Are you a mom who’s experienced the dreadful peeing accident during a workout? When simply coughing or sneezing? Or have you ever had a sudden loss of urine when trying to get to the restroom in time?
I remember the first time this happened to me, shortly after giving birth to my first daughter more than 13 years ago. I was ashamed that I couldn’t even stop the flow of urine and peed my pants, right inside my home. My husband was sympathetic but I was so ashamed, and even worse, I was worried that it would happen again. What if it happened when I was out getting groceries or at a friend’s house? I started packing a change of clothes for baby AND ME inside the diaper bag.
Things improved as my postpartum body healed, but the incontinence lingered long after I felt it should have. Even years later, I had to wear a pad while running just to prevent accidents. I would run first thing in the morning before breakfast, because my bladder couldn’t handle any liquid prior to running. I also got into a habit of going to the bathroom before I left my house. Then I stopped again somewhere in the first 2 miles of running “just in case”. I’m appalled to admit I would intentionally NOT drink water while out on long distance runs, even up to 15+ miles, because I didn’t want to pee my pants and I didn’t want to give up running. I’m glad that I finally woke up and decided enough was enough. I needed to stop running and take care of myself instead of pushing my body to the limits.
I needed to stop ignoring its every clue that what I was doing was wrong.
Even though I was a physical therapist, I didn’t really know how to treat it because it’s such a specialty area of physical therapy that I had no official training in. I asked my midwife for a referral to a pelvic physical therapist and got the help I needed. In my quest to get better, I discovered the world of biofeedback, relaxation training, exercise, everyday tips, and manual therapy to treat the pelvic floor. I was pleasantly surprised to also notice some relief of my headaches as I got the treatment I needed in my pelvic floor. In the quest to help myself, I got passionate about helping other moms and learned that the pelvic floor is a pivotal part of lower back, pelvic and hip pain.
I’d like to share my knowledge in what I’ve learned as a pelvic physical therapist, from a personal and professional view. I’ve been in your shoes, ladies. It’s no fun, but I’m here to assure you that it’s treatable and there is hope; and it doesn’t have to be in the form of medications, injections, or surgery. While these interventions have their rightful time and place, I always recommend giving conservative treatment a go before resorting to more invasive options.
Here are some of my best tips to treating incontinence.
Balance the pelvic bones.
When the pelvis is not balanced then the pelvic floor muscles aren’t able to function optimally. Depending on the position of the bony structure of your pelvis, your pelvic floor muscles can be overstretched, torqued, or develop trigger points. An unbalanced pelvis can make the pelvic floor appear weak. In fact, the muscles are just not lined up properly. It’s like putting on a straight jacket and then expecting to be able to fully move your arms and trunk. As a pelvic physical therapist I look at how the bones are lined up, then I gently restore proper position using manual therapy (my hands) as well as prescribe stretches and strengthening exercises that are specific to the needs of the person I’m helping.
Assess strength of the pelvic floor muscles (PFM).
If you’re a woman, and especially if you’re a mom, you’ve likely heard of Kegels. It’s an exercise that we’re often given to strengthen the pelvic floor muscles. It’s the muscles you would contract if you were urinating and wanted to stop the flow of urine. Proper assessment of the pelvic floor muscles involves checking how well they contract AND how well they relax. Often times women have issues with relaxing the PFM more than generating a strong contraction. I’ve met plenty of women who actually seem to keep their PFMs in a constant state of contraction. This can happen if a woman is drawing in her stomach, if she’s had trauma in her life, if she’s guarded, or if she’s simply unaware that the pelvic floor is supposed to be relaxed.
Many women don’t even know they are holding tension in this area. If you have a constant, low-grade contraction in these muscles then the muscles will start to shorten over time. Then they will lose their ability to generate force and endurance when called upon for more strenuous activities such as jumping, running or sneezing. Assessing the strength can involve the use of bio-feedback but I prefer manual assessment. Manual assessment allows me to feel how well the vaginal walls can close in and constrict. I can tell if one area needs more local training than another. With proper training, this can be checked with a self-assessment or by a trained practitioner who can give you feedback on the strength, endurance, and quality of contraction and relaxation.
