Hey there, Steve Hicks here, lead coach with Simple Success Fitness ONLINE PERSONAL TRAINING. I want to introduce this article about the ugly topic of Exercise Induced Urinary Leakage (and non-exercise induced Urinary Incontinence). I had the privilege of listening to Dr. Julia Salazar, PT WCS present this topic about pelvic muscles and urinary control earlier this year at a Health and Fitness Expo. And I KNEW I needed to bring the message to my audience.
As I worked on summarizing the information, I realized there was no way I could do it justice, so I asked Julia if she’d be willing to write an article here for you about Urinary Incontinence and she agreed!
The reality is, urinary incontinence is a serious issue that can plague middle-aged and older adults, especially women who have given birth.
BUT THAT’S NOT THE ONLY POPULATION THIS AFFECTS!
It’s a misconception that this only affects post-partum women. Post-partum women can be a large percentage, but this can affect everyone.
It’s a true problem that can really cause harm to your quality of life. There’s one exercise culture that does a lot of jump rope that has just resigned to “leaking” during exercise as a way of life. You can even find a LONG LIST of YouTube videos of people exercising and peeing themselves as if that’s just the only way. It ABSOLUTELY DOES NOT NEED TO BE A REALITY and Julia is here to help.
This isn’t the “sexiest” topic, but it’s damn important. I want you to have EVERY tool to live a healthier, happier life. Being afraid to participate in exercise or social events because of a weak (and treatable) pelvic floor muscle prevents you from living life to its fullest. Below, Julia is going to lay out simple home tests, home exercises, and–for the more complex cases–lay out resources for you to find help in your local area.
If you have follow up questions, please feel free to reach out to Dr. Julia Salazar of CORE PELVIC PHYSICAL THERAPY in Spokane Valley, WA at her email address Julia@CorePelvicPT.com
Exercise and Live without Leaking
Leaking May be Common BUT it is NEVER Normal
I want to talk to you about the personal topic of leaking urine due to urinary incontinence. Nobody wants to admit that it happens but there is a reason the fastest growing market is adult absorbent products, ie adult diapers. This is not a glamorous topic but a very important one. It can cause depression and isolation; no one wants to go through the embarrassment of a possible accident so you no longer go out with friends. You are always wondering where the bathroom is and will avoid attending social events if there is not easy access to a toilet.
Leaking is a topic that causes a lot of anxiety which can worsen the problem! I am so happy you are here to learn how you no longer have to miss out on workouts at the gym, family events, enjoying your grandchildren, or a vacation with friends.
First though I want to explain why a Physical Therapist who specializes in pelvic floor dysfunction is the best option for treating urine leaking. As a physical therapist, my specialty is the musculoskeletal system and to optimize quality of life. Your pelvic floor is made entirely of muscle so there is no one better to help get things working the way they should than a physical therapist. Not every Physical Therapist is a Pelvic Floor Specialist though. This is special training that is done after receiving your Doctorate of Physical Therapy. An easy way to know if someone has this special training is to look for WCS after their name. WCS stands for Women’s Certified Specialist. To have this distinction you must apply and sit for a once a year test. To apply you need a minimum of :
- 2,000 hours of clinical experience and
- Submit a reflection paper demonstrating specialty practice in women’s health along with journal articles supporting evidence-based practice for all treatments for review by the board.
Currently there are just 489 Certified Clinical Specialists in Women’s Health Nationally.
Part 1: What is Normal?
Besides leaking, how do you know if there is a problem or if you have some urinary incontinence? Let me tell you what is “normal” for your bladder.
- No leaking! Just because it is common does not mean you have to live and accept it. There is a lot you can do to fix the problem and this will help with decreasing your chance of other scarier things like PROLAPSE!
- Peeing every 3-4 hrs during the day, and 1 time at night IF you are over 65. That’s right people! 3-4 hrs during the day, and it doesn’t count if you stop drinking! You should be able to drink 64 oz of water (anything not carbonated or caffeinated) and still last 3-4 hrs before using the little girls’ room.
