Dribble Drivel: I Peed My Pants!
As I question female patients about any urinary leakage they’re having: on the way to the bathroom, with coughing, sneezing, exercise, jumping, after urination; many times they’ll kind of shrug their shoulders and say “well sometimes, but I’ve had babies.”
Additionally, there seems to be more presence of urinary incontinence products for women in ads recently, where women are raising their hands in solidarity, in regards to experiencing leakage, while glitter flies and fanfare music plays. I appreciate that symptoms are being talked about and that some of the hushed shame being lifted, when people admit that yes, this is something that can happen. But let me state again (you are all going to get a little tired of this), is that urinary incontinence is COMMON NOT NORMAL.
Does the physiology of being pregnant, having an altered posture and changed pressure gradients within your abdomen, and then having damage to musculature, whether via cesarian or vaginal delivery, put you at risk for leakage? Absolutely! Does that mean that’s the way our bodies should be acting or that it’s something “that just happens” after delivering a baby? No way. And pregnancy and delivery are not the only way that people come about having incontinence- some people that have never been pregnant at all have leakage as well.
Urinary leakage is a sign that something is functioning incorrectly within your pelvis- there could be excessive scar tissue, muscles holding too tightly and holding too tightly, or muscles that have been stretched and distorted that now are weak or don’t have effective paths of communication with your brain. There are actually different kinds of leakage and different findings we would anticipate on your exam, based on the type of leakage that you’re experiencing.
Stress urinary incontinence is the leakage that occurs when there’s a sudden pressure through your abdomen, like coughing, sneezing, lifting, or jumping. The person experiencing only this kind of leakage will typically exhibit a weakened pelvic floor, so when the pressure from above (like with a sneeze) out-powers the contraction put forth by the pelvic floor below, urine is forced out.
Urinary urge incontinence, when you’re having leakage on the way to the bathroom, on the other hand, is actually a symptom commonly stemming from musculature being too tight. I know this is counter intuitive. But for all those out there that have squeezed and squeezed, trying to make their muscles stronger, but haven’t seen an improvement in their urge leakage, this is why. You started off with a system that was squeezing all the time and just squeezed it a bunch more. Then when a challenge is brought in front of those muscles, like a sudden need to pee, there’s nowhere else for them to squeeze- they’re already at capacity. For this patient, we need to put together a plan that has them lengthening and relaxing their muscles so that they can return to movement through the entire potential range of motion, thereby returning to their best function.
So the next time your friend makes a comment about how she’s crossing her legs while sneezing or isn’t going to even try jumping on the trampoline at the birthday party, pass on some good news- there’s help! Pelvic floor physical therapy can find the cause of the problem and get you back to skipping and sneezing fearlessly again.
Christina McGee PT, DPT
Christina McGee is a physical therapist at Sullivan Physical Therapy, a pelvic floor specialty clinic in Austin, Texas. She received a bachelor of science in Athletic Training from University of Iowa and a Doctorate of Physical Therapy from University of Delaware. Christina treats men and women with bladder, bowel, and sexual dysfunction, as well as abdominal and pelvic pain. She has specific interests in pregnancy and postpartum care and is additionally the head of Sullivan Physical Therapy's pediatric bladder and bowel program and the Center Coordinator of Clinical Education. Christina also partners with Austin Area Birthing Center to provide pregnancy and postpartum physical therapy care and provide education to AABC clients on site. She is on the medical advisory board of ReCore Fitness.