We wanted to share a story today of a patient that was sick and tired of dealing with leakage and came to us here at Legacy Physical Therapy for treatment. We are hoping that this can help anyone having relatable issues to have a good understanding of how therapy intervenes and can help you!
We are going to start with one of my patient’s, we’ll call her Jennifer:
Her main complaint was bladder leakage during her workouts. She was in her early 30s. She had two children who were 6 and 4 years old, both uncomplicated vaginal deliveries with minimal tearing. She did not have any issues early postpartum.
Soon after her first child was born, she didn’t have any concerns or symptoms with her bladder. Around 6 months postpartum, she started exercising to get back into shape. She was doing a variety of workouts including strength training and a little bit of running.
She started noticing bladder leakage happening during her workouts. She reported jumping jacks were an issue and she started leaking while running. Then, she noticed leakage while sneezing or coughing. She did what most people do and dealt with the symptoms. She continued to workout, then became pregnant with her second child. She modified some things, but kept leaking, especially with coughing or sneezing, all through the pregnancy.
After her second uncomplicated vaginal delivery, at about 3 months postpartum, she was ready to “get her body back.” She started exercising again and noticed a lot more leakage. It required her to start wearing pads and panty liners during workouts. She also told me that she would avoid wearing light colored pants when she was going to the gym because she feared that if she leaked bad enough, it would show on her clothing. She started to get really frustrated. She wasn’t able to work out like she wanted and she couldn’t wear all the cute leggings she had and was stuck wearing black all of the time.
When I began treating her, she was 4 years postpartum. She had been dealing with bladder leakage for a long time. Her workouts were getting more intense because overall, she was getting healthier and stronger, but her pelvic floor wasn’t supporting her enough during these workouts, causing leakage.
Her main goal was that she didn’t want to leak anymore during exercise, especially when she did jumping activities such as jumping jacks, high knees, box jumps, forward jumps.She was tired of wearing pads everyday.
Jennifer had told me that she had been working on Kegels (exercises of the pelvic floor muscles) and didn’t understand why she wasn’t getting better. We hear this a lot from women, that they have been doing Kegels but symptoms aren’t improving. When I assessed her pelvic floor muscles, they were actually pretty strong, not weak. This is not uncommon.
What I did notice on her examination was during a cough, Jennifer would push all of her pressure downward onto her bladder and pelvic floor muscles. Her pelvic floor muscles would actually release and open and stretch when she coughed versus staying closed and supported. Her muscles were working the wrong way, they were not coordinated. A lot of women that present this way have stress incontinence or loss of urine during a cough, sneeze, laugh, jump or other exercise. Her pelvic floor wasn’t weak, it just wasn’t moving in the right direction to help support the cough, the jump, and the sneeze.
The other thing I noticed is that she held her breath a lot. When I had her contract her pelvic floor muscles (Kegel), she would hold her breath. When I had her engage her abdominals, she would hold her breath. Breath holding will push pressure downward on the pelvic floor muscles causing more load. For Jennifer, her pelvic floor wasn’t activating when it should and wasn’t coordinating with her breath.
When we started retraining her pelvic floor muscles it was focused on strategy training. We focused on how to breath and activate your pelvic floor muscles while performing a cough, sneeze, jump, or during a high load or high intensity activity. She started to give her pelvic floor muscles and pelvic cavity every opportunity to support the demand that was put on her and she did fantastic.
Once we retrained her breath strategy and coordination, her leakage improved. With her case, it shows that constant repetitive isolated strengthening of the pelvic floor may work for some, but it does not work for all. Strength training to the pelvic floor is important, but there are different aspects of treatment that are important and everyone is individualized in what they need.
When I followed up with her about a month after working together, she was still doing really well. She was still managing her leakage really well and she was pleased with her overall progress.
If you’re experiencing any of the symptoms like Jennifer experienced, or have tried Kegels without success, it’s time to partner with a pelvic physical therapist that can see exactly how you are moving or activating different parts of your core system.
A pelvic physical therapist can help you unveil why you’re leaking and help you come up with a good way of moving differently or using a different strategy to minimize the leakage. It doesn’t matter whether you are 6 months or 16 years postpartum, or experiencing bladder leakage because of childbirth, pelvic physical therapy can help, reach out to us today: