One of the most common conditions that I treat as a pelvic floor physical therapist is urinary incontinence. While urinary incontinence is very common, it is not considered normal and is not something anyone needs to “just deal with.” It is highly treatable!
There are multiple types of urinary incontinence, each caused by something different:
Stress urinary incontinence
Stress urinary incontinence occurs during specific activities that “stress” the bladder and pelvic floor muscles. Examples are coughing, sneezing, laughing, and jumping, among many others. During these activities, leaking will occur if the forces down on the bladder are stronger than the force the pelvic floor muscles are able to exert. In other words, stress incontinence usually happens because there is relative weakness in the pelvic floor muscles.
Urge urinary incontinence
Urge urinary incontinence occurs when the urge to urinate is so strong and uncontrollable that people leak before they are able to make it to the bathroom. This can happen for a number of reasons, including increased intake of bladder irritants, poor fluid intake and/or bladder habits, psychosocial factors, and increased tension in the pelvic floor muscles.
Mixed urinary incontinence
This is a combination of stress and urge incontinence. Usually the main underlying pelvic floor muscle impairment with mixed incontinence is increased tension in the muscles, which causes them to not function properly.
What can be done for urinary incontinence? Pelvic floor physical therapy to the rescue.
Pelvic floor physical therapy has been shown time and time again to help improve symptoms of urinary incontinence. Pelvic floor PTs can assess the pelvic floor muscles to help determine the underlying cause of incontinence (i.e. weak pelvic floor muscles, tense pelvic floor muscles, or both). Based on the findings from the pelvic floor assessment, your pelvic floor PT will teach you how to address them. Your pelvic floor PT will also look at other factors such as your fluid intake and urinary habits, your overall strength and flexibility, your body mechanics, and your breathing mechanics. Once impairments that are likely contributing to urinary incontinence are identified, your pelvic floor PT will teach you how to address those as well.
What can I start doing right away to address my incontinence?
An overarching principle in pelvic floor PT is learning how to relax your pelvic floor muscles when they are supposed to relax, and how to contract them when they are supposed to contract. So when are you supposed to relax your pelvic floor muscles? Anytime you are relaxing!
And why is it so important to allow the muscles to relax? Because in order for a muscle to function optimally, we need to allow it ample rest between bouts of asking it to work for us. We let our other muscles relax after we exercise them, right? But the thing about the pelvic floor muscles is that they don’t just work when we exercise (and yet - they work when you exercise even if you aren’t purposefully contracting them), they also work when we change positions throughout the day or any time we need to go to the bathroom. And they do this all automatically! When they work so much to begin with, we definitely want to make sure we can let them rest at any chance they get, so that they don’t get too tense or tired to work properly.
And when are the muscles supposed to contract? I already hinted at this. Our pelvic floor muscles contract anytime we are going from a position where we are more supported to less supported (laying down to sitting, sitting to standing, etc), any time we need to go to the bathroom or hold in gas, and anytime the pressure inside our pelvis increases such as with coughing, sneezing, jumping, etc. They should do this reflexively, however sometimes they need a little helping hand and we can benefit from voluntarily contracting them during these moments.
Okay - great! So how DO you actually relax and contract the pelvic floor muscles?
My favorite cue for relaxing the pelvic floor is to picture a flower blooming inside your pelvis (where the vaginal canal is), with the petals facing toward your feet. For contracting the pelvic floor, my favorite cue is to imagine a straw in the vagina and trying to suck up a milkshake through it. Thinking about the way you are breathing when relaxing and contracting your pelvic floor is helpful, too. Our pelvic floor is generally more relaxed and lengthened when we inhale, similarly to how our abdomen rises when we inhale. And it’s easier to contract the pelvic floor when we exhale.
Exhales are also a great way to decrease pressure on the bladder and pelvic floor, so getting in the habit of exhaling during strenuous activities that tend to cause leaking is an excellent habit to get into for anyone with urinary incontinence.
Finally, if you are someone who struggles with urinary urgency, performing repeated pelvic floor contractions when the urinary urge is at its strongest is a great way to calm down the bladder and to help you get to the bathroom in time.