By: Megan Piersol, DPT
Stress incontinence results from an inability to control your bladder’s desire to empty during movements and physical activity such as heavy lifting, exercise, laughing, running, coughing, sneezing, etc.. Abdominal pressure tends to increase with heavier activities and bears down on the bladder causing unintentional loss of urine, usually in small amounts. It doesn’t happen all the time and occurs more often when the bladder is near full. Stress incontinence can be due to weak or improperly trained pelvic floor muscles, a problem with the sphincter muscle that opens/closes the bladder, chronic coughing, obesity, and smoking. Improving the muscles of your pelvic floor, your posture, and a couple other tips can help restore the better function of these muscles and decrease incontinence. Although this problem is more prevalent in older and postpartum women, it can also occur in younger adults, high intensity, and impact athletes, and men (more common after prostate surgery). Another false thought is that incontinence is just another thing that occurs are we get older. It does not have to be a normal part of aging.
It is important to not train your bladder to empty too soon. This can be done through not always going to the bathroom first thing when you get home from work. The sound of keys may start training your brain to want to empty anytime it hears a key rattling or a door unlocking sound. One thing the majority of us do is going to the bathroom “just in case (JICA).” You should never do this. This usually empties your bladder way before it needed to be emptied. If you are training your brain to empty too soon, it becomes hyperactive and wants to empty at even the slightest of filling. Your bladders can hold more than you think. How you go to the bathroom may be contributing to problems as well. Hovering over a toilet seat actually creates more difficulty for your body to relax and evacuate appropriately. It is better to sit down on the toilet. Most restrooms have covers that can be placed over the toilet seats to avoid that dreaded skin contact on the public porcelain. Lastly, peeing in the shower is also training your brain that it is okay to empty at the sound of water.
If you feel the need to go to the bathroom, perform a round of Kegels. If the sensation goes away, then you probably didn’t have to go to the bathroom. If the sensation remains, then you might actually have to use the restroom. The bladder can hold about 2 cups of urine. Urine comes out of your urethra. Women’s urethra ranges from about 1.2 to 1.6 inches whereas men are around 8 inches long. The average person should urinate between 6-7 times a day if you are drinking 6-8 glasses of water. Stimulants such as caffeine and alcohol can change this frequency as can some metabolic disorders such as diabetes. If you are not peeing longer than 8 seconds, there is a good chance that you went too early. Men may take longer since their urethras are longer. If you have the urgency sensation before and after going to the bathroom and go for less than 2 seconds, there may be another problem such as an infection.
Doing a variation of Kegel exercises can help you train and strengthen the pelvic floor muscles and decrease or eliminate the occurrence of incontinence issues. The best thing is that you can do this exercise without anyone even knowing you are doing them. You can knock them out while sitting at your desk, sitting in that boring work meeting, waiting at a red light, etc. Having someone, like a Physical Therapist, assess your posture, core strength, and postural/core control is also an important component to ensuring good pelvic floor health. Your posture can influence how the pelvic floor muscles work or do not work.
A correct Kegel involves squeezing the muscles in between your front and back excretory regions, the area that sits on a bike seat. It is similar to the feeling you get when you are trying to hold your urine from coming out. Most people tend to squeeze their buttock too much when trying to obtain a Kegel. Spreading your legs and turning your feet in a little can help you target the inner area better and decrease overcompensation through the buttock. You can also use a mirror to see if the inner area pulls up when you contract (this is best left done at home).
All these exercises can be done to help strengthen the pelvic floor and should be done in variation. Mix and match the exercises to better train your pelvic floor muscles:
You want to contract and relax your pelvic floor muscles quickly. Build up to doing 50 reps. You want to do it several times a day.
This involves holding the muscles for 5-10 seconds, then relaxing for the same amount of time. Perform 10 repetitions.
Pretend that your pelvic floor muscles are like an elevation in that the strength of the contraction you create places you on a different floor. You can practice tensing the muscles at different intensities to place you on different floors. You can go between the 1 to the 4th floor and 2nd to 3rd, 3rd to 1st, etc based on the strength of your contraction. Bring yourself down to the lobby from time to time to allow full relaxing of the pelvic floor muscles.
Contract your muscles in a wave pattern cycling between front and back. Contract from front to back and then release from back to front and vice versa.
Try these exercises in various positions and with various activities. It is good to contract your core and perform a Kegel with regular weight lifting or exercise routines. Getting in the habit will make this happen more naturally without much thought needed. Your pelvic floor is a part of your core, so it is an important player with activities. Your core has a front (inner abdominals), back (most inner back muscle), top (diaphragm), and bottom (pelvic floor). If one piece is missing, then the whole core unit can’t work properly. You don’t have to have incontinence to want to strengthen your pelvic floor. Our pelvic floors weaken as we get older, so it’s good to always work on strengthening these muscles.
Mayo Clinic website (https://www.mayoclinic.org/diseases-conditions/stress-incontinence/symptoms-causes/syc-20355727)