Author: Christin Tate, PT, DPT, OCS, WCS
Are you having small or large bouts of urinary leakage? For whatever reason (birth, trauma, activity, age), it is never “okay” to leak urine, no matter how insignificant you may think it is. There’s also easy, at-home treatments you can try to eliminate this pesky problem instead of turning to compensatory strategies like adult diapers or changing your underwear. You’re not alone. According to the National Association for Continence, over 33 million Americans suffer some urinary incontinence or bladder problems. These issues can be heavily life impacting and embarrassing for many. If you have additional issues going on simultaneously (painful sex, pelvic pain, bladder pain, constipation), I would recommend seeing a certified Pelvic Health Therapist (directory located at https://www.womenshealthapta.org/patients/).
What Causes Urinary Incontinence?
Incontinence is a complex process that involves many body systems (brain, nervous system, muscular system, reflex system) and the causes of which are likely multifactorial in nature. Determining the specific cause can be a discussion between you and your doctor and/or Pelvic Health Physical Therapist. However, there are conservative, research-based, and non-harmful strategies you can try that often can work well for low complexity cases and highly motivated people!
Diet & Drinking Changes
Many things that we eat and drink irritate the lining of our bladder and cause us to feel urges. These urges don’t indicate our bladder is full, they indicate it’s irritated and wants to expel the contents that’s aggravating it. These items are carbonated drinks, alcohol, caffeine, spicy foods, and acidic fruits. I’ve had patients who just try this tip and experience a huge shift in their symptoms. Worth a try right?
Chronic constipation can put a great deal of pressure on your bladder and pelvic floor muscles, causing them to be less effective. Refer to this pdf to learn about how much and what kind of fiber to eat per day to improve your constipation symptoms.
Urinary urge is a message sent from your bladder to your brain telling you it’s time to empty. Your bladder needs 2-4 hours to fill no matter how much liquid you drink. However, bladder irritants will quicken urges before that timeframe (another reason to ditch the bladder irritants). This message sometimes is not a true representation that your bladder is full (especially if it hasn’t been 2 hours since you last urinated) and can be reduced through research-supported strategies. Research supports a strong 15 second pelvic floor contraction (described below) to reduce the bladder muscle activity telling you “need” to go to the bathroom. Recent scientific studies also endorse mindfulness-based stress reduction programs to reduce urinary urge. Performing 1 minute of heel raises can also help reduce urge.
A bladder diary can help you track how frequently you are going to the bathroom. If your diary reveals that you are urinating less than every 2-4 hours, start adding 15 minutes between bathroom visits each week using some of the urge suppression techniques discussed above. By adding time to your urination intervals, you can increase the size of your bladder and it will hold more urine for you for longer!
Smokers are at an increased risk for a variety of medical conditions, but also stress urinary incontinence due to chronic coughing. Chronic coughing can do long-term damage to your pelvic floor muscles. Smoking is also a bladder irritant which can cause urinary urges when your bladder is not full. Your bladder is a muscle and can, overtime, shrink if you go to the bathroom at every, little sensation of urge. See Bladder Training for more information on controlling urge.
Extra weight can put pressure on your bladder and pelvic floor muscles which can also give you false urges, and overtime, shrinking your bladder size. Eating a healthy diet and regular physical activity can help you maintain a safe weight. The 2018 Physical Activity Guidelines for the public recommend that able-bodied adults should engage in 150 to 300 minutes of moderate-intensity physical activity, or 75 to 150 minutes of vigorous activity, or equivalent combinations of both.
Strengthening Your Pelvic Floor
Many high quality research studies (see references) have validated that strengthening these muscles can help reduce urinary incontinence. I would recommend watching this video to make sure you’re doing the exercise correctly. Here are some tips:
- Do not guess how long you should hold the contraction for or how many you should do.
- Try to build a mind-body connection and feel when the muscle is squeezing and fully relaxing.
- See if you can feel the muscles getting tired. The muscle is getting fatigued when it seems harder to do the exercise then when you first started. In the same way your bicep would get tired if you did 100 bicep curls, your pelvic floor muscles will fatigue. When this fatigue happens, you have done enough repetitions!
- Try to do 3 sets to fatigue everyday for optimal muscle strengthening!
- This takes time! Learning muscle awareness can takes weeks to months to build, but if you feel like you’re really struggling please seek help from a specialized Pelvic Health Therapist.
Disclaimer: Some people have leakage due to a pelvic floor that is too tight. In this case, pelvic floor strengthening will not help. To determine if this is the case, an evaluation by a licensed and certified Pelvic Health specialist is warranted (see above for directory).
These are a lot of changes! How do I make all of these?
My answer is: Don’t. You don’t need to make all of them at once. In fact, it might be more helpful to make one change every week to see which ones affect your systems the most! Urinary leakage is a complex process, but these changes are worth a try! If you need more help or guidance, reaching out to a Pelvic Health Therapist can be life changing. They are licensed Physical Therapists with specialized training in pelvic health. A compassionate and caring group, these highly trained Physical Therapists will listen and collaborate with you to implement the best, most effective treatment that suits your lifestyle and personal goals!
About the Author:
Christin received her undergraduate degree in kinesiology and psychology from Gordon College and Doctor of Physical Therapy from Springfield College, MA in 2013. Following completion of an orthopaedic residency and board certification, she completed a year long pelvic health residency and lymphedema certification training program in 2017. She became board certified in Pelvic Floor Therapy in 2018. She has treated a wide variety of patients ranging from professional athletes to weekend warrior moms! Christin is passionate about positively influencing her patient’s movement and reducing pain as well as empowering them to be advocates for their own health and wellness.