Pelvic Floor Physical Therapy
Seeing a physical therapist can help to ensure that the pelvic floor muscles are working properly and are strong enough either to inhibit leakage or to calm the bladder to resist an urge, Dr. Pulliam says. Along with this more formal training, at-home Kegel exercises can also help strengthen the pelvic floor muscles.
What Causes Bladder Leakage In Women
The three types of urinary incontinence and main causes of bladder leaking are:
- Stress incontinence
- Urge incontinence
- Overflow incontinence
Stress incontinence is the most common cause of bladder leakage in women and is the result of a weakened pelvic floor. The pelvic floor is the system of muscles and ligaments that form a basket of support for your bladder and uterus. The pelvic floor helps regulate the urinary sphincter, which controls the flow of urine out of the bladder. The pelvic floor can be weakened by life events such as pregnancy, childbirth or being overweight. Once weakened, any pressure â or stress â placed on the pelvic floor causes a small amount of urine to leave the bladder. This can be from coughing, laughing, sneezing, exercising or lifting objects.
Urge incontinence , also known as overactive bladder or OAB, is the result of nerve damage to the nerves in and around the bladder, either as a result of a neurological disease like multiple sclerosis or Parkinsonâs or due to previous pelvic surgery or injury. This nerve damage means that the nerves and muscles in your bladder spasm and fire off too often, sending you on a mad dash to the bathroom. This means that your bladder signals that itâs time to go even when itâs not full. The urge to urinate then comes on suddenly and intensely, to the point that you often may not make it to the toilet in time to urinate.
Causes Of Stress Incontinence
Every person has unique triggers when it comes to stress incontinence, but Lindsey says all of them are rooted in your intra-abdominal pressure system. Every single time you breathe , your diaphragm expands, putting pressure on everything that sits beneath it in your body. Theoretically, your pelvic floor muscles should always rise to the occasion by keeping your insides buoyed and protected.
If you leak when you sneeze or cough, it means your pelvic floor muscles arent strong enough to consistently withstand the pressure from your diaphragm. This pressure system also explains why you might not *always* leak when you cough or sneeze. Stress incontinence can depend on the intensity of your breath , how many times in a row you cough or sneeze, or how long youve been enduring triggers. No matter the intensity, there are a few different ways to deal with stress incontinence when it happens.
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Quick Read Leaky Bladder Is Common
- Around 25% to 45% of women will experience leaky bladder.
- Many dont seek treatment out of embarrassment.
- Leaky bladder is often caused by a weak pelvic floor.
- It can also happen because of pregnancy and childbirth.
- A physical therapist can help by building up pelvic floor strength.
I remember the first time I sneezed and peed a little while six months pregnant. Whats happening to me? I wondered, horrified.
Id thought that urinary incontinence, the medical term for a leaky bladder, was something women mostly experienced in their senior years. But there I was, age 29, peeing a little every time I coughed, sneezed or laughed. Was it normal?
As it turns out, leaky bladder is common both during pregnancy and during other times in your life, too.
Dr. Anna Kirby, an OB-GYN and a urogynecologist at UW Medicine, says that 25% to 45% of women will experience some kind of urinary incontinence over the course of their lives, which makes for nearly half of us.
She says the likelihood of incontinence increases with age, but it can happen for a number of reasons not just pregnancy and it often makes women feel so ashamed that they dont tell anyone.
Less than 50% of women with significant symptoms seek treatment, she says.
Diet And Exercise Can Help Stop Bladder Leakage
After an initial evaluation with your healthcare provider, youll receive a treatment plan to follow at home. Recommended therapies may include dietary changes, pelvic floor exercises and/or medication.
For those with urge incontinence, tweaking your diet can help reduce urge incontinence. For example, you might need to scale back on caffeine since the stimulant can sensitize your bladder and increase your urge to urinate. Other foods like milk, tomatoes, avocados and certain fruits can stimulate your urinary tract in a similar way, too.
Often, you can also reduce incontinence with pelvic floor physical therapy. Your first session includes an internal and external assessment of the alignment, flexibility and muscle tone in your pelvic area. Based on that exam, your therapist creates an exercise program and goals for you to work on.
Pelvic exercises increase your range of motion and muscle strength. Your therapist may also use biofeedback, an electronic monitoring tool that shows how much pressure or contraction you can generate with your pelvic floor.
The best part about getting medical treatment for bladder leakage? You can see significant improvement in three to four months, Eutsler said.
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Urinary Incontinence Bladder Control Issues More Common Than You Think
One in 4 women over age 18 experience episodes of urinary incontinence, according to the National Association for Continence. In addition to physical discomfort, women experience emotional pain and embarrassment, isolation and fear of ridicule that often prevent them from seeking treatment. On average, a woman will live with incontinence for more than six years before seeking medical advice, due to embarrassment or believing myths such as incontinence is just a part of aging or being a woman or its brought on from sexual activity or drinking too much water.
