Urinary leakage... no laughing matter
Updated: Nov 26, 2020
Have you ever leaked urine when you run, laugh, sneeze or cough? Stress Urinary Incontinence (SUI) is the name for this issue. When pressure outside of the bladder exceeds the limits of control, a person may not be able to control leakage. Often, someone attempts to go for a run and ends up with an embarrassing wet spot in their exercise pants. Leakage when bending over to lift or when hitting a golf ball are examples of SIU. Leakage when laughing is yet another example of SUI. It's quite the spoiler to the fun.
Although Urinary Incontinence is common, it is not how the body normally works. Under normal circumstances, the bladder should be able to contain urine until we are settled at the potty and relax the pelvic floor muscles (PFMs). These muscles help control continence, support the bladder and help with sexual function.
The bladder is a storage organ. As the bladder fills, a muscle inside of it, called the detrusor, detects the pressure of the liquid as it is filling. The detrusor signals the brain regarding the volume. The muscles and sphincter tighten to maintain continence, or dryness. Eventually, the volume becomes large enough to trigger the brain with a strong urge. One heads to the potty, relaxes the PFMs and relieves the pressure.
A disruption in the normal process can alter the cycle and wreak havoc on one's lifestyle. Issues can arise from an injury to the pelvis, abdominal or pelvic surgery, giving birth and being pregnant. Often, the pelvic floor muscles become weak after a surgery. Carrying a large developing baby is a tremendous strain on the pelvic floor muscles. In these cases, the PFMs are not strong enough to support the pressure of a full bladder. They cannot clench enough to close the urethra (aka the pee tube) so urine may leak out. Strengthening, by way of Kegel exercises, can correct the strength deficit and resolve the leakage.
Sometimes, the muscles of the pelvic floor are too tense. Power is a function of force and distance. If the muscles are tense, from clenching, they are short. (Distance). It would take a tremendous amount of force to create the power needed to compress the urethra and control leakage from the bladder. If a muscle is overly tight and short, it cannot contract any farther. The muscle cannot generate any more force and is therefore, ineffective in its job. To correct this, the muscle needs to be lengthened. Kegel strengthening will only serve to make the muscle shorter, not stronger.
So how does one determine if they need to lengthen or to strengthen?
Some signs of short muscles are pelvic pain, painful intercourse, abdominal and back pain. People who tend to clench their jaws or shoulders also tend to clench the pelvic floor. Being aware of tension in the body is the first step to improvement. Performing a body scan every hour to determine if the jaw is tense, the shoulders are elevated or if the PFMs are gripping is helpful in changing these behaviors. Relaxing these areas by dropping the shoulders, opening the jaw and dropping the PFMs on a regular basis can lead to great changes.
Seek out the help of a pelvic floor therapist to evaluate your issues and determine a plan for treatment. A pelvic floor PT can help you to take back your life allowing you to run and laugh again without wetting yourself.
Go to https://pelvicrehab.com/ to locate a therapist.
Jane O'Brien Franczak, PT, MSPT, WCS
Women's Clinical Specialist, Board Certified
CAPP Certificate of Achievement in Pelvic Physical Therapy