October 27, 2020

By Carolyn Yates, PT, DPT

Do you sometimes leak urine when you are jumping, running, laughing or sneezing? Do you rush to the bathroom when you get home from work even though you went to the restroom only 30 minutes ago? Did you leak urine right after having a baby but thought it would go away on its own and now it’s been over a year and you are still leaking? Incontinence is a common complaint of women who have had babies but often is dismissed as not a big deal. On average, studies show that 25-45% of women have urinary incontinence with some studies reporting a 90% prevalence rate; this is a big deal! Despite how common incontinence is amongst women, it’s not something you have to live with and we will walk you through what to do about it.

What is incontinence?

First, let’s discuss what incontinence is. Incontinence is defined as, “lack of voluntary control over urination or defecation.” (we are just addressing the urinary side of things in this article.) There are three types of urinary incontinence; stress urinary incontinence (SUI), urge urinary incontinence (UUI), or mixed urinary incontinence (MUI).

SUI is when you are jumping or laughing and you leak urine; there is an increase in abdominal pressure and your muscles are not strong enough to resist the increased pressure and a little bit of urine leaks out.

UUI, sometimes called overactive bladder, is when you have a strong urge to urinate even when your bladder is not full enough to be prompting you to have to empty your bladder.

MUI is when you have symptoms of both SUI and UUI.

How is incontinence typically treated?

If you are experiencing leaking of small amounts of urine with events such as strong laughter, sneezing, coughing, jumping, or running (stress urinary incontinence), you most likely need to work on strengthening your pelvic floor muscles. Start by working on your pelvic floor contractions or “kegels”. Unsure of what or where your pelvic floor is? Check out “What is the Pelvic Floor?” for more information. In short, a pelvic floor contraction or a kegel, is performed by pulling up-and-in at your vagina. A good visualization cue to try is to imagine you have a marble at the opening of your vagina; try to pick the marble up with your vagina and pull it up and in. Then, put the marble back down. That movement is a kegel and is the basic way to start strengthening your pelvic floor muscles.

If you are experiencing strong urges to go pee shortly after emptying your bladder (urge urinary incontinence), you most likely need to “retrain” your bladder. The average adult bladder should not send signals to the brain that it needs to be emptied until there is at least 8-12 seconds worth of a steady stream of urine in the bladder. So, next time you have a really strong urge to urinate, sit on the toilet and count how long you pee for. One-one thousand. Two-one thousand...if you only make it to five-one thousand then your bladder is sending you signals saying you need to go pee at an “inappropriate” time. If you find that you routinely have strong urges but not much urine to pee out then start “retraining” your bladder. It is helpful to keep some form of bladder diary. Whether that is a formal one like this found on the Urology Care Foundation website, or you just jot down when you pee and what you drink throughout the day on your phone’s notes is up to you. You need to know when the last time you peed was, how strong the urge was and how much liquid you have drank since then. With this information you can make an educated guess as to whether you are receiving an “appropriate” or “inappropriate” signal from your bladder. If it has been two and a half to three hours and you have been drinking a steady amount of water in that time then you most likely need to empty your bladder. However, if it has only been forty-five minutes then this signal is most likely “inappropriate”. In this case, try to distract yourself for 5 minutes and the urge will most likely go away. This is bladder retraining!

Is it too late to fix it?

It is never too late to fix! Remember, your pelvic floor is made up of muscles just like your bicep. If your bicep was really weak and causing you dysfunction in your everyday life you would do things like bicep curls with weights or resistance bands to strengthen it. You can apply the same strengthening principles to your pelvic floor muscles! The rehabilitation outcome does depend on certain factors such as how many children you have had, whether you had a cesarean or vaginal birth, how much tearing you had, and how close together you had your children, but no matter what, you can make some improvement by strengthening.

I’ve been doing the exercises, and it’s still there. Now what?

Sometimes your pelvic floor muscles are overly tight which leads to weakness and instead of first strengthening the muscles, you must first stretch and increase the mobility of the muscles. Let’s go back to the bicep example; if your bicep muscle was very tight leading to an inability to straighten your elbow completely, you would not be as strong as you would be if you could fully bend and straighten your elbow. You would want to first stretch the bicep and then work on strengthening by doing bicep curls. Again, you can apply this same principle to your pelvic floor muscles. First stretch and gain the appropriate amount of mobility and then work on strengthening. In this case, it is highly recommended that you visit a pelvic floor physical therapist as it is hard to determine if your pelvic floor muscles are tight on your own. If you are experiencing tightness it is important to be instructed by a professional on how to properly stretch and relax those muscles.

Related: What to expect at a pelvic floor PT appointment

Carolyn Yates, PT, DPT is a Colorado State licensed Physical Therapist with a pelvic floor rehabilitation specialty. She received a Doctorate of Physical Therapy (DPT) from Belmont University School of Physical Therapy and is the owner and head physical therapist of Verity Physical Therapy & Wellness in Boulder, CO.