Stress Urinary Incontinence
Have you ever leaked urine when running, jumping or lifting something heavy? Have you ever laughed, coughed, or sneezed and thought “shoot, I just peed”? That is Stress Urinary Incontinence (SUI). All of those activities exert a sudden pressure down on the bladder and urethra causing the sphincter muscles to open and then urine leaks out.
This is a common condition that an average of 40% ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3671107/?report=classic ) of pregnant women face and many of them continue to have symptoms postpartum. For many women it can affect their quality of life as they avoid activities that they enjoy doing to avoid leaking urine.
SUI is often due to the pelvic floor muscles not contracting correctly in order to support the sphincter and close the urethra to prevent leaking during exertional activities. The most common advice given to treat SUI is to do kegels. And while weakness of the pelvic floor is a large contributing factor of SUI, kegels are typically not the only answer as we now know that a lot more plays into a well-functioning pelvic floor than just doing kegels.
The bladder on the left shows the sphincter and pelvic floor muscles not closing the urethra and urine is leaking out as pressure is increased.
The bladder on the right shows the sphincter and pelvic floor muscles closing the urethra, preventing the leakage of urine during increased pressure.
SUI during pregnancy
Ligament laxity, hormonal changes, and changes in our posture all contribute to the pelvic floor having to work harder during pregnancy. It is important to have a strong pelvic floor to meet those demands, it is equally important to have a pelvic floor that can relax and lengthen also for optimal function.
Postpartum Stress Urinary Incontinence
SUI is also common after childbirth. For most women our bodies don’t just go back to “normal” after having children. We just grew a human being inside of us for 9 months and things have changed. We either pushed baby out or underwent a C-section which is a major abdominal surgery. Our posture has changed, core muscle function has changed, pelvic floor function has changed, the way we breath and use our diaphragm has changed, the way we move and the things we do have changed. Now we are lifting baby, car seat, stroller, and maybe baby’s older sibling, all while feeding the baby, cooking dinner and vacuuming and we are stressed out and anxious and tired. ALL of this changes the demands on our pelvic floor and can contribute to ongoing postpartum SUI. Stress plays a huge role because it can cause us to hold tension in our pelvic floor. A tight pelvic floor will not function correctly.
How I fixed my Stress Urinary Incontinence
My SUI started after the birth of my first child and became progressively worse after each child. I decided I needed to do something about it after I ran a 1-mile fun run with my oldest son and I literally peed myself the entire run. I was also getting tired of holding my sneezes or crossing my legs when I sneezed to prevent leaking. I started doing kegels because (even as a PT) I thought “pelvic floor = kegels”, but that wasn’t working for me, I was still leaking. It wasn’t until I started diving into pregnancy and postpartum women’s health education that I realized the pelvic floor is really a whole-body issue. Kegels alone were not going to help me and honestly, kegels in isolation won’t help most women.
In order to get my pelvic floor working well for me again I had to:
learn how to properly contract AND relax the pelvic floor
learn pressure management strategies and stop sucking in my abs
improve my glute strength. The glutes and the pelvic floor are best friends. The glutes need to be strong for a well functioning pelvic floor
learn to breath properly
In summary, YES, your pelvic floor needs to be strong to treat stress urinary incontinence but that is not the only factor. For me and probably many of you, it took peeling back lots of layers, restoring proper pressure management in my “core”, changing old habits, waking up the sleeping muscles and quieting down the overactive ones. It took months of hard work (after years of dysfunction) to get better and now I want to pay it forward and help you too!
There is help available and you don’t have to live with SUI symptoms. Contact me or reach out to a women’s health physical therapist in your area to help you reach your goals.
**Stress Urinary Incontinence is different than Urge Urinary Incontinence (UUI) or Overactive bladder. UUI is the sudden onset of “I have to go now” and is caused by spasming of your bladder muscle which also causes leaking. Treatment for UUI looks a bit different than treatment for SUI. People can have SUI and UUI together. A women’s health physical therapist can help with UUI also.
