Let’s be real—many of us have had that moment in our lives when we pee ourselves, or almost do. I’m thinking of that time with friends when I laughed so hard I had to squeeze my legs tight to avoid peeing. We joke about it a lot—“I laughed so hard I peed my pants”—which I guess is a coping strategy, because normalizing something makes it less of a problem in our minds.
If we’re being really honest, how many of us need to modify our daily movements to avoid having an “accident”? It might be through limiting exercise options to avoid high-intensity movements like jumping, always needing to know where the toilet is in an unfamiliar place, packing a spare pair of underwear/pants or going to the toilet before a long trip “just in case.”
The truth is that although leaking urine is common, it shouldn’t be a normal expected part of being a woman. Let’s talk about what stress urinary incontinence is, the causes of stress urinary incontinence, the best stress urinary incontinence treatment options available and some strategies to manage it.
What is Stress Urinary Incontinence?
Stress urinary incontinence is the involuntary leaking of urine, flatus or faeces in response to increased pressure in the abdominal cavity. In simpler terms, it means being unable to fully control your bladder or bowel (farts or poo) when a certain activity or movement puts a downward pressure or “stress” on our bodies.
So if you’ve ever asked yourself, “Why do I pee when I sneeze?”, stress urinary incontinence is likely the answer.
Today, we’re focusing on urinary incontinence—let’s save the bowel talk for another time!
Causes for Stress Urinary Incontinence
To understand how stress incontinence happens, we need a quick (but painless!) anatomy lesson. Don't worry, I won’t bore you with confusing Latin names. Let’s keep it simple. Let’s just get the basics down.
Think of your abdominal cavity as a house inside your torso: Your abdominal cavity is the space inside your torso, the diaphragm at the top acting as a “roof”, the abdominal and spinal muscles acting as the walls, and the muscles and fascia at the bottom of the pelvis make up the floor.
At the floor of this cavity lies the pelvic floor including both muscular and fascia components that support the pelvic organs: from front to back - the bladder, uterus, and bowel.
Through the pelvic floor muscles are the openings to these organs: the urethra from the bladder, the vagina from the uterus, and the rectum/anus from the bowel.
One of the functions of the pelvic floor muscles is to control the opening and closing of these exit points from the pelvic organs. So when you have the urge to wee or pass wind, the feeling of squeezing those muscles is what stops the leaking. That should make sense now why you might’ve been told to continuously squeeze and strengthen your pelvic floor to control urine leaking. Also known as Kegel’s (pelvic floor strength exercises).
But Here’s the Challenge…
Many of us are told to “do Kegels” to prevent leaks but we aren’t often told how to squeeze the pelvic floor properly, and some of us may not even be sure if we’re “squeezing” the right muscles.
Despite our best efforts, some of us still experience leaks—even after diligently practicing pelvic floor exercises. So, what’s really going on?
Stress Urinary Incontinence Treatment: How to Manage It
Get Checked by a Professional
If you're unsure whether you're activating your pelvic floor correctly, it’s worth getting checked by a professional. Some women think they’re squeezing when they’re actually pushing or bearing down, which can worsen leakage instead of improving it. It may also be a result of damage to the pelvic floor fascia.
Having your pelvic floor assessed might seem daunting, but we prioritise your comfort and safety throughout the process. An internal examination provides the most accurate insight into your pelvic health, but if you prefer not to have one, we can use alternative (though less precise) methods to guide our assessment. A thorough evaluation allows us to diagnose issues effectively, potentially saving you from the daily frustration of relying on incontinence pads.
It’s Not Just About Strength!
I’m going to say something a bit controversial… it’s not all about strength! There, I said it. A lot of people think that leaking is due to a weak pelvic floor, or that they don’t do their “Kegel” exercises often enough.
Did you know that you could have a pelvic floor of steel and still leak? For example, there are elite athletes out there who can turn on their pelvic floor for hours on end, and still end up leaking.
Staying dry depends on more than just muscle strength—it’s about balance. Here’s what you need:
A strong pelvic floor. Working these muscles is like working any other, the more you use them, the stronger they get. Try this:
Imagine you are trying to close your back passage to stop yourself from passing wind in a crowd.
You should feel a squeeze and a lift.
Then let go. You should feel the back passage relaxing.
Try holding for as long as possible, and make sure you feel the relaxing part also. The relaxation phase should be just as long as the squeeze + lift phase.
Pelvic floor muscles that are able to fully relax. Yes, you read that right—your pelvic floor needs to relax completely in order to function properly. Your pelvic floor needs to be able to completely relax (or lengthen) to be able to produce an effective contraction next time you feel you’ll wet your pants.
Think of it like a calf muscle: Imagine you walked on your toes all day long (contracting your calves), then you went to jump with a skipping rope. How effective do you think your jumps would be?
As opposed to walking on your heels, and even stretching out the calves before jumping. You’ll definitely get more success using the latter technique.
The same concept applies to your pelvic floor! Learning how to relax these muscles is essential for an effective squeeze, and therefore maintaining dryness. If you’re not sure how to relax properly, make sure you get a professional to check.
Balanced Pressure in the Bladder and Urethra. This means that the pressure created by keeping the urethra closed should be higher than the pressure – or load – that pushes down onto the bladder. As soon as the downward pressure on the bladder exceeds the pressure used to close the urethra, leaking will occur.
So even if your pelvic floor muscles are strong (contributing to urethral closure pressure), if the loads you place on your body by lifting, pushing, pulling, bending, repetitive coughing, straining the bowels and weight gain are high enough, you will still get incontinence.
Normal Physiological Action of the Pelvic Floor Fascia. It is the network of connective tissue that supports the organs, as mentioned above. Damage to this may compromise the support, leading to increased mobility of the vagina walls and therefore organ positioning—specifically the bladder and urethra. This can diminish the urethra's ability to remain closed under stress, resulting in leakage.
Treatment options for this may involve pessary use, which is a silicone non-surgical device that is inserted into the vagina to support the position of the bladder neck. Another option is surgical intervention, such as a mid-urethral sling that provides similar support as a pessary.
A lack of any of the above requirements, or a combination of them can cause leaking.
Other Risk Factors
Leaking can also be influenced by:
A high BMI, which increases pressure on the bladder
Respiratory issues such as chronic hay fever or asthma, which cause repetitive coughing
It’s important to work on these other factors if they relate to you, as this will maximise your chance of getting the leaking under control.
What’s Next?
Remember, leaking is not a “normal” part of being a woman, and you don’t have to live with it. The good news? You can take control. There are stress incontinence treatments that can help.
Start by tracking your symptoms:
When do you leak?
If so, how much, is it just a drop in your underwear or do you leak through your clothing and need to change your pants?
What activities trigger it?
How do you feel before and after?
Understanding your body is the first step toward improving your symptoms.
Need Support? We’re Here to Help.
Since every woman’s experience is unique, a Women’s Health Physiotherapist or Pelvic Floor Physiotherapist can assess which of these factors affect you. They can provide tailored strategies to help you regain control and confidence.
If this resonates with you, don’t hesitate to reach out. Women’s Health Hub provides tailored strategies to help you regain control and confidence. You don’t have to manage this alone, let’s take this step together.
Comments