What is Stress Incontinence?

Stress urinary incontinence (or SUI) is the term for urinary leakage when there is a rise of intra-abdominal pressure, such as with a cough, sneeze, or laugh. This can also occur upon movement, such as with impact exercises like jumping jacks or box jumps, or with simple daily movements like bending over to pick up the dog food bag or your toddler off the ground.

The severity of SUI can range from a few drops to fully wetting underwear and pants, requiring a change of clothes. Some people deal with this type of incontinence by constantly wearing a panty liner or pad, always having a change of clothes in their purse, or wearing only black leggings or dark pants.

Have you ever thought about how telling any urinary leakage can be when wearing those cute colored leggings? Or why most women stick with solid black leggings only? Look around at your next workout class! You will notice a sea of women all wearing their solid black leggings and only a few outliers in their colorful shorts or leggings. Black leggings are "safe" and tend to disguise any bladder issues when working out. 

We highly encourage anyone dealing with SUI to not settle for this as your normal. In pelvic therapy, this is sometimes one of the simplest issues to correct. Many clients walk away after their rehab journey saying they wish they had made the appointment for their evaluation sooner so they could have nipped this in the bud from the very start! Cheers to wearing those colorful leggings you’ve been avoiding for years!

What is Urge Incontinence? 

Urge incontinence (or UI) is the sneaky one. Someone may be going about their day and seemingly all the sudden they get the very intense urge to urinate. They rush directly to the bathroom and before they know it, they have had an episode of incontinence. While the urge is sensed, the loss of urine seems to be completely out of their control, or involuntary, and difficult or impossible to stop the flow. 

For some people, there are “bladder triggers” associated with this. For example, one person may find it is whenever they finally see the toilet that they totally lose control of their bladder while for another it may be unlocking their front door when getting back from a car ride. Others may find that there is an association with water, such as when washing the dishes. Bladder triggers are completely person dependent. 

Will incontinence resolve on its own?

Short answer – it is highly unlikely that urinary incontinence will resolve on its own. The caveat would be the first 24-48 hours after giving birth. If you notice an issue with urinary incontinence, no matter how big or how small and no matter if stress vs. urge incontinence, it is important to address this concern head on to avoid symptoms worsening. If you have given birth and several days have passed and you are still dealing with leakage, it is time to make the call to a pelvic floor therapist. 

Can I have incontinence when I have never given birth?

Yes! Many folks who have never been pregnant or given birth can experience urinary leakage. Men can also experience this issue as it is not exclusive to women. All humans have a pelvic floor. With that in mind, any person can experience pelvic floor dysfunction, whether that present as urinary incontinence, constipation, pain with sex, etc. It is never too late to put an end to urinary incontinence, even if it started many years ago. 

What if I have both types of incontinence? 

It is most certainly possible to experience both stress and urge incontinence. These are the most common types of incontinence. Overflow incontinence is another classification and is less common. This is when your bladder is remaining too full, whether due to incomplete emptying from a physiological issue like muscle weakness or a blockage or perhaps due to excessive bladder holding during the day. This results in involuntary leakage throughout the day and can worsens with the added layer of impact from what would usually provoke stress urinary incontinence. 

Does Emsella chair really work?

You may have heard of the Emsella Chair or the BTL EMSELLA, which uses High Intensity Focused ElectroMagnetic Energy (HIFEM) to stimulate ~11,000 kegels or pelvic floor contractions within 30 minutes. This device claims to strengthen the pelvic floor to reduce urinary incontinence and improve sexual satisfaction. The recommended frequency of use is often 30 minutes 2 times per week for 3 weeks with a “top off” or “maintenance” session annually. That is 66,000 kegels for the 3-week treatment… that is a LOT of kegels!

Most people are surprised to find out that many people with pelvic floor dysfunction have an issue with overactivity or hypertonicity of their pelvic floor. Muscles can be tight and weak at the same time! Someone can have an issue with pelvic floor muscle overactivity as well as urinary leakage at the same time with the increased muscle tension being a contributor to the pelvic floor muscles’ limited ability to function properly to support maintenance of continence. Put simply, most people do not need to be doing kegels at all, let alone in isolation or when stimulated by a device.

So what does this mean?

Stimulating 66,000 kegels in a 3-week period is likely only going to make matters worse. In fact, we rarely prescribe voluntary kegels—the kind you maybe were told to do at stoplights! Overly squeezing the pelvic floor muscles is an isolated strategy that does not consider the entire person, their body mechanics, strength and muscular balance, intra-abdominal pressure management, and daily habits. Whether voluntary or involuntary with the use of an Emsella chair, there is much more to pelvic floor therapy than kegels. While connecting with the pelvic floor may occasionally be a useful initial strategy to make someone aware of those muscles when doing full body workouts, they are not something that should continue into daily exercise for the long haul.

We wish the answer was as simple as doing your kegels or sitting on an Emsella chair—trust us! One big issue we find with the Emsella chair is progress not being long-lasting or transferring into daily life. What happens when you go for a jog, go to move the furniture, cough or sneeze? If the muscles are strengthened in a seated position, they will probably only know how to activate in that position. 

Then how do I stop leaking urine?

Pelvic floor therapists are experts in identifying the root cause of your leakage and addressing those contributing factors directly for long term results. While you may be leaking because of muscle weakness, it could also be from many other issues or even factors that are preventing the muscles from building strength, such as scar tissue from vaginal tearing or an episiotomy, overactivity of muscles, poor toileting habits, or perhaps compensatory patterns due to weakness elsewhere in the body to name a few. 

It is important to better understand why you are leaking in the first place to ensure the root cause is addressed so that you do not experience a temporary “fix” only to end up with symptoms returning or worsening years later. Once your evaluation is completed, specific treatment strategies will be tailored to you and your lifestyle. They may include internal and external manual strategies, cognitive retraining, whole body movement, mobility, and/or strengthening. There are different techniques used if you have more stress urinary incontinence versus urge incontinence or overflow incontinence. 

The length of your plan of care depends on how long your symptoms have been going on, how responsive your body is to treatment, and other factors. There is no cookie cutter approach at Bloom Pelvic Therapy. Treatment plans depend on the individual person and what will be best to provide you with long-lasting, leak-free relief and confidence!