Let's Talk Incontinence!

What is urinary incontinence?

Urinary incontinence is the uncontrollable loss of urine from your bladder, resulting in leaking. You can experience incontinence to differing degrees, whether it’s only a few drops of urine, a spoon-size amount of leaking, or a full-bladder loss of urine. 

Urinary incontinence is COMMON but it’s NOT NORMAL! I’ve heard so many people joke, “welcome to motherhood!” when talking about incontinence, especially incontinence postpartum. This should not be the new “norm” with which you have to live, and the best part - it’s usually fixable! In order to fully understand why incontinence happens, it’s important to understand the different types of urinary incontinence and the body’s natural mechanism to prevent incontinence. 

Types of urinary incontinence:

Two common types of urinary incontinence are urge urinary incontinence (UUI) and stress urinary incontinence (SUI). 

UUI is when you leak urine due to certain environmental triggers, such as inserting your key in the door, pulling your car into the garage, hearing running water, etc. Usually these environmental triggers are mapped into your brain, starting as simple as, “Oh I’m home, I just need to open the door then I’ll go pee.” Over time, that trigger (putting your key in the door) becomes a learned habit and your bladder starts screaming, “IT’S TIME TO PEE!” That’s when you start noticing leaking, because your body associates urinating with that trigger and your body is full force ready to go and you can have a hard time holding it.

The good news - there’s a way to help with this! Normally, your brain is in control of your body (think homeostasis), but with time, your bladder has decided to become captain of the ship and tells your brain it’s time to pee, even when it’s not. So, we have to get your brain back in control of your bladder! You can do this with changes in habits, practicing holding your urine for 2 minutes, distracting yourself, etc. There are many “tricks,” but essentially, it’s all about environmental habit changes. 

SUI is when you leak urine when you cough, laugh, sneeze, run, jump, or do any other physically-demanding task. Your abdominal cavity is like a canister. It has your diaphragm at the top, your core muscles in the front, spinal muscles in the back, and pelvic floor at the bottom. This abdominal canister acts like a piston; As you inhale and your diaphragm moves down, your pelvic floor relaxes and moves down, and when you exhale and your diaphragm moves up, your pelvic floor contracts and moves up. If you don’t have proper mechanics when performing certain tasks, the pressure has to go somewhere and usually the pelvic floor is the first place to cave. I like to compare this to a water balloon (follow with me) - if you push on the top of a water balloon, the water has to go somewhere, so it bulges out/down. Whenever you cough, laugh, sneeze, run, jump, etc., your intra-abdominal pressure increases (this is normal!). However, that pressure needs to be properly managed and distributed evenly.

It’s all about pressure management when it comes to SUI. Let’s say you’re working out and you’re performing a box-jump. If you are holding your breath, the intra-abdominal pressure increases, but your diaphragm is stagnant due to breath-holding. In this case, the pressure has to go somewhere (think water balloon), and it usually goes down. Additionally, if your pelvic floor muscles aren’t strong enough to support that increased pressure, you can have leaking. Now here’s the kicker - you can have pelvic floor muscles with low tone that are weak, but you can also have pelvic floor muscles with high tone that are weak! It's important to note that kegels are not for everybody. Let me say that again - kegels are not for everybody! It’s best to see a pelvic floor physical therapist to determine if your muscles are weak and high-tone or weak and low-tone. 

What is the “knack”?

The “knack” is the name for a natural reflex that occurs in your body. Whenever you cough, laugh, or sneeze, your pelvic floor naturally contracts, or lifts, to hold back urine and help manage pressure. Sometimes this reflex can get a bit finicky and the pelvic floor muscles don’t coordinate with other muscles as smoothly, leading to a lesser or weakened “knack,” which can then lead to leaking. Again, it’s good to see a pelvic floor physical therapist to understand how your body is functioning!