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Updated: Dec 10, 2019

"I laughed so hard I peed my pants."

What was once a metaphoric saying has become a reality.

Do you carry extra panties everywhere you go? Do you map out where a bathroom is in every store in case you have an accident? Do you cross your legs before every sneeze or cough? Did you have to stop your favorite exercise program because pee was leaking down your leg!?

If this sounds like you, please read on.

Too often I hear people say things like, "Well, I've had 2 kids" or "I am getting older" and "All my friends joke about it happening to them too." Urinary pads and underwear fill the aisles in Walgreens for a reason, right? Perhaps this is just a natural part of life. That last statement is far from true. Society has portrayed urinary incontinence as "normal," but here's the surprising truth: it's not normal, its common. Urinary incontinence impacts 25 million adult Americans. And it affects women of all ages, sizes and levels of activity. It's not only postpartum or older women that are leaking. It affects active adolescents too. In a study of 144 nulliparous (have not beared children) college women, 28% reported urine loss during sports (Nygaard et al. 1994). Hence, you are not the only one suffering with a dribble down your leg, people just aren't talking about it! Nearly 70% of people with urinary leakage aren't even telling their physicians. So let's spread the word, educate folks, and help each other out.

Let me first explain the phenomenon of accidental urinary leakage.

There are two main types of urinary incontinence (UI), urge and stress. It is also possible to have a combination of the two types which is called mixed UI. Urge UI occurs when you have a sudden, uncontrollable sensation to pee, but don't quite make it to the bathroom in time and leak. Stress UI occurs when you do something like cough, sneeze, laugh, jump or walk fast and leak urine. Leaks occur when you do an activity that puts too much downward pressure through your body towards the bladder and your muscles can't hold the urine in against that force or stress. To stay dry, the pelvic floor muscles have to be strong enough to counteract this downward force. The muscles are located at the bottom of your pelvis between your sit bones. They control the external sphincter that closes the urethra, give support to the organs above such as your bladder, uterus and colon and aid is stability for your body. If your muscles are strong enough, you don't leak, if they are too weak, you leak. That's the basic concept, but it's not quite this simple. If it was this simple, kegels would be appropriate for everyone with UI and no one would leak.

Sometimes the muscles are too tense and can't relax. This doesn't necessarily mean the muscles are strong, it means they are overactive and held in a shortened position. Pelvic floor muscles, like other skeletal muscles, work optimally when they can move through the their full excursion in a controlled manner. The muscles need to relax and lengthen to allow for bodily functions such as bowel movements and a baby's arrival through vaginal delivery. Further strengthening a short, tight muscle would not help, it could actually hinder the situation. If pelvic floor muscles are constantly held too tight and you lack the ability to release and control them through movement, then additional problems may arise such as constipation, painful intercourse, or low back or hip/groin pain.

The pelvic floor muscles need to be able to respond and coordinate with your bodies natural movements such as getting up from sitting, walking, and lifting the groceries or kids. You can have great strength, but if the muscles don't respond at the right times then you can still leak.

Other factors that may influence the efficacy of the pelvic floor are posture, breathing patterns (there is a close relationship with your diaphragm and pelvic floor), adjacent muscle imbalances (over worked abdominals and under worked hip muscles), pelvic floor muscle and connective tissue quality (damage during childbirth, surgery or trauma), hormonal imbalances or neurological disorders. An intact nervous system (brain and spinal cord) are necessary for the cycle of bladder filling, awareness of fullness and proper emptying to occur. Another contributor to pelvic floor and bladder activity is emotional stress, anxiety, and depression. For example, as one may hold tension in their shoulders or neck, one may unknowingly grip their pelvic floor muscles in response to stress. As you can see, the conservative treatment of UI is complex and requires more than just a kegel to stay dry. The good news is that there is treatment! You can regain the confidence and control needed to resume the activities you love.

If you're experiencing UI of any kind, it is recommended to seek out a medical professional. In NY state, a pelvic health physical therapist can be the first person you speak with about this condition. They can evaluate you to figure out why you are leaking, create a plan for you to stop the dribble and help you find an MD to be part of your integrative health team.

** If you're experiencing stress UI or interested in more tips to gain awareness of your pelvic floor muscles and improve function and strength, SIGN UP FOR MY MAILING LIST and you'll be the first to know when the next blog comes out!

To learn more tips to STOP THE DRIBBLE, go here.

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