- When you do use the toilet, you should empty enough urine to fill a coffee cup. If you are not emptying this much then your bladder isn’t full and you could have waited. Now if your bladder lied to you and told you that it was an emergency but you barely filled the coffee cup ½ way, that is what we call urgency/ frequency. Don’t worry. We can fix that too!
- Since we are discussing bathroom habits your stream should start as soon as YOU want it to. Not sooner than you are ready and you shouldn’t have to sit and wait for it to start. You should feel empty after, no feeling of having to pee again once you stand up or within 5 min of voiding. Your stream should be constant, no starting or stopping. And you should never feel like you have to bear down to completely empty.
You are not the only one that deals with their bladder not listening to what you want it to do. Again, there is a reason there is a whole aisle in the stores dedicated to bladder leaking. Here are some factors that can contribute to leaking.
Part 2: What are common causes of Urinary Incontinence?
- Hormones. This is something we can’t control but that doesn’t mean we are helpless. Menopause causes decreased estrogen to the lady bits which can cause muscle atrophy/ weakening, tissue thinning, and dryness to name some of the more common issues. If you have no history of cancer personally, you can discuss with your doctor about the use of vaginal estrogen cream. This will increase blood flow and improve symptoms. There are non-hormonal options as well. Use of over the counter creams to help with tissue irritability and the use of red light therapy to increase blood flow to these tissues as well (vFit+: check out my website for more information www.corepelvicpt.com).
- Chronic cough/ sneeze from allergies or COPD. You may have already noticed that after a bad cold your leaking worsened. This is because every time you cough or sneeze, your pelvic floor muscles have to contract. After a day of coughing every few minutes your muscles are exhausted and can no longer tighten effectively and thus you leak.
- High muscle tension. Now this is a hard concept for people to understand. Most people think that if they have tight muscles, they must be strong. WRONG! High muscle tension causes progressive weakening of the pelvic floor muscles. Visualize tightening your fist and keeping it tight all day. After only a few minutes your knuckles are already turning white. This is lack of blood flow. Muscles get their energy from blood and they may be already working with a decreased blood flow thanks to menopause, so keeping them tight just hastens the weakening. If you have urgency/ frequency or you find that you leak more in the afternoon and evening, then high muscle tension might be a reason you are leaking. Don’t worry we can help with that too!
- The last thing that can play a major role in bladder leaking is constipation. Just when you thought this couldn’t get any more awkward and embarrassing, I have to bring up poop! Don’t worry though, everyone poops. Some poop more or less than others.
Now I know all of you are like “I poop every day or even every other day. There is no way I am constipated!” How many of you are on medications? Have you ever read the pamphlet the pharmacist gives you, the number one side effect of most meds is constipation. Also, if you suffer from allergies all those meds are drying out agents and can make the problem worse. Even bladder meds! A side effect of them is constipation. This is why they can work for a period of time and then they “wear off” and you have to increase the dose or they just “stop working.” What you want to see in the toilet is every 1-2 days a medium to large BM that looks like smooth snake, that required no straining.
So now that you understand everything that can affect the bladder and the pelvic floor muscles. How are we going to fix it?!
Part 3: How do we FIX IT??
Everyone is different and therefore everyone’s program is going to look slightly different but the common components are:
- Make sure you’re pooping. Daily, soft, and without straining. Increase your water intake, add a fiber supplement, take magnesium daily, and get a stool (like the squatty potty)! There is a proper posture that helps with having a BM. You want to have your feet supported on the stool with your knees higher than your hips and leaning forward with your forearms resting on your thighs. You have a muscle (puborectalis) that attaches from the tailbone, wraps around the rectum and connects again to the tailbone. When you get into this correct posture the muscle relaxes and you are able to empty easier and more effectively.
- Increase blood flow to pelvic floor muscles. You can do this many ways, topical estrogen, use of LED light with the vFit Plus, or just exercising it.
