Leaking When You Laugh?

Let’s talk about that dribble that some us experience when we’re exercising, having a good laugh with friends or jumping on that dreaded trampoline. That, my friends, is called stress incontinence.

Stress incontinence occurs when the muscles of your pelvic floor are not contracting properly to support your bladder and pinch around your urethra, resulting in leakage. Think about pinching your fingers around a straw to prevent the liquid from coming out of the other end. This is how layers of your pelvic floor muscles work.

This can occur even without a history of childbirth. The truth is most of us experience it, we just don’t talk about it. Studies have even shown that large percentages of high school athletes (!!!!)  have reported leaking when playing high impact sports such as basketball, soccer and volleyball.

So what do you do when you notice you have to stop and cross your legs when you feel a sneeze coming? First off, its NOT NORMAL (No matter how many children you’ve had!).  And please DO NOT start using a liner. As mentioned in my previous post, we don’t put diapers on kids at the first sign of an accident so why do we take that approach when treating ourselves?! Using a a protective liner will tell your brain that it’s ok to leak, there’s protection after all. This will progressively make things worse.

And just doing kegels is not enough. The core and the pelvic floor are a team and have to work together. You can’t contract one muscle group without working on the other.  The key is to identify the dysunction.  How is the core working with the pelvic floor? How are you breathing? Are you contracting your core muscles properly during high impact activities that bring on the leaking?

Breathing is an excellent place to start.  As you inhale, your pelvic floor descends as your ribs expand (outward and downward pressure). As you exhale, the diaphragm ascends as there is an inward pressure at the core and pelvic floor LIFTS. Dysfunctional breathing can contribute to exacerbation of leaking. For instance if you’re performing a squat while exercising or bending down to lift your child and doing this as your inhale and/or hold your breath, you’re adding additional downward pressure on your pelvic floor, pushing your pelvic floor organs downward and adding excess strain to the musculature. Doing this repeatedly can significantly increase your risk for prolapse over time.

If the pelvic floor lifts as you exhale, then that’s the perfect time to perform that task that places added strain on the pelvic floor! So before you bend down to pick up your 3 year old, take a breath and as you exhale draw your belly button in towards your spine (take a long exhale as if you’re breathing out throughout a straw) and proceed with the lift. The same can be done when you feel a sneeze coming on or you’ve been dragged on to the trampoline by your little one. Engaging this muscle by drawing in your belly button will lift the hammock that is your pelvic floor. And please keep in mind, this is just one component of treating stress incontinence.

Every patient is different and although something like breathing and contracting your core sound very simple, it’s amazing how many of us can screw it up. Being examined by a pelvic floor therapist (even just one visit!) is an excellent way to identify problems and prevent them from becoming major issues down the line.

Pelvic Floor Dysfunction is NOT Ok

Women (and men, but let’s focus on the ladies today) have suffered through all types of pelvic floor dysfunction, and are often told that it’s normal.  The new mom may walk into her OBGYN’s office and complain of pain during intercourse and leaking when she’s walking and be told that this is all par for the course.  Or the post menopausal woman may complain of leaking while she’s walking and be told it’s just a part of aging.  These are issues that need to be addressed ASAP!

I find that it’s best to look at these issues like any other musculoskeletal dysfunction.  For instance, if you had a bad knee and put on a brace on it without pinpointing the specific deficits, the problem would most likely get worse.  The muscles around the knee would atrophy and get tighter, progressively affecting how the joint is functioning and eventually move up to the hip and down to the ankle.

Now if you were experiencing leaking with exercise and you started to use a pad to address the problem and maybe urinating more frequently to ensure your bladder was empty, the problem would progressively worsen.  The bladder would adjust to these frequent trips and think that it now needs to empty every 30 minutes, instead of the usual 3-5 hours.  The trips to the bathroom would increase, but you would notice that the volume of urine coming out would be minimal.  And let’s talk about using a pad-do we put a diaper on a child who is being potty trained at the first sign of an accident?  NO! So, why do we use that as a solution for our own problems? This just teaches the brain and the bladder that it’s ok to leak, the  pad’s got me.

Whether it’s pain or incontinence (there are a laundry list of pelvic floor problems but let’s keep it simple for today), it’s important to figure out WHY this is happening. Are the muscles weak and not supporting the pelvic floor? Are the muscles tight and spasming around the urethra? Are my tight muscles contributing to painful sex? Or maybe there’s scar tissue or muscle adhesions from a vaginal delivery. Once the dysfunction(s) is found, then the problems can be addressed head on. But just like that bad knee, if you wait years to address it then things get a little more complicated.

So, lesson of the day is recognize symptoms early and talk to your doctor or a pelvic floor physical therapist. The earlier you address it the more likely you’ll kick them curb in less time!