Laugh so hard you wet your pants?

Avoid jumping on the trampoline with the kids or star jumps at the gym?

It’s normal to have a little bit of wee come out when you cough and sneeze…. right?

Most ladies I see as a physio who has a special interest in Women’s Health think its completely normal to have a little bit of urine leakage every now and then after having babies.  Most just add this occasional loss lack of bladder control to the list of sacrifices you make when you enter the world of motherhood.

So many ladies are surprised to know that there is a proper diagnosis for this loss of wee, its called “Stress Urinary Incontinence”. Do you want to know the good news? There is something you can do to fix it!

Stress Urinary Incontinence occurs when there is loss of urine during physical exertion such as coughing, jumping, lifting. When you perform something physical such as a star jump or sneeze, you increase pressure down through your abdomen. This pressure will then push down on your pelvic organs, including your bladder. When the pressure in the bladder is higher than the pressure on the urethra and there is involuntary loss of urine.

So why is the pressure on the urethra not strong enough to hold the in the bladder during physical exertion? It can be due to 3 main reasons

  1. Damage to the Anatomy of the pelvis such as stretching of fascia (the ligaments that hold your pelvic organs in place) or stretching of the pelvic floor (the muscles that tighten around the urethra to hold urine in).
  2. Decreased strength and endurance of the pelvic floor
  3. Poor motor control which causes absent, delayed or asymmetrical contraction of the pelvic floor

This weakness and damage can happen during pregnancy, birth or as the result of repetitive high impact and high resistance exercise.

It is important to understand that your pelvic floor muscle isn’t entirely responsible for holding urine in your bladder. The pelvic organ fascia plays an important role which most women don’t know about. The pelvic fascia attaches to your bladder, uterus and bowel and holds them up onto the inside of your pelvic bones. It provides a solid base for your pelvic floor muscles to push off. The pelvic floor muscles work with the pelvic organ fascia to create enough force around your urethra when you cough to prevent any leakage. So if you have damage to your pelvic floor or fascia the force around the urethra is less.

A nice way to think about it is water running through a hose pipe (urethra). If your hose is lying across solid concrete (pelvic fascia) when you stomp your foot down (pelvic floor muscle contraction) the flow or water (urine) will stop. However if we were to place the hose pipe on a soft piece of grass (damaged pelvic fascia) when we stomp our foot down (pelvic floor muscle contraction) it will be harder to stop the flow of urine because there isn’t nice solid ground (fascia).

So what can I do about it?

Whipping your pelvic floor into shape through strength and motor control training has great results. In order to activate your pelvic floor gently squeeze and draw up the muscles between your tail bone and pubic bone like you are trying to stop a wee or pass wind. Hold your pelvic floor for 3 seconds and repeat 10 times whilst maintaining a normal breathing pattern. When you can easily perform 3 seconds x 10 gradually increase the time you hold your pelvic floor by 1-2 seconds a week. You are aiming to achieve 10 x 10 seconds holds. Once you have achieved this level of endurance you can start working on power. Power training involves you squeezing your pelvic floor as hard as you can for a second and repeating as fast as you can 10 repetitions. Another trick you can use is known as “The Knack”. This involves you contracting your pelvic floor hard as you do an exertional movement such as coughing or jumping. If you find that these exercises aren’t working you may need some extra guidance by a physiotherapist who treats pelvic floor dysfunctions.

No longer will you have to clamp your legs together as you sneeze in your morning work meeting or as you laugh hysterically after a glass of wine or two. Try these exercises or come in and see a physiotherapist who has experience treating women’s health patients.

EMily Standen – Physiotherapist