- Getting chronic cough under control. Give your Pelvic Floor Muscles a break so they can recover and start the strengthening process
- Finally doing a pelvic floor muscle contraction correctly! A study showed that only 50% of people who were told to contract their kegel (pelvic floor muscles) actually did it correctly! And ¼ of those that contracted their pelvic floors wrong were causing symptoms.
Here is how you are going to design a personalized home strengthening program. To do this you need to figure out how “in shape” your pelvic floor is. You are going to do this by following the 4 F’s. FIND IT. FIND ITS LIMITS. FAST FLICKS. And then FORCE THE LIMITS.
- Find it. There are many different ways to achieve this. There are tools you can purchase that you insert into the vagina, think tampon size, that will tell you if you are doing them correctly (The Educator). They can be very inexpensive and basic, or they can get more complex that even have an app that connects to your phone (Kgoal or Elvie) . Or you can use the most basic but effective tool, your own finger. First, you want to be in a semi reclined position. You are going to place your finger inside your vaginal canal and then you are going to do a contraction. Cnontractions can by done by:
- Squeezing as if you’re trying to not pass gas
- Imagine there is a string attached to the front of your pubic bone, you are going to grab it and then lift it towards your head
- Place a hand on the pubic bone and the other on your tailbone. Now squeeze them together
- In the mirror when you are undressed, watch your lower tummy- if it moves inwards more than just slightly you are over-trying. No other muscles should be contracting
- The next step is Find it limits!
- How long can you hold? And still breathe!
- How many can you do? Before you start squeezing everything to maintain the contraction.
- Make sure you rest! Rest is just as important as the contraction. If you don’t relax between contractions you will not get the strengthening your wanting. Think about when you do a bicep curl. You start by holding the weight next to the side of your body, you then contract your bicep which bends your elbow and brings the weight up to your shoulder. You then relax and your arm is straight again at your side. This is the full range of motion of the bicep. Exercising through this full range is how you will gain strength. Now picture when you relax your arm is only going down half way and then you are contracting again. You are no longer strengthening the muscle through the full range and therefore you will not see changes in strength. This applies to the pelvic floor as well.
- Feel the fast flicks!
- There are 2 types of muscle fibers so you have to strengthen both types. You will do long holds like what you just practiced and also quick 1-2 second holds. When you do a quick contraction practice contracting when you exhaling. You will do the same amount of reps that you found was your limit with the long holds.
- The last F is Force the limits!
- If you are consistent with these exercises you should be able to progress weekly. You want to increase the length that you can hold your contraction until you reach 10 seconds 10 times.
- You want to do 4-5 sets of both the long and short contractions daily.
- Start while laying down then progress to sitting and then to standing. (Each position progressively adds more gravity which makes the contraction more difficult for the body)
- Avoid cheating and using extra muscles when standing by standing feet apart and toes turned in, then contract the Pelvic Floor Muscles
How long until you should see results? It depends, but only on how committed you are to making the changes and putting in the work. If you are consistent and are doing the exercises correctly you will start to see changes within a week. Remember, your pelvic floor muscles are still muscles so this is a life long habit. If you stop exercising for an extended period of time your symptoms will return.
So that is the down and dirty quick version of everything you can affect and what you can start doing today to regain control over your bladder again. I want to leave you with a few thoughts.
- The most important is that leaking is common, but don’t let it take control of your life. Get help to fix the problem, but until then Pad up and Play on! Don’t miss out on life.
- Bladder leaking is not an easy fix. Kegels alone are not going to fix the problem. If that was true everyone would be dry. I have spent 8 years in college to receive my doctorate degree and another 9 years post doctorate degree learning about the pelvic floor. This is something that can be complicated, trust me.
- To find a specialized physical therapist in your area go to the American Board of Physical Therapy Specialists at www.abpts.org and click on the “Find a Specialist” tab on the right side of the page.