Incontinence is Common, But Not Normal

Urinary incontinence is incredibly common. In fact, studies have found anywhere from 30-80% of women experience incontinence. Some of the biggest risk factors for experiencing leaking are history of vaginal birth(s), being over 70 years of age, and having a BMI >40. Many women are told that leaking is normal after having children or is normal as you age, especially during and following the hormonal changes of menopause.

While leaking is very common, it is not normal! It doesn’t matter how much you leak; you don’t have to live with incontinence. The bladder is one of the most trainable parts of our body. In fact, retraining your bladder can occur in as little as 3 days!

Urge vs Stress Incontinence

In order to retrain your bladder, you first need to determine which type of incontinence you have. There are 3 categories of incontinence: stress, urge, and mixed (both stress and urge). Urge incontinence is when you get a sudden urge to urinate before your bladder is full. You feel like you might not make it to the bathroom in time. Leaking may or may not occur with that strong urge.

Stress incontinence is when the demand on the bladder is increased through impact or force. The pelvic floor muscles are not strong enough or relaxed enough to handle the pressure placed on them. Leaking occurs without an urge. Stress incontinence most commonly occurs with sneezing, coughing, running, jumping, or lifting.

Tips for Urge Incontinence

First, you should identify any triggers causing your urge – keys in the door, stepping into the shower, putting on your shoes to leave the house, etc. Sometimes an urge occurs with triggers because you may have trained your bladder that it needs to empty when you do these activities.

In order to end urge incontinence, you have to retrain your brain and bladder. Here are some tips on how to do that:

• When you feel an urge to go, try a few Kegels and take some deep breaths. Distract your mind with something sensory (like digging your fingernail into your thumb) or visual (stroll through social media, watch a video). When the urge subsides, then calmly walk to the toilet.
• Stop the “just in case” pee. This trains the bladder to empty too early, and the bladder will start to think partially full = completely full. You should be urinating about 8 times per day or every 2-4 hours.
• Avoid bladder irritants – coffee, caffeine, alcohol, acidic foods, etc.
• Keep hydrated. You should drink half of your body weight in ounces daily. Drinking less to avoid leaking actually causes your bladder to become more irritated by a higher concentrated urine (dark yellow pee). Higher concentrated urine can also increase your risk of developing UTIs.
• Stop smoking.
• Practice deep breathing. Try the 360 Breathing technique in the video below.

Tips for Stress Incontinence

Stress incontinence can occur for many reasons, including weakness in your pelvic floor muscles, tightness in your pelvic floor muscles, poor breathing strategies, poor posture, and poor intra-abdominal pressure management.

In order to determine if you have tightness versus weakness in your pelvic floor muscles, take a deep breath in. Do you feel a hard stop? Is it difficult to take a deep breath in? Do you have difficulty beginning urination when sitting on the toilet? Does performing a Kegel cause pelvic pain? If your answer is yes to any of these questions, tightness in your pelvic floor may be leading to your leaking.

Tips for weak pelvic floor muscles:

• Try “the Knack.” This is an incredibly effective strategy. Before you sneeze, cough, jump, lift, etc, perform a Kegel. This reminds your pelvic floor muscles to kick in and helps teach your pelvic floor muscles better coordination and timing.
• Work on the strength (10 quick, max contractions) and endurance (10 second sub-max holds x10) of your pelvic floor muscles. When you perform Kegels, you should feel a squeeze, then a lift, and then a full relaxation. Check out the video below on how to perform a Kegel.

Tips for tightness in your pelvic floor muscles:

• Try meditation and decrease stress. Some great apps to try are Calm, Headspace, and UCLA Mindful.
• Work on deep breathing.
• Stretch and relax your pelvic floor muscles. Try happy baby pose or child’s pose in the videos below.

Tips for both tightness and weakness in your pelvic floor muscles:

• Stop smoking.
• Reduce bladder irritants – caffeine, alcohol, carbonated drinks, etc.
• Work on good posture – keep your ribs stacked on top of your pelvis. This will help reduce pressure down on your pelvic floor.
• Avoid shallow breathing (shoulders moving up and down). Shallow breathing also places more pressure down on your pelvic floor.
• Limit breath holding. Breathe out when doing something difficult, such as lifting, jumping, or during exercise. Holding your breath increases the pressure in your abdomen by 2-3 times.

End Your Leaking

You don’t have to live with leaking! If you put a pad in your underwear every morning “just in case,” it’s time to retrain your bladder and pelvic floor muscles. As you can see, there is much more to ending leaking than just doing your Kegels. Because there are many factors that can lead to incontinence, it is beneficial to be evaluated by a physical therapist. We can help you determine which type of incontinence you have, what factors may be contributing to your leaking, and assist you in ending your incontinence for good.