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“I laughed so hard that tears ran down my legs” and “I can laugh, cough, sneeze and pee all at the same time” are just a few of the many jokes about incontinence. Many women shake it off stating that they have had children so of course they leak or that they are older so that’s what happens. An instructor in one of my fitness classes recently commented that she can’t jump when she is excited because she is 50 and who knows what could come out. When did we normalize urinary incontinence and why are so many people accepting it as their fate?

Leaking urine is common, and seen more frequently in females. Statistics show that up to 30% of young adults, 40% of middle age and 50% of elderly women are affected. It is most common for symptoms to start during and after pregnancies, but can happen to younger teens and also those who have never had children. Stress incontinence; when you leak with jumping, coughing and sneezing is the most common. Urge incontinence is less known and occurs when you can’t make it to the bathroom in time, or when the leakage follows a strong urge to urinate.

There can be several causes behind urinary incontinence including hypermobility of the urethra and pelvic organ prolapse. However, pelvic floor strength and coordination deficits are one of the biggest causes and also one of the easiest to fix. Many people think that just doing Kegels will fix symptoms, but there is a little more to it than that (including how long, how many and in what position for starters). And the question of whether you are doing the contraction correctly and without using other muscle groups. If you need to cross your legs when you sneeze then you are most likely using your leg muscles to assist with pelvic floor contractions.

The pelvic floor works in coordination with our breathing, and when we exhale, they naturally contract to lift up. This is important when there is a forceful exhalation and the muscles don’t contract to close and lift, to counter balance the stress of the cough/sneeze or laugh. That force then pushes urine out the bottom when air comes out the top. Learning to sequence your Kegel with your breathing helps this coordination.

Often times, the pelvic floor muscles are tight. This most often causes pain, but it also affects their ability to be strong. Tight pelvic floor muscles create increased tension, which leads to increased pressure to the bladder and urge incontinence. When this happens, the muscles need to be lengthened (stretched) before they can work correctly.

Joking about leaking urine can help make light of an embarrassing situation, but know that it can be reversed. And it should. Most often these symptoms resolve quickly, and completely with pelvic floor physical therapy. They are honestly one of my favorite diagnosis’ to treat, because of the early progress and great prognosis!


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