Stress Urinary Incontinence
Today, I want to talk about a specific type of bladder leakage called Stress Urinary Incontinence. One in 3 women will experience bladder leakage at some point in their lifetime and although it is common, it is not normal. Let me reiterate that…
Bladder leakage is not normal. Not when you exercise. Not when you sneeze. Not after you have had a baby. Not when you laugh. Not when you are post-menopausal. Not when you lift. Bladder leakage is never normal. It is a sign of dysfunction in our core support system.
Stress incontinence happens when physical movement or activity — such as coughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder. Stress urinary incontinence is often a result of weakness or poor recruitment patterns of the pelvic floor muscles.
With stress incontinence you may experience urine leakage when you:
- Stand up
- Get out of a car
- Lift something heavy
- Have sex
Amount of leakage can vary from a few drops to a complete emptying of bladder. Some people experience the bladder leakage with many different activities and for others it is limited to a single activity type.
Treatment for Stress Urinary Incontinence
Stress urinary incontinence is probably one of the most common things that I see here at my practice. The good news is that it respond really well to conservative treatment and simple changes that you can make in your daily routine.
Contrary to what the Poise commercials want us to believe, the treatment for stress incontinence is not buying the latest, greatest absorbent pad or diaper. Instead, most people report a significant improvement in their leakage with training for their pelvic floor muscles. Many times stress incontinence is a result of weak pelvic floor muscles.
Not sure if your pelvic floor muscles are weak? See if you can stop the flow of urine mid stream. When you contract your pelvic floor muscles (AKA Kegel exercise) you should be able to get the stream to stop completely. If you can’t, then this is a sign that your pelvic floor muscles may be weak.
Word of caution… do not repetitively start and stop your flow of urine as a exercise. This can mess up the normal mechanisms for completely emptying your bladder.
One of the tips I tell people to do if they are having leakage with a cough or sneeze is what we called “The Knack.” It is a little precontraction of the pelvic floor to brace for the load of that is going come from the pressure of the cough or sneeze. If you have warning that a cough or a sneeze is going to happen then stop where you are and contract your pelvic floor to brace for the load.
If you are experiencing stress incontinence, know that you are not alone and there are things that you can do to make a difference. Partnering with a pelvic physical therapist can be a great option. They can help you identify your pelvic floor muscles and come up with a rehabilitation program specific to your individual needs and goals.
Pelvic physical therapy is something that is unfamiliar to many people. I would say for about every 10 new patients that come to see us here Legacy Physical Therapy, about 7 or 8 of them start out their evaluation by saying that they have never heard of Pelvic Physical Therapy and they are not sure how we can help them.
We are passionate about helping women & men of all ages enjoy active, healthy lifestyles, by restoring confidence and dignity in pelvic, bladder, bowel, and sexual function, without relying on medications or surgery. We provide conservative treatment options for many conditions that people may be unaware that they even can do anything about.
Conditions Pelvic Physical Therapy Can Help
- Bladder Issues:
- Leakage, Urgency, Frequency, Painful Urination, Urinary Retention
- Bowel Issues:
- Constipation, Fecal Leakage
- Pain Conditions:
- Back Pain, Pelvic Pain, Tailbone Pain, Sacroiliac Joint Pain, Vaginal Pain, Rectal Pain, Vulvar Pain, Abdominal Pain, Penile Pain, Painful Sex
- Pelvic Prolapse Issue:
- Cystocele, Rectocele, Uterine Prolapse, Vaginal Vault Prolapse
- Pregnancy/Postpartum Related Issues:
- Low Back Pain, Sciatica, Diastasis Recti, Clogged Milk Duct, Episiotomy or C-section Scar Tissue Adhesions
Many people are surprised to learn that all of the above conditions can be helped by pelvic physical therapy. One of the things that we commonly see happen is that a patient will be referred to us by their urologist for bladder issues. Then once we get talking with them, we find out that they also have some back pain or hip pain issues that despite treatment aren’t going away. We teach the patient how all everything can be related.
