Bladder leaks are common in postpartum and menopausal women, but even occasional leaks are NOT normal.  Let me explain why…

It is estimated that bladder leaks in women affect every 1 in 4 to 1 in 2 women.  That’s an astounding 50% of all women in the US.  By some estimates that number may be undercounted due to the stigma associated with urinary incontinence.  

This very common, under-reported condition is often cited as the number one barrier to exercise, travel, and is strongly associated with low quality of life measures and depression.  As a pelvic health physical therapist, my clients are interested in how to NOT have this happen to them.  If you are nodding in agreement, this blog post is for you.

Why do bladder leaks happen?

Your pelvic floor muscles stretch from the front of your pelvis to your tailbone in the back, and these muscles work with your urethral sphincter to either relax and allow urine to flow out or to contract and hold back or delay the flow of urine.  

If these muscles become weak, either from childbirth, hormonal changes, lack of exercise, or some combination of all three, then you become susceptible to bladder leaks.  These leaks present in two different forms depending on the type of weakness you are experiencing in your muscles.

Why do I leak when I cough or sneeze?

One type of bladder leak is called stress urinary incontinence.  This problem occurs when there is an increase in inner abdominal pressure, as in the case of a cough, sneeze, or laugh and this pressure overwhelms your body’s ability to keep the urethra closed.   

When your body is unable to meet that pressure with closure strength, you get leakage.  If you get sick (an increase in coughing) or have a flair of your allergies (an increase in sneezing) it will make this problem worse. 

Why do I have difficulty making it to the toilet in time?

The other type of bladder leakage is called urge urinary incontinence.  This is associated with large bladder urges that come on suddenly and result in difficulty making it to the toilet in time.  This problem occurs when the strength of the muscles surrounding the urethra is not enough to maintain the urethral closure pressure when the bladder is filling.  

When this happens, urges become amplified and a wave of urgency will send you running to the toilet.  This type of bladder leak is often particularly distressing due to the sudden onset of the urgency, and the unpredictable nature of when it will come on.  The threat of this happening can be very restrictive, many of my ladies report feeling anxious at the mere thought of being caught away from a toilet.  

More strategies for controlling bladder urgency are available on the link here.

In either case, as a pelvic health physical therapist I often hear my clients state; I thought it was normal to have bladder leaks!

My response is NO, bladder leaks are common but NOT normal, and here’s why…

The muscles of the pelvic floor are striated just like the muscles in your neck, back, or surrounding your joints.  Because they are striated, they have the ability to change, become stronger and develop better coordination.  

This means your pelvic floor muscles have the ability to change, so just as you can strengthen your neck or back muscles to have better posture, you can strengthen your pelvic floor muscles to have better bladder control.  

How do I strengthen my pelvic floor muscles?

If you look at the anatomy of the pelvic floor muscles, there are two primary layers of muscles.  The first layer is the most superficial or the closest to the skin.  

This layer consists of a triangle that forms between the sit bones of the pelvis and circular muscles that surround the urinary and anal sphincters.  These circular muscles are like the muscles of your mouth, when they contract it closes.  

The second layer is the Levator Ani muscles that form a bowl at the bottom of the body.  These muscles are supportive for our pelvic organs and when they activate they lift upward, toward the center of our body.  

To do a pelvic floor muscle contraction properly you need to activate both layers of muscle, by closing and lifting, in that order.  

To get the muscle activation correct, I often suggest visualizing a ‘zipper’.  

A zipper on a pair of pants starts at the bottom and zips to the waistline. 

This is the movement sequence for the ‘close and lift’ technique as well.  The bottom of the zipper is the closure and the lift is the movement of the zipper upward to the level of the belly button. 

How long do I hold it for and how many should I do in a day?

There are two types of exercises for pelvic floor muscles.  The first is a quick muscle contraction, the second is endurance or sustained ten-second hold. 

• Quick muscle contractions utilize the closure and lift technique (zipper), with immediate relaxation afterward. 

• Endurance Holds involve closure and lift (zipper) technique but with a sustained hold for 10 seconds while you count out loud to ten.  

Counting out loud ensures that you are breathing while holding, which is important because breath-holding can generate pressure in the pelvis and potentially cause leakage.  

I recommend doing 10-15 of each type of exercise in various positions during the day.  Helpful positions include sitting, standing, and lying down.   

As in any exercise program, go slow and if you get tired, stop exercising and resume later.  The pelvic floor muscles are small and get tired easily, so gradually building strength is key!!!

Want even more specifics on pelvic floor exercises?  Check out my free printable available here.

Any other topics would you like to hear about?  Love to hear from you, post in the comments below!

Happy Bladder Wishes!

~ Tami

Interested in taking a deep dive into women’s health coaching?  Contact me to see if coaching is right for you!

Tami Lines is a licensed Physical Therapist with certifications in Pelvic Rehabilitation and Women’s Health Coaching.  She is the founder of Pelvic-Health-Matters.  Tami has over 15 years of experience with expertise in bladder Health, and pelvic floor muscle dysfunction for adolescent and adult women.  She is also a mom of two wonderful young adults working their way through college. 

References:

Lukacz, Emily S, Yahir Santiago-Lastra, Michael E Albo, and Linda Brubaker. 2017. “Urinary Incontinence in Women: A Review.” JAMA 318 (16): 1592–1604. doi:10.1001/jama.2017.12137.

Lukacz, E S, C Sampselle, M Gray, S Macdiarmid, M Rosenberg, P Ellsworth, and M H Palmer. 2011. “A Healthy Bladder: A Consensus Statement.” International Journal of Clinical Practice 65 (10): 1026–36. doi:10.1111/j.1742-1241.2011.02763.x.