Why Do I Have Urinary Leakage?

Your pelvic floor serves as a vital support system for your pelvic organs. However, research reveals that a significant number of women experience hypertonicity in their pelvic floor muscles, characterized by a contracted and shortened position.

Consider your pelvic floor as you would a trampoline—it must possess the capacity to dynamically lengthen and contract to effectively support your organs, much like a trampoline flexes and rebounds.

Contrary to popular belief, experiencing leakage doesn't necessarily signify weakness. The misconception that strengthening alone can alleviate the issue overlooks a critical aspect: the need for lengthening. Merely focusing on "strengthening" by further shortening already contracted muscles can disrupt motor control and hinder the coordination of relaxation and contraction. Hence, the indiscriminate practice of Kegels may exacerbate symptoms rather than resolve them.

When was the last time you consciously worked on lengthening your pelvic floor? Have you ever received advice to prioritize lengthening over strengthening? The analogy of a bent elbow illustrates this concept aptly: just as a bent elbow struggles to pick up objects without first straightening, a shortened pelvic floor lacks the space to effectively contract further to support the bladder, resulting in leakage.

Pelvic floor hypertonicity (PFH) is prevalent and associated with various urological, gynecological, gastrointestinal, and sexual issues, along with chronic pelvic pain. Despite its high prevalence, Kegels alone aren't the “Gold Standard” for pelvic floor dysfunction. Instead, they risk exacerbating the condition by further shortening an already compromised muscle group, leading to failure.

Having a shortened muscle doesn't necessarily equate to strength. To effectively strengthen a muscle group like the pelvic floor, we must first focus on facilitating its full range of motion through dynamic movements. Despite their small size, the muscle fibers in the pelvic floor are incredibly powerful, akin to those found in your hamstrings.

Moreover, hormonal imbalances, particularly a reduction in estrogen, can contribute to urinary leakage by causing rigidity in the urethra and pelvic floor atrophy. Understanding the root cause of your leakage is essential for effective treatment. Therefore, it's highly recommended to consult with a pelvic floor physical therapist for a personalized assessment and targeted treatment plan tailored to address your specific symptoms. By addressing the underlying issues, you can take proactive steps towards achieving long-term relief and pelvic floor health.

In addressing pelvic floor dysfunction, it's crucial to shift the focus from exclusively strengthening to incorporating techniques that promote both lengthening and strengthening. By understanding and prioritizing the need for balanced muscle function, we can better manage and prevent pelvic floor issues, restoring comfort and confidence.

Learn the 3 Types of Urinary Leakage:

• Stress Urinary Incontinence (SUI):

  Stress urinary incontinence (SUI) is a common type of urinary incontinence characterized by the involuntary leakage of urine during physical activities that exert pressure on the bladder or pelvic floor. These activities may include coughing, sneezing, laughing, lifting heavy objects, or even just standing up. Unlike urgency urinary incontinence, which is caused by bladder muscle contractions, SUI occurs due to weakened or damaged muscles and tissues that support the bladder and urethra.

  Examples: Coughing, sneezing, laughing, and jumping.

• Urgency Urinary Incontinence (UUI):

  Urgency urinary incontinence (UUI) is a type of urinary incontinence characterized by a sudden and strong urge to urinate, followed by an involuntary loss of urine. This condition often occurs unexpectedly and can significantly impact a person's quality of life.

  The key feature of UUI is the sense of urgency, where the individual feels a sudden and compelling need to urinate that is difficult to control. This urgency can be triggered by various factors such as hearing running water, touching water, or simply the thought of using the restroom.

  UUI is typically caused by an overactive bladder (OAB), which is a condition characterized by abnormal contractions of the bladder muscle. These contractions can occur involuntarily, leading to the sudden urge to urinate even when the bladder is not full.

  Examples: Running water, walking through a doorway, or putting your keys in a door

• Mixed Urinary Incontinence (MUI):

  Mixed Urinary Incontinence (MUI): Mixed urinary incontinence combines features of both SUI and UUI, where individuals may experience leakage due to both physical activity and sudden urges. This combination often presents challenges in diagnosis and management, as it requires addressing both the weakened or tight pelvic floor muscles and the overactive bladder contractions simultaneously. Factors contributing to MUI can vary widely and may include a combination of pregnancy, aging, neurological conditions, or hormonal imbalances.

