The Cure for Stress Urinary Incontinence
Stress urinary incontinence is known as involuntary leaking of urine with activities that increase stress on the pelvic floor such as during coughing, sneezing, laughing, lifting, jumping, changing positions or exercising. It is the most common type of urinary incontinence as compared to urge incontinence (leaking with urinary urgency AKA overactive bladder) or mixed incontinence, a combination of the two.
Stress incontinence was primarily thought to be a pressure problem with increases in intra-abdominal pressure exceeding intra-urethral pressure or the strength of the pelvic floor muscles. Despite the advice you might have heard to "just do more Kegels", muscle tightness might also be to blame. The latest evidence is pointing to urethral squeeze pressure as a culprit. The circular muscle known as the external urethral sphincter is what contracts to squeeze the urethra and stop the flow of urine. The pudendal nerve, which consists of branches from sacral nerves 2-4, is the main innervation of the urethral sphincter and travels from the spine through the pelvis and hips in a path similar to the Cuyahoga River. Those of you who live in northeast Ohio know what I am talking about with our "crooked river." Because urethral squeeze pressure is known to decline by 10% each decade (sigh) and maximal urethral pressure is the strongest determinant for stress urinary incontinence, declining age is a risk factor. This might be due to declining estrogen levels or other factors like a history of adhesions or tight muscles that compress the pudendal nerve along its path anywhere from the sacrum to the pelvic floor.
Bladder leakage is not only a problem for older women and is more common in the last decade among nulliparous women (women who have never birthed a baby). It is estimated that 25% of women will have a pelvic floor disorder at some time during the lifespan. The majority of research between pelvic floor dysfunction and sports/exercise has focused on urinary incontinence and relaxing muscles, however far less is known about nonrelaxing pelvic floor dysfunction. In competitive athletes, the prevalence of stress incontinence across multiple studies ranges from 20% to 80% with volleyball considered the sport with the highest prevalence at 75.6%, followed by trampolining 72.7%-80%, indoor soccer 50%, cross country skiing 45.5%, running 44%, jumping 37.5%, basketball 34.8% and handball 20%. Jumping sports and activities have a rate of 37.5% which can include gymnastics, dancing and cheerleading. I could write a separate blog on Cross Fit athletes. Stress incontinence is underreported in many individuals due to embarrassment. Many studies also correlate the amount of time spent (dose dependent) in a sport or activity as a factor in stress incontinence and bladder leakage is reported more during training than during competition.
The good news is that an evaluation and treatment from a skilled pelvic floor therapist can address high muscle tone, adhesions, poor breathing habits and other risk factors. Stress urinary incontinence is one of the most common reasons someone seeks help at our clinic and is often accompanied by other muscle syndromes like hip stiffness, back pain, pelvic pain and even jaw tightness and TMJ dysfunction. A few months ago, we made a video for Instagram where I threw a physioball at Gina and she wasn't ready and it knocked her over. This is similar to what happens when a sneeze catches you off guard. If your muscles are not trained or prepared to catch the sneeze, your urethral sphincter might let go, causing a loss of urine when you did not expect it. We also shared on social media a few months ago how pelvic floor health can be life saving. Since pelvic health concerns are a barrier to exercise for 50% of postmenopausal women and exercise reduces the risk of death from cardiovascular causes, having a pelvic floor issue can be bad for your health. Movement is medicine and the ability to exercise is a large factor in determining your well-being and longevity.
So how can you combat stress incontinence without surgery or expensive pads or medications that have unpleasant side effects like dry mouth, constipation, memory loss and more?
Here are some of our top TIPS to reduce stress incontinence caused by pelvic floor dysfunction:
Check in regularly with your pelvic floor muscles. Are your muscles tight? Is your urine spraying? Do you have downward pressure? Do you feel you are emptying your bladder completely? Do you have pain when you sit? Do you have pain with intercourse? These are some of the signs your pelvic floor has too much tone or that the pudendal nerve is being compressed.
Be more mindful of your breath and the state of your nervous system. Are you holding your breath a lot? Regular breath holding keeps the diaphragm from moving through its full excursion which affects the pelvic floor since they move together like a piston. For more information on strengthening vagus nerve tone and function, the most important regulator of nervous system health, read our blog here.
Bend backwards when sneezing or coughing. This lessens the slack of the pelvic floor making it taut, similar to holding your hand over your pelvic floor, but more socially appropriate. Just like hinging at your hips and bringing your knees to your chest to relax the pelvic floor (think Squatty Potty), the opposite can tighten the pelvic floor.
Avoid constipation and poor gut health. Gas and bloating can make the pelvic floor tight as you attempt to hold in gas during the day. Straining to eliminate can contribute to outlet constipation, where the pelvic floor muscles tighten instead of relax. In addition, the health of organs contributes to the state of the muscles and connective tissue overlying it due to the viscerosomatic reflex.
If you try these tips and continue to have involuntary leaking with activities and especially if it limits your ability to exercise, it might be time to seek the help of a pelvic floor therapist who can evaluate WHY you are having this issue. Our expert doctorate-level physical therapists take a full-body approach and get to the bottom of your bladder dysfunction. Click here to schedule a FREE virtual consultation with one of our pelvic floor therapists so you can get back to physical activity and doing what you love.
Pires T, Pires P, Moreira H, Viana R. Prevalence of Urinary Incontinence in High-Impact Sports: A Systematic Review and Meta-Analysis. Journal of Human Kinetics. July 2020.
Louis-Charles, Kaina MPH; Biggie, Kristen MD; Wolfinbarger, Ainsly; Wilcox, Becky PT, MPT, PRPC; Kienstra, Carolyn M. MD. Pelvic Floor Dysfunction in the Female Athlete. Current Sports Medicine Reports. February 2019; 18 (2): 49-52.
Hallam, Taryn "Stress Incontinence: Pelvic Floor and Urethral Considerations in Rehabilitation". Pelvicon, 9 Sept. 2023, Atlanta, GA.
written by Janine Laughlin, PT - January 2024