Think of a womans pelvic floor muscle like a trampoline, said Sarah M. Kane, M.D., urogynecologist with Norton Urogynocology Center. Sometimes the muscles wear out through a lifetime of activity, including heavy lifting, chronic coughing, constipation and childbirth. If the muscles of the pelvic floor and urethra are weak, this can allow leaking.
Chances of weakened pelvic muscles increase with subsequent pregnancies, and theres also evidence of a genetic predisposition to incontinence issues. Other risk factors for stress incontinence include obesity and previous gynecologic surgery such as hysterectomy.
Stress Urinary Incontinence: Women Vs Men
Women are more likely to have SUI than men. More than 15% of adult women experience it. About 77% of those call it bothersome while nearly 29% say its moderate to severe.
SUI increases with age, particularly during menopause. One study found that roughly 41% of women over age 40 develop urinary incontinence and up to 77% of elderly women in nursing homes live with some form of it .
Men also experience SUI, but not as often. Having the prostate gland removed increases the likelihood. Damage or changes to the nerves, sphincter, or pelvic floor can also lead to SUI in men .
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What Are The Symptoms Of Stress Incontinence
The main symptom of stress incontinence is a leakage of urine at times of physical movement or activity. Examples of the kinds of activities associated with urine leaking include laughing, coughing, lifting, or exercise. The leakage may be as little as a drop or two, or may be a “squirt,” or even a stream of urine.
What Are Stress Incontinence Symptoms
Leaking urine when theres pressure on your bladder is the top sign of stress incontinence. Mild stress incontinence may cause you to leak drops of urine during activities like heavy exercise, laughing, coughing or sneezing.
With moderate to severe stress incontinence, you may leak more than a tablespoon of urine even during less strenuous activities like standing up or bending over. You may even leak urine while having sex.
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Get The Right Treatment For You
Seeking help for stress urinary incontinence is important. Not only is the condition physically distressing, but there are also emotional consequences. Avoiding the condition is not the solution. Speak with an OB/GYN right away. After an assessment, the doctor can put together a plan to make sneezing a bit more comfortable.
How To Treat Stress Incontinence
Sudden loss of urine can be described in varying degrees, such as leaking, dripping, or flooding. How much incontinence affects you can help guide your treatment decisions.
Some recommended tactics include pelvic floor muscle exercises , along with lifestyle and behavioral changes. If these arent enough, medical approaches can be used to help prevent urine leakage .
Which therapy works best for you depends on whats causing your incontinence and the severity of it. The following are typically incorporated into an overall SUI treatment plan.
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Lower Urinary Tract Symptoms
The lower urinary tract includes the bladder and the tube that urine passes through as it leaves the body .
Lower urinary tract symptoms are common as people get older.
They can include:
- problems with storing urine, such as an urgent or frequent need to pass urine or feeling like you need to go again straight after you’ve just been
- problems with passing urine, such as a slow stream of urine, straining to pass urine, or stopping and starting as you pass urine
- problems after you’ve passed urine, such as feeling that you’ve not completely emptied your bladder or passing a few drops of urine after you think you’ve finished
Experiencing LUTS can make urinary incontinence more likely.
Page last reviewed: 07 November 2019 Next review due: 07 November 2022
What Else Causes Bladder Control Problems In Women
- pregnancy and childbirth
Weak pelvic floor muscles can make it hard for your bladder to hold urine in during stress incontinence. Stress incontinence occurs when an actioncoughing, sneezing, laughing, or physical activityputs pressure on your bladder and causes urine to leak. A weak pelvic floor can also cause fecal incontinence, or bowel control problems.
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Do I Damage My Pelvic Floor When I Cough
Chronic coughing and sneezing can lead to a damaged pelvic floor over time. However, if your pelvic floor is already weakened, you may already present symptoms such as urinary incontinence, in the form of sudden leakage when coughing or sneezing. This can be both a perplexing and embarrassing experience for women. A sneeze can happen anywhere and at any time, but no one wants to live in constant fear of peeing themselves in public. That, or having to wear a pad or diaper as a preventative measure.
When you cough or sneeze, the heavy feeling in the vagina or urinary leakage, occurs due to the sudden abdominal pressure that is exerted and directed towards your pelvic area through the diaphragm and abdominal muscles.
First of all, this is not your fault, and you are not doing anything wrong. The movement of pressure is the natural movement of the muscles before sneezing, coughing, or lifting weight. It can also occur when you vomit or have nausea.
The problem is, that the pelvic floor may be weak, and receiving this pressure, only weakens it further. Therefore, it is important that this area receives minimal impact during these bouts of sudden pressure.
Tests For Stress Incontinence
Some tests can help determine whats going on, she says. I will ask, do you leak when you cough, sneeze or exert yourself?’ she says.
If the answer is yes to any of these questions, it puts you in the stress urinary incontinence realm.
Your doctor will conduct a physical exam with a focus on the organs in your pelvic floor.