Aren’t You Just Going to Teach Me to Kegel?
One of the things that we get asked all the time is, “I’m already doing Kegel exercises. It doesn’t help, why would coming to pelvic physical therapy help?” For those of you who don’t know a Kegel exercise is simply a contraction of the pelvic floor muscles like you are trying to hold back gas or pee. Muscle function is not simply about contraction. We need to make sure that we have a variety of different movements with the muscles. Muscles need to be able to contract, relax, stretch, and coordinate with other muscles.
As pelvic physical therapists, our job is to figure out how your pelvic floor muscles are working and coordinating with other muscles. We really take the whole body approach to looking at how things are coordinating together. It is never simply just about Kegel exercises. Those may be a part of your treatment plan, but it may not be. For some people, the problem is that they are doing pelvic floor muscle contractions or Kegel exercises incorrectly and that is actually causing more of the problem. For other people their pelvic floor muscles may be too tense or tight and trying to squeeze them more isn’t going to improve their symptoms. Instead, we need to actually teach them to relax and let go.
Pelvic PT Can Help Before or After Surgery
Another thing we hear commonly when we talk with patients on the phone is that I’m planning them to having the surgery so why would I need to see pelvic physical therapy. Our simple answer to that is if you’re planning on having shoulder surgery, neck surgery, back surgery, or knee surgery; 9 times out of 10, you’re going see a physical therapist either before or after the surgery to help make sure that you rehabilitate the muscles and that everything is working well together. Similarly, working with the pelvic physical therapist after you’ve had surgery for a bladder sling, prolapse repair, hysterectomy, or giving birth can promote return to optimal muscle function allowing you to have better, longer lasting surgical outcomes.
Pelvic PT Helps During Pregnancy & Postpartum
Females who have given birth are at a greater risk for pelvic dysfunction. Here at Legacy Physical Therapy, we feel strongly that every women should see a pelvic physical therapist for at least for 1 visit postpartum to identify any musculoskeletal issues that may be preventing her from improving her core and pelvic function postpartum. This should happened before she starts out with any type of exercise regimen, especially a high level one, to make sure that the pelvic and abdominal muscles are functioning the way that they should be. The therapist will also review movement patterns to make so she doesn’t develop any bad habits that will potentially lead to problems down the road such as bladder leakage or pelvic prolapse.
Pelvic physical therapists also work with women during their pregnancy. We help make sure that the pregnancy progresses as comfortably as possible and that you are able to be as active as you want to be. Pregnancy is a time that can be very stressful on the abdominals and pelvic floor because of the changes in your body. Working with the pelvic physical therapist to help you maximize pelvic and abdominal support and control can really make a big difference for a comfortable pregnancy.
You May Need Need to Advocate for Yourself
So now that you have learn a little more about what pelvic physical therapy is, you may be wondering why you haven’t heard of it before or why your doctor has not told you about it despite you mentioning some of the symptoms. Unfortunately, many doctors are unaware that pelvic physical therapy is an option out there to help their patients. Even the ones who do refer to pelvic physical therapy already may not be aware of all of the different thing that we can be doing to help patients. Because of this, you may have to be an advocate for yourself if you feel like you need to see a pelvic physical therapist. Don’t be afraid to ask your doctor for a referral to pelvic physical therapy.
If you feel like you’re dealing with any of these issues that we’ve been talking about, you may have to be the one to advocate for pelvic PT. You as a consumer, have the right to go wherever you want to go for your treatment. You do not have to necessary to go only to a place that is in your doctor’s office. You can seek healthcare from a pelvic physical therapist with whom you feel comfortable.
So, that is the brief introduction to pelvic physical therapy. If anything you have read about seems like something you are dealing with, give us a call at 636-225-3649. We are happy to chat with you about what you are experiencing to see if pelvic physical therapy would be a good option for you.
