Crossing your legs when you cough, laugh or sneeze? Avoiding trampolines with your kids or jumping jacks during your workout? Are you leaking with running or with your weight training program? When you feel the urge to go, do you leak trying to get to the bathroom in time?
You are not alone my friend! All of these things could be a sign of urinary incontinence. Although we often joke or whisper about incontinence, it is one of the most common pelvic floor issues among women and worth talking about! There are three types: stress, urge and mixed urinary incontinence. Stress urinary incontinence (SUI) is defined as the involuntary loss of urine during effort or exertion including exercise, coughing, laughing and sneezing. SUI is the most prevalent, affecting an estimated 46% of women in the United States.(1) Urgency urinary incontinence (UUI) is the involuntary loss of urine during the feeling of an urge to urinate and is the second most prevalent with approximately 30% of women affected.(1) Lastly, mixed incontinence is a combination of both SUI and UUI and is the least common, affecting an estimated 18% of women.(1) Common risk factors for urinary incontinence include age, body mass index or obesity, history of pregnancy and vaginal delivery, history of smoking and high impact activities.(2)
When our pelvic floor muscles have become weakened, dis-coordinated or possibly even too tight, they are not able to contract fully or quickly enough when we cough, laugh, sneeze, jump, exercise, etc., and so we leak a little (or a lot of) urine. If we're having trouble making it to the bathroom in time and leak on the way, then often bladder or pelvic floor spasming and dis-coordination is a cause.
Incontinence can be an annoyance or even a huge burden for women. It can affect our quality of life. We may avoid certain activities, like that trampoline park with our kiddos or signing up for that half marathon we always thought we would do. We are sure to only wear black leggings when we exercise; we go to the bathroom right before we exercise even if we just went 5 minutes earlier and then go again during our workout “just in case". We buy hundreds of dollars of absorbency pads or sometimes carry extra clothing in case we are caught off guard outside our home.
Urinary incontinence can be embarrassing and many of us women avoid talking to our doctors about the issue and if we are brave enough to do so are often told to “live with it”. Incontinence is not a condition that we should have to accept nor feel is an inevitable part of childbirth or aging. Instead, incontinence is treatable, manageable and pelvic floor physical therapy can help! From basic exercises to special strengthening tools including vaginal weights or biofeedback to name a few, there are options to suit the type of incontinence and your learning style.
More and more evidence shows that pelvic floor muscle training should be an initial go-to treatment strategy for incontinence. In fact, it has been shown that women who perform pelvic floor exercises are 8 times more likely to reduce or eliminate symptoms of urinary incontinence compared to those who did not complete an exercise program.(2) AND, the effect is further improved if the training program is regularly supervised with education and specific cueing. (Guess what? This is where I come into the picture).
Friend, I see you and I understand what you are going through. I’ve so been there; leaking down my leggings every time I would try running in the first few years after the birth of my second son. But, I’m here to tell you that with a little patience, knowledge and work, you can stop the leak!
A little pearl for you: if you tend to leak with coughing, laughing or sneezing, try gently contracting your pelvic floor just beforehand and during. In order to contract the pelvic floor, think of trying to pick up a blueberry or pinch and lift the anus.
For more information check out these other resources:
National Association for Continence:
American Urogynecologic Society:
International Urogynecological Association:
American Physical Therapy Association: Section on Pelvic Health
Citations:
1 Abufaraj M, Xu T, Cao C, Siyam A, Isleem U, Massad A, Soria F, Shariat SF, Sutcliffe S, Yang L. Prevalence and trends in urinary incontinence among women in the United States, 2005-2018. AM J Obstet Gynecol. 2021 Aug; 225(2): 166.e1-166.e12. doi: 10.1016/j.ajog.2021.03.016. Epub 2021 Mar 13. PMID: 33727114.
2 Bø K. Physiotherapy management of urinary incontinence in females. Journal of Physiotherapy. 2020; 66(3): 147-154.