“I laughed so hard, tears ran down my legs!”
“When I sneeze, I cross my legs and hope for the best!”
“Trampoline? Not without a change of pants!”
Do these statements sound familiar? If so, you’re in good company! Think of three cis women in your life. One of them has likely dealt with bladder leakage at some point.
Incontinence is a significant problem that is often under-discussed and misunderstood. Rather than sweep it under the rug, let’s shed some light on incontinence: what it is, why it occurs, and what you can do about it.
WHAT IS INCONTINENCE?
Incontinence can be classified into one of three categories. Stress incontinence is leakage when coughing, lifting, running, laughing, etc. Urge incontinence—also known as overactive bladder—is the sudden and strong urge to urinate. This is the feeling of, “I’ve gotta go...and I’ve gotta go NOW!” Mixed incontinence is a combination of both stress and urge incontinence.
Not only frustrating and annoying, even mild or occasional incontinence can become a social and hygienic problem that can ultimately impact your general health. If you leak every time you work out, you’re not going to want to exercise! This can lead to global deconditioning, weight gain…and in turn, this often leads to increased severity of incontinence.
WHY DOES INCONTINENCE OCCUR?
Urge incontinence is generally linked to instability of the detrusor (bladder) muscle. Stress incontinence is usually related to dysfunction of the pelvic floor muscles not doing their job, which is to support the pelvic organs and to help close off the urethra (the tube that carries urine out of the body).
Many people begin having incontinence issues for the first time when they are pregnant. Urinary leakage can occur due to the weight of the baby creating a downward force on the pelvic floor muscles, which are stretched—sometimes to the max—during the course of pregnancy. When the pelvic floor muscles are overstretched, they can’t effectively help close off the urethra. This can cause spontaneous leakage of urine while standing, walking, or during activities that cause an increase in intra-abdominal pressure such as lifting, moving from sit to stand, and coughing or laughing.
WHAT CAN YOU DO ABOUT INCONTINENCE?
Be easy on your pelvic floor.
- Don’t strain on the toilet. Try to keep your bowel movements smooth and regular by eating a diet rich in fruits and vegetables, and by staying well hydrated. Use a stepstool to prop up your feet for easier elimination.
- Lift properly by engaging your pelvic floor and core muscles and exhaling as you lift. This goes for any type of lifting: from weights, to a heavy bag of groceries, to picking up something tiny (like a pencil) off the ground. Always remember to “exhale with exertion!”
- Depending on the severity of your incontinence, high impact exercises and abdominal crunches might need to be avoided or modified to prevent excess pressure and strain on the bladder and pelvic floor muscles. Don’t stop exercising and please do not fear movement; however, take note of how much is “too much” for your body, and gradually progress from there. Seek the guidance of a personal trainer or physical therapist skilled in pelvic floor rehabilitation.
Stand (and sit) tall.
- Proper posture is important not just for back health, but also for the health of your pelvic floor! Sit and stand so that your pelvic floor muscles are in the perfect position for optimal firing.
- In standing, feet should point straight ahead (not inward or outward). Position your ear holes over your shoulders over your hips over your heels. If you were to drop a plumb line from your ear canals to your ankles, your body should align with it.
- Sit on your sitting bones (not slouching in your low back or tucking your bum under). Lift the crown of your head toward the ceiling. As above, align your ear holes over your shoulders over your hips.
Safely strengthen your pelvic floor.
- It’s important to know how to engage your pelvic floor (i.e. how to do a kegel contraction) so that you can consciously turn your pelvic floor muscles “extra on” when you need a boost. Some examples include when you’re holding your bladder during a long business meeting, or when you’re about to cough or sneeze. However, do NOT do hundreds of kegels exercises each day! Overly active, overly tense pelvic floor muscles will not help with bladder control; in fact, excess pelvic tension can make incontinence issues worse.
- Check in: can you do a correct kegel? Lift your pelvic floor muscles (think of your vaginal muscles and your peeing muscles) inward and upward, and then relax them completely. If you can do both phases successfully – the contraction and the relaxation – then it’s safe for you to complete 5-15 reps each day to maintain pelvic floor control, strength, and coordination. However, if you are unable to sense the contraction or relaxation, or if you feel like you’re causing your pelvic floor to bulge downward when you contract, then STOP. Seek guidance from a pelvic floor physical therapist before going further.
- Nothing weakens your pelvic floor faster than sitting all day! Take mini movement breaks throughout your day, and walk regularly for global hip, core, and pelvic floor health.
If you suffer from any type of incontinence, please do not be ashamed. If you address it early, you can prevent progression and even reverse your symptoms with proper time, attention, and treatment. In many cases, conservative treatment (as outlined above) can help reduce or even eliminate symptoms without resorting to measures such as medication or surgery. A pelvic floor physical therapist can help determine a treatment plan based on your specific needs.
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