Urinary Incontinence
Last week we talked about weakening of the core, diastasis recti, and how to appropriately engage and strengthen your deep abdominal muscles. Just as the abdominal muscles become stretched and weakened during pregnancy and delivery, so too are our pelvic floor muscles.
The pelvic floor is made up of several muscles divided to a superficial and a deep layer, which provide support to our abdominal organs (gravity is pulling these muscles down whenever we are sitting or standing), help maintain urinary and bowel control, and play a role in sexual function. Because the function of these muscles is related to sensitive and personal matters, many women don’t feel comfortable talking about them and attribute dysfunction of them to a normal part of a female’s life after having a child. Many live with the symptoms for several years, and may even turn to surgery as the solution. The estimated lifetime risk of surgery for either stress incontinence or pelvic organ prolapse in women is 20.0% by the age of 80 (Lifetime Risk of Stress Incontinence or Pelvic Organ Prolapse Surgery - PMC).
Urinary incontinence
A common issue women face postpartum and beyond is urinary incontinence. There are different reasons that may cause incontinence, but the two main types of incontinence are stress incontinence and urge incontinence (or overactive bladder). Some women may experience both, which is classified as mixed.
Stress Incontinence
Stress urinary incontinence (SUI) is the involuntary loss of urine associated with increased intra-abdominal pressure during activities, such as coughing, laughing, sneezing, impact movements or squatting (Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women | Stanford Urology) . It affects 25–45% of women. Essentially, when you perform activities that cause more pressure to push down on the pelvic floor muscles, the muscles are not strong enough to stay contracted to keep the proper orifices closed, resulting in urine leakage.
Exercises to improve pelvic floor strength and endurance (i.e., kegels, among others), diaphragmatic breathing, hip opening stretches, as well as core and hip strengthening can help reduce symptoms of stress incontinence. Most of us are familiar with a kegel, but we may not be sure if we are performing them correctly. When performing a kegel, you should be tightening the muscles that would stop the flow of urine. Once you have determined you are contracting the correct muscles, it is important to train them in different ways, such as performing quick pulses, longer holds, and coordinating contraction with deep, diaphragmatic breathing. From there, it is essential that you also work the pelvic floor muscles with activation of hip and core muscles to improve the ability of these muscles to work together. Finally, you must train these muscles to work correctly with functional activities, such as coughing, laughing, squatting, and hopping, so that they will learn to turn on and work with the activities that you need them to.
Urge Incontinence
Urge incontinence is a sudden, intense urge to urinate followed by an involuntary loss of urine. You may need to urinate often, including throughout the night. It can occur when the brain, spinal cord, and bladder aren’t appropriately working together to control urination (Urinary incontinence - Symptoms and causes - Mayo Clinic ). Whereas with stress incontinence we can think of it essentially as a weakness issue, urge incontinence has more to do with the nerves that control these muscles, and there is involuntary contraction of the bladder detrusor muscle.
Lifestyle changes can help ease urge incontinence, such as:
Staying hydrated by drinking 6–8 cups of water a day
Avoiding bladder irritants like coffee, soda, alcohol, and tobacco
Avoiding the urge to urinate "just in case"
Eating high-fiber foods to prevent constipation
If you are experiencing any symptoms of pelvic floor dysfunction, I highly encourage you to talk to your ob-gyn about it, and ask about pelvic floor physical therapy. Pelvic health specialized PT’s have extensive training on the anatomy and function of pelvic floor muscles, to provide a specific treatment program that involves re-training these muscles so that you can return to pre-pregnancy activities without symptoms. They can also help to ease stress that come along with these symptoms, and give you agency to take control over them.