  While urinary leakage can significantly impact one's quality of life, understanding the distinctions between stress urinary incontinence, urgency urinary incontinence, and mixed urinary incontinence is essential for effective management and treatment. By recognizing the underlying causes and symptoms associated with each type, individuals can work with healthcare professionals to develop personalized strategies to regain bladder control and improve overall well-being. Stay tuned for our upcoming blogs, where we'll delve deeper into each type of urinary leakage and explore treatment options in detail.

Stop Leakage By Starting HERE.

Understanding proper breathing techniques is paramount in addressing pelvic floor hypertonicity and promoting relaxation within the central nervous system.

Let's start with belly breathing, also known as diaphragmatic breathing, which is a foundational practice. Rather than the commonly demonstrated method of breathing upward, belly breathing allows the diaphragm to descend, enabling the lungs to fully expand. Contrary to societal norms dictating that we should suck in our stomachs to appear slimmer, this action inhibits diaphragmatic breathing and increases tension in the pelvic floor.

Ever heard of the vagus nerve? It serves as a counterbalance to the body's "fight or flight" response, inducing a relaxation response. Guess what activates the vagus nerve? You got it—diaphragmatic breathing. This explains why practices like meditation and yoga often incorporate this technique to soothe the central nervous system, bringing about a sense of calm. Hence, the familiar advice to "just breathe" in moments of panic.

But how does this relate to leakage? Picture this: with a deep inhalation, your belly expands, prompting relaxation in the pelvic floor. As you exhale, engage your pelvic floor and abdominal muscles, as though you're zipping up a zipper.

Now, imagine the onset of a sneeze. Inhale deeply, allowing your belly to expand and your pelvic floor to relax. As the sneeze approaches, brace your pelvic floor and abdominals, supporting your organs to release the sneeze fully, rather than holding it in to minimize intra-abdominal pressure. Here, the analogy of the trampoline relaxing and contracting comes to life.

This is merely scratching the surface! Consult a pelvic floor physical therapist to delve deeper into the causes and treatments for your specific type of leakage. Remember, there is hope, and you need not rely on pads or liners. Leakage may be common, but it is not normal, and with the right approach, it is entirely treatable!

COZEAN PELVIC DYSFUNCTION Screening Tool

Instructions: Check all that apply:

1. I sometimes have pelvic pain (in genitals, perineum, pubic or bladder area, or pain with urination) that exceeds a "3" on a 1-10 pain scale, with 10 being the worst pain imaginable.

2. I can remember falling onto my tailbone, lower back, or buttocks (even in childhood).

3. I sometimes experience one or more of the following urinary symptoms: Accidental loss of urine. Feeling unable to completely empty my bladder. Having to void within a few minutes of a previous void. Pain or burning with urination. Difficulty starting or frequent stopping/starting of urine stream.

4. I often or occasionally have to get up to urinate two or more times at night.

5. I sometimes have a feeling of increased pelvic pressure or the sensation of my pelvic organs slipping down or falling out.

6. I have a history of pain in my low back, hip, groin, or tailbone or have had sciatica.

7. I sometimes experience one or more of the following bowel symptoms: Loss of bowel control. Feeling unable to completely empty my bowels. Straining or pain with a bowel movement. Difficulty initiating a bowel movement.

8. I sometimes experience pain or discomfort with sexual activity or intercourse.

9. Sexual activity increases one or more of my other symptoms.

10. Prolonged sitting increases my symptoms.

**IF YOU CHECKED 3 OR MORE BOXES, PELVIC FLOOR DYSFUNCTION IS LIKELY. CONSIDER TALKING TO A PELVIC HEALTH PHYSICAL THERAPIST

Warrior Physical Therapy LLC

Screening Tool Created By: Nicole Cozean, PT, DPT, WCS, CSCS