I Am Leaking Urine, So I Need To Strengthen My Pelvic Floor…Right?
Answer: Maybe, but probably not!
If you’re experiencing urinary leakage, it is entirely possible that you don’t need to be working on strengthening your pelvic floor. In fact, the next five reasons can be major contributors to urinary leakage. (Hint - it does not include doing 100+ Kegels a day)
Increased thoracic kyphosis
The normal curve of our spine is a slight “S” shape where we have a slight forward curve in the middle part of our back (where the ribs are). The key word is SLIGHT forward curve. When that curve becomes larger and more pronounced, it puts a lot of pressure downward into the abdominal cavity. It makes it difficult to breathe properly with our main breathing muscle (diaphragm), and can absolutely affect our pelvic floor. Increased pressure in the abdomen can be a major contributing factor to urinary leakage. This increase in forward curve can be a result of poor posture, weakness of postural muscles, or even a symptom of osteoporosis (loss of bone density). Working to improve your strength and mobility in the mid-back might be one of the ways to start addressing your urinary leakage symptoms!
Constipation
What does my digestive problems have to do with urinary leakage?? Well, again when we look at increased pressure of the abdominal cavity due to fullness of the intestines, that can also create issues with urinary leakage. It is also possible that dealing with a long history of constipation can impact your pelvic floor health from chronic straining. If you are not addressing underlying gut health, you might be missing an important piece of the urinary leakage puzzle.
Brain/nervous system
Urinary leakage is not always because of a pressure issue in abdomen. Urinary leakage can also be due to having increased signals to our brain from our nervous system. Think about a time when you were very anxious or nervous about something - it may be triggered the sudden sensation of needing to use the bathroom. That occurs because our nervous system is in the sympathetic (fight or flight) response pathway. If leakage is happening due to sudden urges, the problem is generally not weakness of the pelvic floor - the treatment usually starts with strategies to calm the brain and move the nervous system into the parasympathetic (rest and digest) state. Again, Kegels will NOT be the answer to this type of urinary leakage!
Tight pelvic floor muscles
Just like any other muscle in the body, our pelvic floor muscles can be susceptible to tightness. If you’ve ever had a painful, tight muscle - you know that it can be difficult to contract or use that muscle. In our pelvic floor muscles, if they have become tight (and sometimes painful) it can also be difficult to contract those muscles. A pelvic floor physical therapist can help identify if you have muscle tightness that is contributing to your urinary leakage and discuss ways to address this tightness. Hint - this does NOT mean doing 100 Kegels a day!
Scar tissue from previous vaginal delivery or abdominal surgery
If you have ever had abdominal surgery (appendix, gallbladder, colon, uterus, or any abdominal surgery) or if you have experienced a tear during a vaginal delivery, you will have scar tissue in the abdomen or vaginal area. Often when scar tissue heals, you can experience adhesions of the scar tissue that can restrict movement or mobility of the muscles in that area. Since there are many fascial connections between the abdomen and pelvic floor, having scar tissue in either of these locations can contribute to issues with urinary leakage. Without addressing the “stuck” scar tissue, just doing 100 Kegels a day will NOT fix your leakage issue.
So, I think you get the point that Kegels (pelvic floor strengthening exercise) are not always the answer to urinary leakage. There are a number of factors that are outside of the pelvic floor that need to be assessed. If you have seen a medical provider who told you to do pelvic floor strengthening to fix your urinary leakage, but they have not actually fully assessed you…then you might not be getting the right advice! See your pelvic floor physical therapist to find the RIGHT plan for helping you gain confidence and control of your bladder issues!!
Written by: Renee Hancock, Pelvic Floor Physical Therapist
