Had a baby and now you pee your pants when you sneeze? Maybe you have an exceptionally funny partner & every time they make you laugh you just can’t hold it in? This is called urinary stress incontinence. It is something that frequently occurs after pregnancy, during that 4th trimester / postpartum phase [ though there can be other causes as well ].  Let’s talk about what can contribute to urinary stress incontinence and what PHYSICAL THERAPY for urinary stress incontinence can look like. Keep reading for tools to help!

What is Urinary Stress Incontinence?

First, let’s define urinary stress incontinence. There are multiple types of incontinence but stress incontinence means you leak when there is a stressor. For example; coughing, laughing, sneezing, or even things like jumping and running. This can be combined with urge incontinence leading to mixed incontinence.

Your Pelvic Floor Isn’t Too Weak!

It is often assumed that incontinence is only caused by weakness [ but that isn’t always that cause ]. Especially if you are postpartum, it can be easy to assume that urinary incontinence is caused by a 'stretched out' pelvic floor, and that strengthening is the way to go. But often, strengthening [especially with kegels] isn’t the way forward. It can even make things worse if it’s not what your body needs.

It turns out that a muscle needs to be at an appropriate resting length in order to function optimally. If your pelvic floor muscles are already tight 'at rest' then they are unable to contract more when you do something like sneeze or cough. If they're too tight, they can't 'squeeze' enough to hold in urine. So we have to get those muscle to relax before they can contract when needed. That being said, if you need to do some strengthening, make sure you allow your muscles to fully relax between contractions in order to function optimally.

How do You Know if Your Pelvic Floor is Tight?

Firstly, certain people/ characteristics lend to having tension in your pelvic floor. If you hold tension in other areas (jaw, shoulders, abs, hold your breath), you likely hold pelvic floor tension. A Type A personality or high anxiety personality might contribute to pelvic floor tension. Being generally strong, engaging in fitness classes, exercising frequently, or running can also lead to pelvic floor tension. Other conditions like urinary urgency and painful intercourse can also be associated with a tight pelvic floor

Remember, these generalizations don't apply to everyone. A good place to start is Pelvic Floor Therapy, as pelvic floor physical therapists can assess to determine if your pelvic floor is weak or tight.

Stretching and Mobility Exercises for Incontinence

If you want to improve how your pelvic floor functions and improve your incontinence symptoms, start with these mobility and stretching exercises! The mobility and stretching playlists below include exercises to help get your pelvic floor to a more optimal resting position. If you work through some of these exercises and notice any really tight or tender muscles, this can indicate pelvic floor tension. 

Proper Breathing & Urinary Incontinence

Pelvic floor mobility exercises help with urinary incontinence, but we must also ensure that your "core canister" effectively manages pressures. The core functions as a closed system with the diaphragm, pelvic floor, abs, and low back muscles. You can picture it like a soup can! In order to maintain the correct amount of pressure and prevent the 'core canister' from bursting, the diaphragm & pelvic floor need to work together. Inhales make the diaphragm and pelvic floor drop, while exhales make them lift. Maintaining pressure in this system is crucial to avoid symptoms like urinary stress incontinence or prolapse. This is why it is so important to AVOID bearing down on the pelvic floor when coughing, sneezing, or even lifting.

Good Posture for Incontinence Relief

Knowing all of this, we need to make sure that our core canister is functioning optimally. One of the ways we can do this is to be mindful of our posture. Keep your rib cage stacked over your pelvis. If your diaphragm stays stacked on top of your pelvic floor, this pressure system will work more effectively.

IMPORTANT TIP: When you sneeze or cough, try to avoid bending forward as you do it. Stay tall so that your pelvic floor can work more effectively!

Pelvic Floor Lift Exercise for Urinary Incontinence

With normal pelvic floor function, our pelvic floor should contract or lift whenever we exhale [ remember—with exhales your diaphragm lifts & your pelvic floor should lift too ]. For people with stress incontinence, it is common for this system to be out-of-sync which means the pelvic floor will fall instead of lift. For example, the pelvic floor will drop with a cough or a sneeze rather than lift.

So the next time you cough or sneeze, pay attention to what your pelvic floor does. If it is dropping, intentionally work to make it lift as you sneeze or cough!

Pelvic Floor Physical Therapy for Stress Incontinence

⬆️ Video Playlist [updated regularly!!] ⬆️

Moral of the story : addressing stress incontinence isn’t as simple as doing a bunch of kegels [ as exercises like that can even make it worse ]. And, although leaking can be common during the 4th trimester / postpartum phase, it is not normal AND you don’t have to live that way. Pelvic floor physical therapy for urinary incontinence can be a really helpful way to address the imbalances and get your pelvic floor functioning as optimally as possible!