A great strategy to protect a leaky bladder!
by Tus Jierasak, women's health physiotherapist
If you leak urine when you cough, sneeze, skip or run, you might be experiencing what is known as stress urinary incontinence. To understand why this happens, it is first important to know a bit about why.
Why does leaking happen?
Now the 'stress' in stress urinary incontinence is not referring to the stress that we all experience (work and commitments, bills, and the general cost of living in Sydney!). It actually refers to the downward pressure in your abdominal cavity onto your pelvic floor. With activities like coughing, sneezing and laughing, there is downward pressure from your abdominal cavity onto your pelvic floor, and it is often sudden.
Behind your urethra sits a wall of connective tissue (fascia). Every time you contract your pelvic floor, this tightens that wall of connective tissue. Most of the time to counteract downward abdominal pressure, your pelvic floor will automatically contract, and tighten the fascia behind your urethra so the urethra closes, and ta-da! No leaking.
But.... you might have had a cold or cough for a few weeks which has put a lot of downward load down on your pelvic floor, and weakened it so it now cannot provide enough support up against the downward pressure. And now you might have new symptoms of leaking with a cough or sneeze, when you previously never leaked. Or maybe your pelvic floor contraction is a bit slower and can't quite lift in time to counteract the downward pressure. There can be a lot of factors that contribute.
So what should I do to stop the leaks?
If you leak (or fear that you might) during activities such as sneezing, coughing or laughing, you should try "The Knack". This is a pre-emptive, fast and maximal pelvic floor contraction that you do right before coughing, sneezing, or laughing. So let's take a cough for example. Before you cough, you consciously engage in a fast, 100% pelvic floor contraction, and try to hold this throughout your cough. Have a go right now and test one. It might be a bit harder to hold during multiple coughs or sneezes, or sometimes one might catch you off hand, but the more you practice, the easier it will get, and the more automatic it will become.
But what about when you can't hold your pelvic floor lifted throughout, like running?
Our pelvic floor is designed to pre-emptively contract during the instant of cough, sneeze or laugh. However, it is not designed to lift and support constantly throughout an activity such as running or skipping where there is intermittent downward pressures on your pelvic floor. This is where us women's health physios come in, and might suggest something like a pessary for use during your exercise. A pessary is a little silicone device that comes different shapes, sizes and fits, and sit within the vagina (if fitted correctly, you shouldn't feel anything), and can do many wonderful things such as providing support for your pelvic organs. For stress urinary incontinence, we use special ones often with a knob that sits can sit against the back of your urethra and provides that firm backstop to prevent leaking.
If you do experience any leaking, come and have a chat with any of our women's health physios to find out more about what you can do, and for a personalised pelvic floor assessment to see exactly what is going on. Please know that leaking with activities is common but not normal, and not something you should have to put up with. Don't feel embarrassed-
contact us!