of the hip and back also contribute to bladder control due to the muscular attachments to the pelvic floor. Did you know that one of the deep hip rotators actually attaches to the pelvic floor? Stress urinary incontinence (SUI) occurs when one or more of these components is not working correctly due to poor management of intra-abdominal pressure.
Most often, our patients with leakage during exercise report difficulty running, doing jumping jacks or other high impact activities. When exercising, the pelvic muscles contract and relax in sync with your other trunk and hip muscles to respond accordingly to the demands you are placing on them. When the system works correctly, each component adapts to heavier weights, faster movements and challenging surfaces. Stress on the system, such as weakened muscles or soft tissue, poor coordination with abdominal muscles and breath holding can all contribute to increased pressure on the bladder and urethra and result in SUI. Poor exercise technique coupled with impaired structural support can contribute to the problem.
Not everyone experiences leakage during activity. Urge urinary incontinence (Urge UI) is involuntary bladder leakage associated with a strong urge. Sometimes there is a trigger that accompanies the urge, such as running water or putting the key in the door upon arriving home. Women who experience this will often minimize fluid intake and void frequently or ‘just in case.’ At the gym, this means hitting the bathroom before, after and sometimes during a class to avoid having an accident.
Normal voiding frequency is every 2-4 hours on average. As the bladder fills, it stretches, and when it’s about half-full will trigger the first urge to void. Typically, this is a light urge and easily inhibited- more like ‘hey, this is your bladder speaking- just a friendly reminder and in another hour you’ll want to find a bathroom.’ The urge gently subsides, until it returns a bit later, a bit stronger and you empty in typical fashion. For people with Urge UI, often that first urge is more like ‘RUN! If you don’t run RIGHT NOW you will have an ACCIDENT RIGHT HERE!’
Two things happen when this becomes a consistent pattern:
1) Your bladder and brain start to get used to more frequent voiding with smaller amounts of urine, which can result in even more frequent urges and
2) The nervous system, in response to an already amped up bladder urge and fear of leakage, gets further stimulated when you rush to the toilet. Which further amps up the bladder urge and fear of leakage, lending to more panic and even more stimulation, ultimately resulting in wet pants or at the very least, a close call. (If you have ever fumbled the key in the door and made it to the bathroom just in time to pee your pants before you even have time to get them off, you know what I am talking about.)
Be confident and continent!
If you are experiencing any of these symptoms, you are not alone. Common does not mean normal, and pelvic floor physical therapy can help you regain control of your bladder and get you back to the active life you love. Try a few of the tips below to get you started. If you are experiencing a sudden onset of either stress or urge incontinence symptoms, see your doctor to rule out a urinary tract infection or other medical causes of incontinence. To learn more, call us or your local pelvic physical therapist today and schedule your first appointment.
Stress Incontinence- Tips & Tricks
|Bladder diary: Keep track of voids, fluids and activities that trigger leaking episodes
|Breathing: Coordinate lifting, pushing and pulling with your breathing by exhaling with exertion.
|Kegels: Gently pull vaginal and rectal muscles in and up as you exhale. You should feel your belly gently draw in as you complete the movement.
*You may find this easier to try lying down at first. Once you are able to coordinate the pelvic muscles with your belly and breathing, change to sitting or standing and try some longer holds without holding your breath. You can do it!
|Train to your weakest link: You may be able to do squats and curls with heavy weights, but if you are leaking then you may need to drop your weight and focus on form until your floor & core catch up. And if your core routine results in leakage, scale it back until you are strong enough to do your full program leak-free.
Urge Incontinence: Tips & Tricks
|Bladder diary: Keep track of void intervals, potential irritants and any leakage triggers
|Quieting: Diaphragmatic, mindful breathing practiced regularly (no TV, no phone, no laptop distractions) can help to calm down the nervous system, decreasing bladder urge.*Need practice & want some guidance? Try an app that focuses on breathing, or check out our YouTube channel for some tips.
|Avoid Triggers (things that may contribute to urge, frequency and/ or leakage):
*Bear in mind that drinking too many fluids (sometimes seen in diets that require large amounts of water consumption) or too few fluids can also trigger urgency symptoms.