So this time a year a lot of times people resolution is to get healthy and workout more which is awesome. We see a lots of exercise routines and new workouts started but unfortunately sometimes that can bring to light a problem that people don’t know that they have … pelvic floor dysfunction.
Today I want to talk to you about 10 signs that pelvic floor dysfunction may be affecting your workout.
- You have Bladder Leakage when you run, jump do burpees, jumping jacks, jump rope, Push ups, Squats any physical activities. Leakage with Physical activity is not normal, “It is not a badge of honor to leak while you exercise” it is a sign of pelvic floor dysfunction and there’s something that you can do about it.
- Low back, pelvic, hip or a Abdominal pain with or soon after your workouts, “Pain should not be a part of your workouts.” Yes should be pushing yourself hard but there’s a difference between muscles burn and pain. And if you’re dealing with pain any of these areas it may be a sign that your core muscles are not functioning well together and you need to make a change.
- If you need to pee, pre and post workout then this is a sign that your bladder and pelvic floor muscles may not be function optimally, if you’re doing a 40 to 60 minute workout you should be able to make it without having to urinate before or after class.
- You are experiencing pelvic heaviness, pressure or falling out feeling during or shortly after workouts, This can be a sign that you are experiencing pelvic floor dysfunction and/or pelvic organ prolapse and it’s a definite sign you need to modify activities in order to performed at a level that your core and pelvic support muscles can function at appropriately.
- Your belly bulges out or pushes out especially when you’re performing abdominal exercises. You should be able to maintain a gentle belly pull in during the exercises. If you feel that your abdominal wall is pushing out or your back arching off the floor then “you are not using right support muscles to perform the exercise and you’re actually not going to get the same benefit out of it” This also is putting more pressure down through your pelvic floor area. It can be a sign of dysfunction.
- You need to pee mid workout. Again going back to number 3, you should not need to pee before after or during workout and if it’s only 40 minutes to an hour long. So if you need to stop your workout to make sure that you don’t pee your pants then it’s a sign that you probably have some bladder or pelvic floor issues that need to be taken care of.
- You hold your breath to complete an exercise. Whether you doing crunches, plank, squats, lunges, bridges or any type of exercise, “If you find that you have to hold your breath to complete those exercises that is using a pressure system to create stability vs thoroughly engaging your core support muscles well”.
- You feel that your form fails you or you get exhausted easily from your exercises. Again it’s can be a sign that your core support muscles are not working the way that they should be and your body’s trying to compensate with other areas but it’s not able to do so.
- “You skip part of your workout because you know you will have bladder leakage if you do it”, So if you are avoiding the double unders, jump lunges, jump ropes, jumping jacks or squats because you will know you will leak when you do them, then that is a sign that you have pelvic floor dysfunction. There is something you can do about it so that you can get back to doing your entire workout.
- You have gas leakage while performing your exercises. So if you cannot hold the fart in while your are exercising then this is the sign that your pelvic floor muscles are not performing optimally.
So we just went through 10 signs that pelvic floor dysfunction may be affecting your workout. How many of these applied to you? If they do, Don’t worry. There something that you can do! Partnering with the pelvic physical therapist is one of the best options that you can do to make sure that your pelvic floor and core muscles are performing optimally to get you back to your exercise routine. We want to help you reach those new year resolutions and goal that you would like to achieve. So if you answered yes to anyone of these 10 signs then we’d love the opportunity to work with you. You can give us a call @ 636-225-36-49 and we can get you setup for a free discovery session to find out if pelvic physical therapy is right for you.
Today I want to clear up of some common misconceptions about bladder health that we hear all the time. Do you know how to keep your bladder healthy and happy? Check out below to learn 10 simple tips for a healthy bladder.
