What to do About Urine Leakage

Why do some people leak?

Urine leakage can happen for a lot of reasons. Some of them may seem pretty standard like pelvic floor muscle weakness or changes in the body from pregnancy. There are other reasons leakage might happen that are way less obvious.

What are some other things that might cause urinary leakage?

Leakage can also be triggered or worsened by certain habits or anatomical changes that may not seem like they would be involved:

• constipation: a backed up bowel takes up space and space can be pretty limited in the pelvis. You can imagine that if there’s a bunch of stool in your colon, it might push on your bladder and stop it from being able to easily expand. Lots of folks are constipated and don’t know it!

• abdominal muscle gripping: when we tense the muscles in the abs that are right around the ribcage, there can be extra pressure going downward onto the pelvic floor that makes it harder to keep pee in when intra-abdominal pressure goes up

• consuming bladder irritants: there are certain beverages and foods that can be irritating to the lining of the bladder. This list can be highly individual, so your bladder irritants might be different from your best friend’s or your sibling’s.

• hip muscle weakness: hip muscles overlap with pelvic floor muscles, both anatomically and physiologically. These muscles can sometimes compensate for each other if someone isn’t doing their job. So if the hip muscles are weak, pelvic floor might be working overtime and then the muscles are just can’t give you that extra squeeze when pressure goes up.

• holding your pee for too long: results in a bladder that’s just too full and prone to leakage because the muscles can’t hold a flood back.

• chronic pushing or straining to have a bowel movement or empty your bladder: if we’re pushing or straining, this usually means we’re trying to get something out of a door that’s closed or cracked. Repetitive straining can lead to fascial weakness or overstretching that can stop the muscles from working as well as they should.

• hormonal changes like gender-affirming hormone therapy or the menopause transition: the urethral and genital tissues usually lose some mass, aka atrophy, with hormonal changes. This can mean the urethral closure muscles have to work extra hard because there is just less tissue to close against.

• surgical changes to anatomy like prostatectomy, hysterectomy, gender-affirming pelvic surgery, etc: surgery can lead to temporary or lasting changes in the urinary system that will vary depending on which surgery was performed. Pelvic rehab is a great idea after any type of pelvic or abdominal surgery to help get the muscles back on track.

Stress incontinence

Stress incontinence happens with physical exertion that increases intra-abdominal pressure like:

• coughing

• sneezing

• laughing

• jumping

• lifting something or other exercise

• standing up from sitting down

• screaming or yelling

Urge incontinence

Urge incontinence or urgency incontinence is when leakage happens with a strong urge to pee. Maybe you didn’t make it to the bathroom on time and leaked few drops? Urgency can also be triggered by something specific like:

• putting your key in the front door

• getting in the car

• hearing running water

• almost anything else your brain decides to associate with peeing

You can also have urgency without urge incontinence if you can get to the bathroom without actually leaking.

Mixed incontinence

This just means a combination of the others and is pretty common. They might have some overlapping causes, but we usually try to get your brain/bladder connection better to manage urgency before addressing stress incontinence, although sometimes they both magically get better.

So what do we do about urine leakage?

Kegels are sometimes considered a catch-all corrective exercise for leakage, but this is just not true! Kegels can be right for some people some of the time, but doing repetitive pelvic floor muscle contractions can also make a lot of symptoms worse, even symptoms involving leakage. You can’t just assume you’re weak and need to do kegels. We’ve all probably read a magazine article somewhere that says everyone should do 100 kegels every day to stop leakage or for better sex, but take that as a reminder that we should not believe everything we read! (Including this blog post! Do your research! Although I like to believe I’m giving good advice, the evidence is always growing and changing and clinical recommendations definitely change over time. Even if I’m up to date in real life, maybe I haven’t updated this post in a while because I’m a busy human just like you.)

Also a lot of people do kegels wrong! Like a lot. The pelvic floor can be hard to connect to because we can’t see it. It can take time to learn how to tune into those muscles.

The muscles in the pelvic floor typically don’t need to be repetitively squeezed. For a lot of people, these muscles would benefit from something else entirely. They might need to learn to relax or recalibrate so they can remember how to turn on in a more efficient and automatic way. A healthy pelvic floor reacts automatically to internal pressures to stop the bladder and urethra from running the show.

There’s no way to really know what’s going on without getting an individual assessment from a qualified professional. This person will either be a pelvic floor occupational therapist or pelvic floor physical therapist. Some urologists and urogynecologists are also trained in assessment of pelvic floor muscles, but they do way more intense medical procedures and typically need to reserve their continuing education for things like honing their surgical techniques. That’s why it’s important to have a team of specialists because we can’t all be good at everything.

Urge incontinence can be managed with behavioral strategies known as bladder training or urge suppression techniques, but physical solutions to leakage really depend on what’s causing the problem. So if you’re feeling frustrated with your leakage, now’s as good a time as any to get your butt to a pelvic floor therapist and get some actual help for your unique self.

I believe in you. Feel free to schedule a discovery call if you’d more information or are considering working with me and I’ll do my best to help!

This content is for informational purposes only and is not medical advice. Please consult your qualified medical provider for an individual assessment or plan of care.