Look at your postural habits.
When you are standing, your pelvis is tilted in such a way that your pubic bones creates a shelf for the bladder to rest upon. If there is tightness in the hips and buttocks, it changes the way the pelvis rests when standing and sitting. Standing with your “tail tucked under” or “spilling forward” changes the way the pelvis sits; therefore changing the bladder’s support. Another example is always crossing your legs to the same side which shifts the weight onto your sits bones. This creates soft-tissue imbalances in your pelvis, hips and buttocks and can then put more pressure through the lower abdomen and pelvis, right where the bladder rests. Make an intention to be more mindful of how you hold yourself, what your habits are standing and sitting, and see if you can make some healthy changes, if needed.
Treat your abdominal scars.
Scar tissue is simply fascia, or soft connective tissue, that is normal in the body. Fascia can get bound down, start to twist and pull, and create a fishnet over structures. If you have any type of scar in the lower abdomen (think C-section, laparoscopic surgery, hernia repair, gallbladder, appendectomy, belly button ring, traumatic scar) then those inner fascia fibers can be reaching out in any direction. This creates tension and increases pressure into the abdomen and pelvis. The bladder rests right behind the pubic bone. Since the bladder is a sack, if the fascia surrounding it or near it starts to tighten, it can affect how well the bladder is able to fill and empty. Again, think of a straight jacket around the bladder which can limit how well it can fill. Urgency, incomplete emptying, sudden loss of urine with stress….any and all of this can occur when scar tissue is present.
Scars can be treated with light pressure over any areas that are hot, hard or tender.
- Simply place your fingertips or hand over the area you want to treat
- Press gently under you meet resistance (never force)
- Wait for the tissues to soft and melt under your touch
- Hold there for 5 minutes or longer and reassess
I find this type of release to be more effective long-term than simply massaging over the scar.
Go (only) when you get the urge to urinate.
When you feel the urge to use the restroom-go. Avoid urinating “just in case” like when you’re leaving the house. This confuses the reflex responsible for alerting you when you need to use the bathroom. Instead, listen to your internal cues and just use the restroom when it’s needed. On the flip side, don’t ignore your body’s cues that you need to urinate; this is just as confusing to the body and can disrupt the signals sent from your bladder to your brain.
If you’re a woman, don’t pee standing up.
This tip might make you giggle, as you think to yourself, “Duh, I’m a woman, I always pee sitting down”. But do you? Do you ever get the sensation to pee when you’re in the shower? If so, resist the urge as this can change the Micturition Reflex and be confusing to your body. The result may be a signal to your brain at inopportune times that it’s okay to pee while standing.
Assess the position of the bladder.
If you’ve been pregnant then you know that things can get rearranged in your abdomen to accommodate baby’s growing size. The stomach and liver get pushed up into the lower ribcage, the uterus expands as baby grows, your ribs may flare out and upward, and you may feel increased pressure into your lower back and hips. The bladder can also get shifted to one side or the other. Shifts are particularly common in the third trimester as baby prepares for birth and settles in to the left side of your body. Often times mom’s lower left abdomen gets tighter and it starts to pull the bladder to the left side. The good news is that this can be checked and easily fixed postpartum.
All it takes is an assessment by a trained provider who can check to see where the bladder is in relation to midline. Then the bladder can be gently released and coaxed back to midline. There’s a correlation between an unhappy bladder and PFM tension. When the bladder is stressed out and pulled, then the PFMs aren’t happy either. Give the bladder some loving and get it back into its happy place within the pelvis, then the PFMs can relax again.
This is not an all-inclusive list of treatment options when it comes to incontinence. Rather these are some of the more important points I look at as a pelvic physical therapist. Leaking is common, but it’s not normal, so don’t put up with it! If you could use some help in this area, seek out a pelvic physical therapist that specializes in helping women restore their core. Ditch the shame, ditch the fear that you’ll leak, and ditch the idea that you won’t be able to be as active as you’d like.