- Do not push to pee. We are not designed to strain or push to empty our bladder. Women especially tend to be what I called “Power peers.” They go as quick as they can because they hurry to get in/get out out and get back to their day.However forcing or pushing to urinate puts more strain on our pelvic floor and bladder. We are designed “just to sit and relax and let the urine come out”. Take a moment sit down and let the flow happen vs trying to strain or push.
- “To keep your bladder happy, you need to drink more water”. Most people, especially if they are dealing with bladder leakage, urgency or frequency will limit their fluid to reduce the amount of times that they have to go to the bathroom or that they leak. Unfortunately when we limit fluid it actually irritates the bladder. Concentrated urine is more irritating to the bladder, so we need to take in plenty water throughout the day to stay hydrated and keep the bladder happy. You can tell that you are drinking the right amount of fluids by looking at the color of your pee. Your pee it should be a pale yellow color. If it’s a dark yellow or even towards a brown side that is definitely a sign that you are not drinking enough water.
- Sit down on the toilet. Many women hover over the toilet because they are worried about germs. However, “we are designed to sit down and relax to urinate.” If you are worried about germs on public toilets, then use toilet seat covers or line the seat with toilet paper, because we need to sit to empty fully.
- Limit or avoid caffeine. Now this can be a sad one for lots of people. Don’t get me wrong I like my cup of coffee in the morning but “caffeine is a bladder irritant” and can cause increased urgency and frequency. If you’re dealing with urinary urgency and frequency the first thing I would recommend is to cut out caffeine. If you absolutely cannot cut it out then for every cup of coffee that you drink, you should also have a cup or 2 of water to try to dilute the bladder irritant.
- Be gentle when you wipe. Our tissue down in there is delicate. Wipe front to back and potentially just dab to be even more gentle.
- “Don’t ignore the urge to go”. Our bladder communicates with our brain to tell it when our our bladder. This usually occurs every 2 to 4 hours. “Listen to your bladder”. When you feel that need to urinate and it’s been close to or over the 2 hour mark then go. If you are going more frequently than every 2 hours then you may be dealing with urinary urgency and frequency.
- Squeeze before you sneeze. When we have warning that a sneeze, a laugh or a cough is coming we want to pre-contract our pelvic floor to brace and prevent bladder leakage. To contract your pelvic floor, try to pucker around the anus or draw the vagina up and in. If you’re having through doing this or not sure that you are doing it right, then this is a great opportunity to connect a pelvic physical therapist to figure out how your pelvic floor muscles are working. We need the pelvic floor muscles to be on and ready to accept that extra pressure that is going to happen when we cough, laugh, or sneeze.
- When you finish peeing, rock side to side and back and forth on the toilet to funnel fluid down in the bladder to make sure that you are emptying completely. Rock ‘n’ roll on the toilet instead of trying push or strain to get that last a little bit of urine out.
- “Don’t Rush”. Sit down, “Relax and let your body do it’s thing”. Rushing can prevent completely empty your bladder fully. While sitting on the toilet take 5- 10 deep breaths to help everything empty out fully. If you have trouble slowing down try setting a timer on your phone for 1 minute to get you to sit for a little longer.
- Partner with a pelvic physical therapist. A pelvic physical therapist can help you evaluate your bladder habits and assess your pelvic floor muscle function. They can help you identify potential bladder problems and come up with a plan to address issues.
After reading these 10 tips for healthy bladder, how many are you practicing? Could your bladder use some healthier habits? We are here to help. Feel free to call us at 636-225-3649 to talk with one of Legacy Physical Therapy’s pelvic physical therapists to get your questions answered.
November is National Bladder Health Awareness Month. Earlier in the month we shared Ashley’s story about bladder leakage and her return to #LifeWithoutLeaks. Today, we are sharing our top 10 tips for healthy bladder.
10 Tips for Healthy Bladder
- Don’t strain or push to empty your bladder. Forcing urine out will put strain and stress on your pelvic floor and bladder.
- Drink more water. Limiting fluids actually irritates the bladder rather than helps it. Drink plenty of fluids (primarily water) throughout the day to stay hydrated and keep your bladder happy.
