Understand what leads to urinary leakage, and what can be done to help manage it.

Treatment for urinary leakage is one of the top things that pelvic health physical therapists specialize in. Urinary leakage is extremely common among women, especially after pregnancy and as we age.

What is urinary leakage?

Urinary leakage, or incontinence, is the involuntary loss of urine. This can occur due to added pressure placed on the bladder during tasks such as sneezing, coughing, lifting, jumping and running. Urinary leakage can also occur with the presence of a strong urge to urinate.

How does age affect urinary leakage?

After the age of 35, the muscles in the pelvic floor weaken about 2% per year. If a woman is not performing strengthening exercises as she ages, the pelvic floor muscles can atrophy which can lead to urinary leakage.

In addition, as we age estrogen levels decline, which also has a significant effect on pelvic floor muscle strength.

Is urinary leakage normal?

Even though it is common especially after pregnancy and as we get older, urinary leakage is never normal. Our body and pelvic floor muscles should be able to withstand the pressure of everyday activities like coughing, sneezing, jumping and running.

Urinary leakage and exercise.

Many women experience urinary leakage with exercise, especially with higher impact exercises.

Unfortunately, presence of urinary leakage is one of the top reasons that women stop an exercise routine. By ceasing an exercise routine, we are taking away all of the positive effects of exercise such as improving our cardiovascular strength, muscle strength, bone quality and mental health.

Some women choose to “power through” their leakage and wear a pad during exercise. While we love that they aren’t letting urinary leakage stop them, we also have to treat urinary leakage like we would an orthopedic injury.

What we mean by that is that if every time you worked out you experienced pain, you likely would modify the workout to avoid the pain. We want our patients with leakage to do the same. You shouldn’t be leaking when you exercise and leakage is a sign that the body isn’t doing something it should.

We shouldn’t push past the point of leakage because this can lead to compensations and further problems. Instead, we should perform exercises that we are able to perform without leakage. With the assistance of a pelvic floor therapist, you can work on the activities that are causing leakage and eventually progress to them.

What is treatment for urinary leakage?

Pelvic floor therapy is one of the most effective treatment for urinary leakage. A physical or occupational therapist is the professional that specializes in pelvic floor therapy. When it comes to successful treatment for urinary leakage, we have to figure out what exactly is causing the leakage to happen and treat or modify anything that is playing a role.

In pelvic floor therapy we can also work on exercises to help strengthen the pelvic floor, modify current exercises that are problematic and work towards performing any movement or activity without leakage.

Pessaries are sometimes a really good pairing with pelvic floor therapy. A pessary is essentially a support that is worn vaginally and can help hold the urethra and bladder in a better position and therefore decrease leakage. Sometimes patients would benefit from wearing a tampon or a one time use “pessary” like the Poise Impressa.

Surgery is a last resort for many patients. Research supports physical therapy as a good conservative treatment for urinary leakage, however there are some patients that would benefit form a bladder sling procedure.

Should Kegels be part of urinary leakage treatment?

Sometimes- although often times they don’t. Kegels, or repetitive pelvic floor contractions are commonly associated with pelvic floor therapy and thus treatment for urinary leakage.

In order to get stronger however, we have to lift weights with progressive load. This means that as you get stronger, you need to lift heavier.

Doing weighted squats, lunges, hinges, deadlifts, and core exercises are also great exercises to help strengthen the pelvic floor since the pelvic floor also contracts with these movements. It isn’t all about doing Kegels and many times we can train the pelvic floor in a much more functional way with movements that are much more meaningful.

Urinary leakage is treatable.

Bottom line- urinary leakage is treatable and pelvic floor therapy is extremely helpful for many patients!