Pelvic Therapy for Incontinence: Treating Urinary Leaking and Breaking The Stigma

What’s the deal with black leggings

Have you ever wondered why so many women opt for black leggings at the gym? We never wondered either until we became pelvic floor therapists. Now, all we can see is a sea of black leggings whenever we walk into a HIIT class, barre, yoga, or our favorite studio. Many people will shy away from lighter, colored leggings or pants for fear of possible urinary leakage during their workout. Some people say they cannot tell if they’ve leaked or are just sweating, so they wear a darker color just to be safe. As pelvic floor therapists, we are all about helping you feel like you do not need to live your life “just playing it safe.” Let’s pull the cobwebs off those Lululemon leggings in the bottom of the drawer and get you feeling your best – wearing whatever you want, whenever you want. 

Incontinence after childbirth

No amount of urinary leakage, whether a few drops or full bladder emptying, should be taken as your “new normal” after having babies. While there is camaraderie in affirming to a friend not to worry, you deal with that pesky leakage too… There is even more power and womanhood in challenging your best friend that they don’t need to settle for any amount of incontinence or for wearing a panty liner for the rest of their life. There’s something they can do to resolve that – and no, it’s not with kegels. 

After years and years of someone dealing with urinary leakage that now has grown children, that person may wonder, “Is it too late?” You do not have to be newly postpartum to put an end to urinary incontinence. There is an immense difference that can be made in your symptoms even 20+ years down the road. 

But I am leaking and I never had babies…

Women (and men!) can struggle with urinary incontinence even when they have never been pregnant or birthed. There is a common misconception that leakage is normal after having children and, while damaging on its own, also leaves those without children wondering why they have incontinence or thinking that something must be seriously wrong with them. 

There is a lot of shame that can underlie urinary concerns. While “peeing a little” with sneezing may be more talked about in the postpartum population, the 17 year old girl dealing with incontinence during her gymnastics meet may feel even more isolated. The 35 year old guy without any prostate issue that is experiencing incontinence with crossfit really may not know where to turn.

How about the woman-boss business executive, chugging her coffee, rushing between meetings without any history of pregnancy or childbirth… she might experience the floodgates opening just when she locked the bathroom stall door and was hurrying to pull her pants down. She didn't quite make it in time and is scrambling in her purse to see if she brought her extra pair of underwear – in pure disbelief that this happened yet another time. What about her? 

There are different reasons people may experience urinary incontinence, and it is not only related to childbirth. There are also different types of incontinence. Understanding the presentation of leakage, such as when it occurs, how much, or any associated patterns as well as thorough history taking combined with a pelvic floor evaluation can help to determine the root cause of urinary symptoms. 

On a positive note, whether it is the 17 year old gymnast, the 35 year old active dad, or the no-time-for-exercise coffee-chugging female business executive, there is a reason they are leaking and there is something that can be done about it. Rarely in these circumstances is surgery or more invasive medical interventions necessary. Some people are surprised to find out that even years down the line after symptoms began, conservative management with pelvic floor therapy is first line treatment, makes a world of a difference, and helps people to get their confidence back. 

Incontinence even when the bladder seems empty

Whether it is urinary incontinence with coughing, sneezing, laughing, movement, or exercise, this typically falls under the category of stress incontinence. When there is a rise of intra-abdominal pressure or mechanical “stress” onto or near the bladder without adequate pelvic floor support, strength, or coordination, stress incontinence occurs. Regarding movement, some people will notice this when they transition postures or perhaps shift from sitting to standing. Fitness enthusiasts may notice dribbling or incontinence with exercises like running, jumping jacks, double-unders, kettlebell swings, burpees, etc. People get frustrated and often try to figure out how they can possibly be leaking when they just went to the bathroom to empty their bladder moments before their workout began. 

The first 3 steps you can take to start tackling your urinary incontinence with exercise include:

• Make sure you are not arching your back or flaring out your ribs and chest when you are running, jumping, or engaging in more dynamic movements. Instead, think of your rib cage as a bowl and your pelvis as another bowl. Try to keep the rim of both bowls stacked on top of one another. Keep your gaze down towards the ground a couple of feet in front of you to help with this. 

• Make sure you are breathing! Holding breath can sometimes cause your low abdomen to inflate with all the air being held. When you combine that with impact, such as landing a box jump, it can result in the floodgates opening as your pelvic floor does not have the strength to meet this demand. 

• Unclench and untuck! If you find that you are clenching your pelvic floor, abs, glutes, or anything else for that matter when you are working out… Let it go!

Of course if it were as easy as 1, 2, 3, then we would not be having this conversation. Some people do find that making these corrections starts to nip away at their symptoms right away. More individualized recommendations provided by a pelvic floor therapist upon evaluation and treatment will help these symptoms not only decrease but be eliminated for the long-term. 

The race to the bathroom 

The hypothetical business woman we spoke about was dealing with urge incontinence. This is when an overwhelming sense of urgency to empty the bladder accompanies the incontinence episode, rather than a cough, sneeze, laugh, or movement. In fact, these folks may have no problem at all with leakage during any of those things. Urge incontinence is more often seen during seemingly innocuous times of the day as people are partaking in day-to-day activities, such as doing the dishes, getting home from the grocery store, leaving a meeting, and more. While urge incontinence episodes often take people by surprise, they often are able to identify patterns in the leakage as they are working together with a pelvic floor therapist to mitigate bladder triggers and strengthen the pelvic floor muscles. 

When the simple fixes are not working

When it seems like it is not just a “quick fix,” we’ve got your back at Bloom Pelvic Therapy. We are happy to help you get better, faster with long-term results. Treatment by a pelvic floor therapist for urinary incontinence includes manual therapy, exercise prescription and guidance, and lifestyle modifications. Building your confidence back up is one of our favorite things to do.