- Avoid the JIC or “just in case” pee. Going to the bathroom “just in case” can train your brain and bladder to think you need to urinate more frequently than you actually have to.
- Sit down on the toilet. Sitting all the way down on the toilet allows your pelvic floor muscles to fully relax improving your ability to empty your bladder.
- Limit or avoid caffeine. Caffeine can irritate your bladder causing increased urinary frequency or urgency.
- Dab, dab, dab. Our tissue “down there” is very delicate. Wiping front to back might make you feel clean and dry, but it’s abrasive and can be irritating to the tissue. Instead dab front to back.
- Don’t ignore your urge. Your bladder and brain communicate when the bladder is full and it’s time to urinate every 2-4 hours. Listen to your bladder (and brain). When you feel that sense to urinate (and it’s been at least 2 hours), then go!
- Squeeze before you sneeze. Don’t get caught off guard! Squeezing the pelvic floor muscles before you cough, laugh, or sneeze can minimize or eliminate leaks and dribbles.
- Rock and tilt on the toilet. Rocking your pelvis front, back, and side to side can help empty the bladder to get any last dribbles out.
- Don’t rush. Sit down, relax, and let your body do it’s thing. Rushing the process can prevent you from completely emptying your bladder.
We hope this helps you improve your bladder health! Here at Legacy Physical Therapy, helping people achieve and maintain healthy bladders is our specialty. If you are experiencing urinary leakage, frequent urination, and/or urinary urgency, feel free to give our office a call at 636-225-3649 to find out how we can help you.
Bladder leakage with exercise is NOT normal.
I had the opportunity to help a patient awhile back. Let’s call her Ashley. When I met Ashley, she told me her story, an all too common tale for many women. Here’s her story…
Ashley is a 31 year old mother of two kiddos under the age of 3. Her youngest was born 6 months prior to the time she came in to see me.
In the past, she exercised a few days per week varying her activity from walks around her neighborhood, to boot camp and strengthening classes at the gym, to the occasional run.
At 6 weeks postpartum, when she was cleared to return to exercise from her OB/GYN, she returned to regular walks pushing a double stroller. Her body felt pretty good overall.
At around 8 weeks postpartum, she returned to the gym for her first boot camp class. She realized quickly how little strength she had in her body, especially her abdomen. What startled her most was that she could not seem to do any jumping exercises without a trickle of urine coming out.
Ashley fully admitted she figured the leakage was a fluke- maybe she hadn’t emptied her bladder fully, or she drank too much water before class… but it wasn’t a fluke.
Ashley explained to me that her urinary leakage continued to happen every time she would jump during boot camp— jump squats, jumping jacks, even with mountain climbers. Then she noticed leaking urine when she would cough or sneeze. Her problem seemed to be getting worse, not better.
She was frustrated.
She couldn’t exercise like she wanted to, nor could she let out a cough or sneeze without fear she would pee herself. She eventually stopped going to boot camp classes and started wearing a pantyliner “just in case.”
Then one day, scrolling through social media, she read a post on how physical therapy could help with bladder issues. She figured it wouldn’t hurt to try. That’s when she called me at 6 months postpartum.
She told me her goal was to be free of leakage again— to not leak urine when she jumped, coughed, or sneezed. She wanted to return to bootcamp classes 2 times per week and potentially run a 5k in the future. She did not want to wear a pad every day. She did not want to feel limited by her bladder problems.
Ashley met with me for weekly appointments to start, then phased down to appointments every few weeks as she saw improvement in her urinary leakage. We worked together on focused strategies and exercises to target her specific problem areas.
By the end of our time together, she wasn’t leaking any longer with a cough or sneeze. Ashley had returned to boot camp classes without fear of bladder problems.
Ashley told me at her final visit, “I am so grateful that I found pelvic physical therapy. No woman should have to live in fear of her bladder. And I’m thankful I no longer have to.”
