What’s the Deal with Leaking?

What is leaking?

Let’s first talk about how a healthy bladder works. As urine is produced and fills the bladder, the bladder “detrusor” muscle relaxes and stretches to accommodate the fluid. As the bladder fills up, you start to be aware of the feeling that you need to pass urine, but are able to hold on. When the bladder is filled to a certain level, an urge to pass urine is felt and when it is appropriate (i.e. in a toilet, at a convenient time), the brain signals the “detrusor” muscle to contract and the urethral sphincter to relax, thus allowing urine to be passed. Normal voiding is 5-7 times a day and should take at least 8-10 seconds (flow-dependent).

The urethra and bladder are supported by the pelvic floor muscles, which contract during coughing, sneezing, and exercise to prevent leakage. Weakness in the muscles or changes to the bladder neck support can result in suboptimal positioning or neuromuscular dysfunction, which can ultimately lead to leaking of urine.^1-3 This leaking of urine is called “urinary incontinence” (UI) and is a common health issue problem with rates ranging from 25-45%.¹

There are different types of incontinence:

Stress Urinary Incontinence (SUI): leakage of urine when performing a physical activity or movement, such as sneezing, coughing, sporting activities or a sudden change in position that puts pressure on the bladder.¹

Urge Urinary Incontinence (UUI): leakage of urine associated with an urgent need to urinate that cannot be postponed.¹

Mixed Incontinence (MI): a combination of the two types; leakage of urine associated with urgency, and also with physical activity or movement.¹  

Here’s the good news… it’s treatable!

How do I get better?

• Pelvic Health Physiotherapy & Exercise: pelvic floor muscle training (PFMT) is the first line intervention research to help manage UI.¹ PFMT aims to builds strength, endurance, power, relaxation or a combination of these.¹ It also provides perineal support, and improves muscle tone.² Women with SUI who do pelvic floor muscle training are 8x more likely to report cure compared to controls and women with any type of incontinence are 5x more likely to report cure compared to controls.^1,4 In addition, women with SUI have fewer leakage episodes per day and have less urine leakages, better quality of life and higher satisfaction with the PFMT program.¹ Research has shown that it takes a minimum of 3 months of progressive pelvic floor muscle training to focus on endurance (long holds) and coordination (quick pulses).
• Bladder retraining program: your pelvic health physiotherapist may ask you to follow a time voiding schedule, increase your water intake and use a “double voiding” technique to ensure you are fully emptying your bladder. In addition, there are bladder irritants, such as coffee, wine, acidic foods that can irritate the bladder and increase bladder frequency, urgency and/or incontinence. Temporarily eliminating these irritants from your diet can improve your symptoms. Once you are feeling better, you can begin to add foods/drinks back into your diet, one at a time. This is an effective intervention along with pelvic floor muscle training for mixed or urge incontinence.⁵

Some take-home tips if you are experiencing leaking:

1. Scale the intensity back and see if this helps.
   For example, when performing a “jump squat” exercise, try regular squats instead, or decrease the distance or height of your jump squats.
2. Decrease the weight/resistance with exercise.
   Using lighter weights or resistance, especially in exercises that may cause increased downward pressure on your bladder and pelvic floor, can minimize leaking.
3. Posture and alignment.
   Stacking your ribs over your hips can help offload the pelvic floor on impact, contributing to less leaking.
4. Incorporate a pelvic floor breath during exercise. 
   Reconnecting with your pelvic floor during movement can help to optimize proper pelvic floor function and minimize leaking. Try this pelvic floor core connection exercise to learn how to do this.
5. Don’t hold your breath during exercise.
   Cue my favourite line “blow as you go,” this means you exhale on the strenuous part of a movement. Likewise, you would inhale during the rest/relaxation phase of a movement.
   For example, when doing a hip bridge exercise, practice breathing in when preparing to lift up into a hip bridge (rest/relaxation phase) and breath out as you actively engage your glutes and core to lift up into a bridge (during the exertion phase).
6. Gradually progress with your exercise program.
   This helps build up the functional strength in your pelvic floor muscles.
   The Prenatal Academy and The Postnatal Academy programs by Jenni both include strategies to help you build your strength and exercise safely and effectively, even with urinary incontinence.

• Consider other adjuncts: there are lots of tools that can help you get back to activities that are important to you. Some examples include: pessaries (over the counter, such as Uresta or custom fit), Poise Impressa bladder supports, or supportive external garments (such as the restore leggings from SRC), etc. The internal products act as a backstop to the urethra and significantly reduce or stop leaks.

 Strategies for daily life:

• Trying the “knack” before you cough/sneeze: The knack has been described by Ashton-Miller and Delancey as the ability to initiate a pelvic floor contraction before a rise of the intra-abdominal pressure. The knack is completed by contracting your pelvic floor before you cough or sneeze. After a while you will feel the muscles contract without conscious control.
• Blow as you go: One thing that we often don’t realize, is that we tend to hold our breath throughout the day, especially during strenuous activities, such as lifting groceries bags, picking up your baby, etc. By using your breath during these moments, it helps recruit the right muscles to work and help take the load. This can help decrease symptoms.
• Maintain Good Bowel Function: The bladder and bowel organs sit in very close proximity to each other in the pelvis, so constipation can make incontinence worse (as it can irritate the bladder). It’s important to prevent constipation by eating high fiber foods, drink plenty of water, and exercise daily.
• Stop Smoking: coughing is one common symptoms from smoking, which puts strain on your pelvic floor muscles and can lead to incontinence.
• Hydrate: Contrary to popular belief, water intake is really important. When you are dehydrated, the urine is more concentrated and this irritates your bladder lining. Instead of gulping water down, try taking frequent sips throughout the water.

In summary:

Don’t let leaking stop you from movement and exercise!

If you’re experiencing leaking, you may benefit from working with a pelvic health physiotherapist, and participating in an evidence-based exercise program, such as The Prenatal Academy or The Postnatal Academy.

I hope this blog provided some insight about your pelvic floor and simple strategies to starting taking control of your pelvic health. If you have any questions or want to learn more you can email Lea directly!

Lea’s Info:

Email: lea_damata@live.com

IG: @leadphysio

Book online at: https://raisethebarphysio.janeapp.com/locations/rtb-mibody-health-fitness/book#staff_member/5

References

1.    Dumoulin C, Hay‐Smith EJ, Mac Habée‐Séguin G. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. The Cochrane Library. 2014 May 14.

2.    Price N, Dawood R, Jackson SR. Pelvic floor exercise for urinary incontinence: a systematic literature review. Maturitas. 2010 Dec 31;67(4):309-15.

3.    Bø K, Hilde G. Does it work in the long term?—A systematic review on pelvic floor muscle training for female stress urinary incontinence. Neurourology and urodynamics. 2013 Mar 1;32(3):215-23.

4.    Dumoulin C, et al. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. 2018 Oct 4;10(10):CD005654.

5.    Culbertson S, Davis AM. Nonsurgical Management of Urinary Incontinence in Women. 2017 Jan 3;317(1):79-80.

6.    Garritty CM, Norris SL, Moher D. Developing WHO rapid advice guidelines in the setting of a public health emergency. Journal of Clinical Epidemiology. 2016 Aug 31.

7.    Ayeleke RO, Hay‐Smith EJ, Omar MI. Pelvic floor muscle training added to another active treatment versus the same active treatment alone for urinary incontinence in women. The Cochrane Library. 2015 Jan 1.