Ugh...has it happened to you? Jamming through your HIIT class or out for a much needed run and just as
you start to pump up the intensity
….ooops…. there goes a warm trickle from down there. Not again!
Well, guess what, you are NOT ALONE, and there is a management for it. The prevalence of stress urinary incontinence (SUI) which is defined as urine leakage that occurs during loaded, physically stressing activity is 4-10% of women (1).The incidence increases to about 50% for those who have given birth. A number of risk factors increase the odds for incontinence following pregnancy and they include: vaginal delivery, advanced maternal age, high BMI and history of episiotomy (2).
Now, guess what again? Is this common, yes. Is it an acceptable, “normal” side effect of pregnancy or age that we just have to suck up and deal with. No.
This is treatable.
But before we talk about how to fix the problem we must first understand how and why it happens.
Pathophysiology of Stress Urinary Incontinence
Most of us already know the bladder holds urine in our body. The muscle of the bladder is called the Detrusor, it contracts and squeezes the bladder to initiate urination. Coming out of the bladder is a tube called the urethra. The urethra has a sphincter that acts like a gatekeeper, opens to release urine, closed to keep urine from leaking out. The pelvic floor lies underneath all of this to support the entire structure. The pelvic floor must stay somewhat contracted or engaged to work with the sphincter to keep any urine from leaking out. It also must be able to relax to allow urine flow when the time is right. If the Detrusor muscle contracts and the sphincter is not closed, leakage occurs. If the Detrusor contracts and the pelvic floor coordination is delayed, leakage can occur.
A nerve feedback loop also occurs between the bladder and brain that send messages regarding the urge to pee. With the brain involved, urination can also become a behavioral process. Do you always seem to have to pee RIGHT NOW as soon as you pull in your driveway or get to work. That's a behavioral loop happening where your brain is primed, by habit, to signal urination in certain common situations.
Image from Herman and Wallace Curriculum Pelvic Floor 1, 2020
Certain foods, ones that are considered more acidic, can also “irritate” this feedback loop causing the pathway to be overactive, thus increasing the signals to the bladder that it's time to void, when the bladder may not even be full..
So, you can see that we have a multifaceted system working that affects how, when and why we pee. Although stress urinary incontinence can be complex and not a one-size-fits-all problem. There are a few easy things you can try first:
Management of Stress Urinary Incontinence
1. Avoid Bladder Irritants
Certain food and beverages will cause the bladder and nerve pathways to become hypersensitive and create a situation where the urgency to go is greater. Once the urgency becomes elevated and then you add increased downward pressure on the system, leakage can occur.
Foods known as bladder irritants include:
Soda (any and all)
Artificial sweeteners and processed foods
Energy drinks (sorry! 😬)
Acidic fruits and juices like orange and grapefruit
2. Make sure you fully empty your bladder
Sounds like an obvious suggestion but many women, let’s face it...
are often multi-tasking and thinking about the next 5 things on the to-do list,
don't always pay attention to or
in some cases lack sensation for when the bladder is empty.
Full bladder emptying should occur without bearing down, by the way, so this doesn't mean wringing out your pelvic floor to squeeze out every last drop. It just means be patient and let your urine stream come to a complete and natural stop on its own.
3. Observe (but don't obsess over) your breathing mechanics
In order to maintain a nice healthy pressure management system that we discussed earlier, it is important to be aware of our breath. This is something that you can practice outside of your workouts when you are in a relaxed state before you try and practice it in a “loaded” situation.
Pick an exercise that is easy for you such as an unloaded (unweighted) squat.
Slowly move into a squat position while you inhale, pause.
Next, start to exhale slowly as you begin to return to a standing position. Keep exhaling the whole way through until you are fully standing. If you can, also envision the pelvic floor, your perineum or space between your vagina and anus lifting up and drawing in, like an elevator rising from the ground floor. Avoid clenching these muscles, that will be counterproductive. Just begin with envisioning a gentle engagement and lift.
Repeat a few more times and again over the next few days until you are comfortable with timing and coordination with the breath cycle. Then go ahead and try it with an added load by adding a weight to the exercise, it can be a literal weight or a laundry basket or your child. Start with the smallest weight first. See if you can avoid leaks with just this simple exercise then gradually increase the load.
The more you practice this pattern of breathing while exerting, it will eventually become natural and you won't have to think about it every time and hopefully, your leakage will decrease dramatically! Won't that be great?!?
Give these 3 things a try and let me know how it goes!
If you continue to struggle with urine leakage during exercise or exertion you may need to see a healthcare provider that specializes in Women's Health. You can also reach out to me here for a free 20 min consultation to discuss your needs.
1. Reynolds WS, Dmochowski RR, Penson DF. Epidemiology of stress urinary incontinence in women. Curr Urol Rep. 2011 Oct;12(5):370-6. doi: 10.1007/s11934-011-0206-
0. PMID: 21720817.
2. Wang K, Xu X, Jia G, Jiang H. Risk Factors for Postpartum Stress Urinary Incontinence: a Systematic Review and Meta-analysis. Reprod Sci. 2020 Dec;27(12):2129-2145. doi: 10.1007/s43032-020-00254-y. Epub 2020 Jul 7. PMID: 32638282.
3. Herman and Wallace Pelvic Floor 1 Course Manual 2020