This type of “leaking”, more properly known as “stress urinary incontinence” (SUI), is common amongst recreational and elite athletes who participate in high impact sports. It is a misconception that incontinence only happens to women who have undergone natural childbirth.
In fact, nulliparous women (those who have not had children) and men can experience SUI too. Many people, also incorrectly, believe this is a normal part of the aging process and nothing can be done about it. However, in most cases, this is not true, and with a little conservative intervention, you can stay leak-free during your sport and daily activities.
SUI is primarily caused by weakness of the pelvic floor muscles.Therefore, if you can isolate and properly strengthen these muscles, you can maintain continence and prevent leaks. Sounds simple, right? But I have at least one patient a week tell me they’ve never heard of the pelvic floor before and had no idea there were even muscles “down there”.
So, where exactly is the pelvic floor and how do you isolate these muscles? The pelvic floor muscles can be found at the base of the pelvis, running from the pubic bone to the tailbone and sacrum, and they form a sling that supports the pelvic organs. To isolate and strengthen these muscles, you need to squeeze tight and lift slightly inward. This motion is what some people might refer to as the “Kegel” exercise. One way to check if you are accessing the right muscles is to try to stop the flow of urine. However, I would discourage you from doing this frequently, as it can weaken the same muscles you are trying to strengthen. Once you think you are squeezing the right muscle group, try practicing your squeezes while sitting or lying in a comfortable position.
- Begin with three sets of ten repetitions, holding each contraction for three seconds and relaxing for three seconds in between squeezes.
- Rest 30 seconds between sets.
- Repeat this three times a week, with a day of rest in between.
If you practice for one month and don’t notice a significant improvement in your symptoms, don’t give up, you just may need a little coaching on proper technique. A recent study showed that 70% of women who thought they were doing pelvic floor muscle exercises correctly were actually bearing down and weakening their pelvic floor or using the wrong muscles entirely. So, if your symptoms aren’t improving, make an appointment to see a physical therapist who specializes in treating the pelvic floor. You will want to find a therapist who is working toward or holds a CAPP or PRPC certification to treat the pelvic floor, or who is working towards or holds a WCS which means they are board certified women’s health and pelvic floor specialists.
During your visit, your therapist may do an internal examination to determine if you are able to access the pelvic floor properly. They may also suggest other interventions like biofeedback, which helps you see your muscle activity on a computer graph, or electrical stimulation, which helps the muscles contract if they are very weak. Your therapist will work with you to determine a plan of treatment including any referrals to other physicians as necessary. Once you are finished with your therapy visits, you will want to continue to practice the exercises your therapist gives you to maintain the health of your pelvic floor and minimize the return of symptoms.