Other tests involve coughing or bearing down with a full bladder. This is the cough stress test and helps identify leakage on exam, Dr. Laudano says.
Pad tests may be recommended to see if you leak when you move around. There are two types: a one-hour test and the 24-hour test. After the test, the pad is removed and weighed to see how much urine leaked.
Other tests may help rule out any other potential causes of the leaking, including a urinalysis check for a urinary tract infection or blood in the urine or a bladder scan, Dr. Laudano explains.
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How To Talk To Your Doctor About Bladder Leaks
How do you bring up urinary incontinence to your doctor? And what do you say? Hereâs a helpful guide to get the conversation going!
An easy way to begin the conversation is describing the bladder issues you are experiencing. For example, you could start by saying, âI pee a little when I laugh or cough,â or, âI wake up with wet sheets,â or even simply, âMy bladder leaks.â
Every healthcare professional will tell you that the more information, the better. A good diagnosis depends largely on the information you can give your doctor when you talk. The questions listed below can help facilitate a productive conversation about your sensitive bladder with your doctor that will allow you to start discussing next steps.
- When do you experience urinary losses?
- How often do you urinate each day?
- How often do you get up during the night to use the restroom?
- How much liquid do you drink daily?
- Do you experience unexpected leaks? Do you leak when you sneeze, cough or exercise?
- Do bladder leaks prevent you from participating at work or in your social life?
Your healthcare professional may also decide to perform a physical examination. They may be looking to inspect the way your abdomen contracts. They may also check the firmness of your pelvic floor when you cough.
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Leaking Urine During Pregnancy: Causes And Coping Methods
Leaking urine is a common hazard for many pregnant women. However, the problem is worse for some than others. Urinary incontinence or involuntary passage of some urine happens occasionally in many women, and more frequently in others. A womans body mass index and age are some of the known risk factors of incontinence during pregnancy.
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If You Experience Bladder Control Issues You Dont Have To Just Live With Leakage
Story by: Sara Thompson on May 27, 2022
Bladder control, bladder incontinence, urinary incontinence, peeing when coughing whatever you might call it, its an issue that affects many women. Its not just a change of life or aging issue urinary leakage affects women of all ages. There is a certain stigma to it that keeps many women from getting treatment. However, there is help for the condition, which sometimes is corrected through treatment with a urogynecology specialist.
What Are Stress Incontinence Treatments For Women
Stress incontinence treatments for women include:
- Vaginal estrogen creams, gels, rings or patches that strengthen vaginal muscles and tissues after menopause.
- Insertable vaginal pessary devices that support the bladder and urethra.
- Urethral injections to temporarily bulk up the urethral muscle and keep the sphincter closed.
- Surgery to place a sling made of your tissue, donor tissue or surgical mesh under the urethra to support it.
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All About Stress Urinary Incontinence
Urinary incontinence is the involuntary release of urine, often due to a loss of bladder control. The pelvic floor and bladder muscles hold the bladder in place. When the bladder fills, the brain sends signals to the muscles to contract and expel the urine. If the muscles are too weak, urine can escape with a cough, sneeze, lifting, or physical exercise. This is known as stress incontinence. Some people with stress incontinence will also have an overactive bladder, or needing to go to the bathroom frequently.
Medical Devices For Urinary Incontinence
Devices which are designed to treat women with the incontinence which include:
Urethral insert, which is a small, tampon-like disposable device which is inserted into the urethra before a specific activity, like tennis which can trigger the incontinence. The insert acts as a plug to prevent leakage and is removed before the urination.
A pessary is a stiff ring which is inserted into the vagina and wear all time. This device is typically used in someone who has a prolapse which is causing incontinence. The pessary helps to hold up the bladder which lies near the vagina and to prevent urine leakage.
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Why Does My Bladder Leak When I Sneeze
For those new to or frequently experiencing a loss of urine when you sneeze, cough or exercise, it may be a perplexing issue. Why does my bladder leak? Do I have a problem with my bladder? What do I do?
Why We Leak?
To help you better understand what is happening down there wed like you to think of your anatomy as a water balloon. The body of the balloon is your bladder, the spout is your urethra, and the knot that keeps the water from escaping represents your pelvic floor muscles.
Over time, the knot of the balloon begins to slacken and loses its ability to hold water in when pressure is applied to the body of the balloon. The same can be said about a womans anatomy. As you age and your body undergoes pregnancy or menopause, your pelvic floor muscles lose their ability to hold urine in when force is applied to the bladder during activities such as laughing, sneezing, or running.
This animation shows what happens to an incontinent womans bladder when she sneezes:
Stress Urinary Incontinence: Name it to Tame it
Unfortunately, most of these women wont talk about their bladder leakage because of feelings of embarrassment and shame. As a result, treatment is often not sought until about two years after symptoms first appear. Using period pads or pretending that it wont happen only makes the mental part of stress urinary incontinence worse.
Taking Action Against Bladder Leaks:
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