“I just leak a little”: Why Leaking isn’t Normal
Urinary incontinence is defined as the involuntary leakage of urine. It is not normal but it sure is common. Studies show the prevalence anywhere from 25-45% of women experiencing this and the prevalence tends to increase with age. “Well, I had a baby that’s normal right??” Nope! Although pregnancy and birth are risk factors for developing urinary incontinence, there are plenty of women (and girls) out there experiencing a trickle down their leg with coughing, jumping, sneezing. But there’s different types of incontinence–let’s break it down…
Urinary incontinence can be broken down into stress incontinence–leaking urine that occurs when a stress or force is happening like coughing, jumping, sneezing. Then urge incontinence–leaking urine because you were bee-lining it to the bathroom but didn’t make it there on time. Or you can have mixed where you are experiencing a combination of both. So why does this happen?
For many women, they start experiencing this after pregnancy and birth. Pregnancy itself puts a lot of downward pressure on the bladder and we are carting that baby in our bellies for months. For a vaginal birth, the pelvic floor muscles need to stretch and relax to allow the baby out of the birth canal, sometimes there is tearing that occurs, or even with a casearan section the incision that was made in the abdomen has to go through a healing process. Did you know that when soft tissue heals like the skin, fascia, muscles part of the healing process involves laying down scar tissue and it goes through a process of maturing. This is how our tissues heal and become sturdy again. But this tissue doesn’t move quite like it did before. In fact, we often have to work on soft tissues where there were incisions or tears to help improve circulation to the area, make the tissue pliable again so it can move with ease, and re-train muscles how to properly contract again to do their job. This is where pelvic floor physical therapy comes in. These physical therapists have taken special training to comprehensively assess and treat your pelvic floor muscles.
But what if I leak and I have never had children? Yes, this happens too. If you are a female athlete or active exercises, you may have experienced this. Although every person is different, believe it or not this can be due to the pelvic floor muscles being too tense/tight and not allowing this area to work properly. We find this often with dancers and gymnasts. It may also be due to the strategy your body is using to execute your movement for your sport or performance. Since our pelvic floor muscles are literally the basement of our core, how they work can easily be affected by the way we breathe or, the way we tighten our abdominal muscles. At the end of the day soft tissues like muscles and fascia need to be able to move freely and they need to be able to contract fully when they get a message from the brain to do so. If we can’t fully relax our muscles or fully contract our muscles voluntarily, then we probably are going to have a hard time doing it when it’s time to do so during an activity. But remember, it’s not just about how strong you are or how tight you can squeeze these muscles. Many times, women are having problems with urinary incontinence from these muscles being chronically too clenched and tight. So before you start doing kegels until the cows come home, I recommend finding who your local pelvic floor physical therapists are and get an evaluation so you know what’s happening for you down there.
But I went to pelvic floor PT and my muscles seem to be doing their job just fine! Yes, this can be true, but pelvic floor muscles are only part of the equation. The other piece that influences continence or the ability to not pee yourself is ESTROGEN. Estrogen is a hormone that has its hand in SO many things. It influences: cholesterol levels, blood sugar levels, bone and muscle mass, circulation and blood flow, collagen production and moisture in the skin, brain function/focus. So if you are a woman during a time when estrogen levels are dropping (breastfeeding, peri-menopause/menopause), you may be experiencing urinary incontinence not just because of your pelvic floor muscles not working right but also because the tissues down there are not as hydrated as they used to be when estrogen was higher. So ask your women’s health provider if vaginal topical estrogen (often called estrace) could be helpful for you.
Moral of the story: Don’t rely solely on what worked for your best friend’s pelvic floor. Maybe her muscles were weak and needed strengthening. Or maybe they were overly tense, and she benefited most from relaxation techniques and gentle stretching. Everyone’s body is different—and so is the root cause of symptoms like urinary incontinence.
As someone who started in orthopedic physical therapy before specializing in the pelvic floor, I’ve seen firsthand that while the pelvic floor plays a key role, it’s rarely the only factor in solving pelvic/low back/hip pain or urinary incontinence. We’ll dive deeper into that in an upcoming blog post.