By Dr. Sneha Gazi PT, DPT – snehaphysicaltherapy.com   “Peeing”

My Story.

Fully admitting this to the world today… I used to pee my pants as a kid when I laughed too hard. My friends and family made it a joke (they still do… ugh!). 

And then, in college, I would have the strongest urge to pee, and sometimes leaked, every time I entered the elevator of my NYU Union Square dorm. My roommates knew when I stepped through the door that they better get out of my way or I’d pee my pants! 

I didn’t know why and if it happened to others as well. There would be times when it was worse and times when it was better. Only when I started my life as a physical therapist and learnt about the pelvic floor did I get a chance to fix it once and for all. 

What I experienced as a child was called stress urinary incontinence (stress UI). Basically this means that a physical “stress” to the body (like coughing, laughing, jumping, running) causes leaking. What I experienced later was called urge urinary incontinence. This is frequently referred to as the “key-in-the door” phenomenon where you link a specific place/smell/action/sight/sound to leaking. Having both types is referred to as mixed urinary incontinence. 

Having gone through both has made me a better clinician to treat urinary incontinence (UI). Today I treat men, women, and children with all forms of bladder issues, including bladder prolapse (cystocele), painful bladder (interstitial cystitis), overactive bladder, incomplete bladder emptying, urethral pain, and more. 

Here, I focus specifically on stress urinary incontinence – why it happens and what you can do.

Why do I leak?

UI in general is present in 25-45% of the population and is three times more likely to occur in females than males. Stress UI is the most common type of the three forms of UI across all age groups. Not surprisingly, vaginal delivery increases your chances of leaking, with 35-67% of women having UI during pregnancy. Also, urinary tract infections, constipation, genetics, age, and obesity can increase the risk. 

It’s clear that some factors, such as age and genetics, we cannot control. With age, we naturally lose muscle mass, the very muscles that serve a huge supportive role in the pelvic floor. Generally speaking, weakness in the pelvic floor muscles is a prime factor for stress UI. The heavier we are, due to obesity or pregnancy, the more pressure we exert on our pelvic floor. This stretches the muscles and weakens their supportive function. If you are constipated, you may be straining and pushing on the toilet, which can further lengthen the tissues of the pelvic floor. Refer to our second blog post for more on how you can help constipation. 

What can I do about it?

Young female athletes to elderly men with prostate dysfunction experience stress UI. Whether you plan to get pregnant or not, we are all going to age. So strengthening the muscles of the pelvic floor is relevant regardless of age or sex. 

As a general rule of thumb, you should always check with your pelvic floor physical therapist on whether you are strengthening your pelvic floor muscles correctly or not. Many times, I will have to retrain people’s pelvic floor muscles, because, while they might think they are doing a pelvic floor contraction (AKA a “kegel,”) they are actually squeezing their inner thighs or glutes. Once you learn how to do this, it’s great practice to perform 3 sets of 12 kegels, 3-4x/week. Remember, both men and women have pelvic floor muscles, so strengthening is equally important to both. 

It’s also great to contract your pelvic floor muscles before and during a cough or sneeze to prevent unwanted leaking. 

Last Thoughts.

Incontinence can strongly interfere with your life. Some of my patients will admit that they don’t drink half as much water as they should because of their peeing issues. Don’t even get me started on how harmful lack of water intake is (a blog for another day!). Other patients will admit how embarrassing it is to take multiple bathroom breaks during long car rides because of their incontinence. In addition, studies have shown that stress UI can hinder people from wanting regular physical exercise due to fear of leaking. 

Women who have given vaginal birth(s) and have had UTIs in the past should be mindful. If they don’t already experience stress UI, they should take preventative measures sooner than later.

The bottom line is, when it comes to stress UI, there is a lot you can do about it. Seeing a pelvic floor physical therapist has proven benefits to help you decrease leaking and improve the overall quality of your life. Speaking from personal experience, incorporating pelvic floor work in my daily exercise routine has put away any thought of UI for me!

There it is folks – our second post in our 3-Part Pelvic Series on Peeing! Coming up next week are issues people face with… PROCREATION.

References:

  • Mannion CA, Vinturache AE, McDonald SW, Tough SC.The Influence of Back Pain and Urinary Incontinence on Daily Tasks of Mothers at 12 Months Postpartum. Plos One. 2015; 1-18.  
  • Milsom & M. Gyhagen. The prevalence of urinary incontinence. Climacteric. 2018; 1-6.
  • Mørkved S, Bø K. Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: a systematic review. Br J Sports Med. 2014; 48:299–310.
  • Wesnes SL & Lose G. Preventing urinary incontinence during pregnancy and postpartum: a review. Int Urogynecol J. 2013; 24:889–899.

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