If you have a story similar to Ashley, we want you to know that you are not alone. 1 in 3 women will experience bladder leakage some time in their lifetime. You DO NOT need to live with it. Pelvic Physical Therapy can help. If you are experiencing bladder leakage with exercise, contact us at 636-225-3649 to set up a free discovery session to see if Pelvic Physical Therapy is right for you.
“Pelvic floor dysfunction, what’s that? I have never heard of pelvic floor dysfunction. Sure I have had a few kids, but I doubt that I have any pelvic issues. Pelvic issues only happen to little old ladies, not me”
Does this sound like what is running through your head right now? You are not alone. Many women suffer from pelvic floor dysfunction, but are unaware that the symptoms they are experiencing are related to their pelvic floor.
Have you ever experienced any of the follow?
- Bladder Leakage– Whether it be a small drop with a sneeze or a complete loss of urine while on the way to the restroom, bladder leakage is NOT NORMAL. However it is common. One in three women will experience bladder leakage in their lifetime.
- Urgency and Frequency– Do you know where all the bathrooms are in town? Do you urinate more than 7 times a day? Do you constantly feel like you need to pee? Are you getting up at night to pee? If you answered YES to any of these then you are probably dealing with urgency, frequency, and pelvic floor dysfunction.
- Fecal Incontinence– This can come in many forms: inability to control gas, staining or smearing on the underwear, fecal urgency, or complete loss of stool.
- Bladder pain or Burning with Urination– Many women think that they are dealing with frequent recurrent UTIs and subject themselves to countless rounds of anti-biotics only to have the symptoms not go away. The missing factor may be pelvic floor dysfunction.
- Constipation and/or Straining to Have Bowel Movement– We are designed to push to have a bowel movement, but not to strain. Our pelvic floor needs to relax appropriately to let the bowel movement pass We should be having regular bowel movements that are the consistency of soft log.
- Pain with Sex, Tampon Use, or Gynecological Examination– These things are not supposed to be painful. Too many women, “grin and bear it” thinking that pain with sex is just part of it. I am here to tell you that it is NOT!
- Vaginal Heaviness, Bulging, or Feeling of Falling Out– These symptoms are common signs of a pelvic organ prolapse, where one or more of the pelvic organs starts to push into the vaginal canal and cause these symptoms. TOO MANY WOMEN are told that these symptoms are normal after having children and they just need to live with it until the symptoms are bothersome enough that surgery is needed. This is NOT THE CASE for many women. By identifying and working to rehabilitate their pelvic floor dysfunction, many women can alleviate these symptoms.
- Low Back Pain, Abdominal Pain, or Pelvic Pain– Many women are surprised to learn that their low back pain may be caused by pelvic floor dysfunction. The pelvic floor is part of our core support system, so if it is not working appropriately then we can get extra stress and strain on our low back, abdominals, or hips.
- Difficulty Starting Urine Stream or a Hesitant Urine Stream– We were not designed to push to pee, but many women feel like they need to push to get the urine to come out.
- Inability to ‘Kegel’– A kegel exercise is the generic name for a pelvic floor muscle contraction. Contracting the pelvic floor prevents urine or feces from escaping. Research has shown that over 40% of women think they are doing a Kegel exercise correctly, but they are not.
If you answered YES to any of the above then you may have pelvic floor dysfunction. The National Institutes of Health found that pelvic floor disorders affect 10% of women ages 20-39; 27% of women ages 40-59, 37% of women ages 60-79 and nearly 50% of women over 80.
If you have experienced any of the 10 signs listed above you are a perfect candidate to explore the possibility of your pelvic floor being the cause or a contributing factor.
Remember there are treatment options for you! Don’t suffer and compromise your quality of life when the treatment is so easy! If you believe you or someone you know may be dealing with
pelvic floor dysfunction, call our office at 636-225-3649 and
we will help you determine your best treatment options.