Why am I leaking?

Stress incontinence:

happens with physical exertion that increases abdominal pressure like coughing, laughing, sneezing, jumping, screaming

Urge incontinence:

is usually triggered by something specific like putting your key in the front door, getting in the car, hearing running water, etc.

Leakage happens when pelvic floor muscles are:

• overactive

• underactive

• bad at coordinating

• slow to respond

Leakage can be triggered or be worsened by:

• constipation

• abdominal muscle gripping

• consuming bladder irritants

• hip muscle weakness

• holding yr pee for too long

• chronic straining

• hormonal changes like gender-affirming hormone therapy or the menopause transition

• surgical changes to anatomy like prostatectomy or hysterectomy

So what do we do?

Kegels are sometimes considered a catch-all corrective exercise for leakage, but this is not true! Sometimes the muscles need to learn how to relax or coordinate before they can be strengthened. This is why an individual assessment is always a good idea.

Also, a lot of people do kegels wrong :(

Unfortunately, physical solutions to leakage really depend on what’s causing the problem, and this blog cannot assess your muscles. (Wouldn’t that be cool?) BUT it could definitely help to connect your brain to your pelvic floor muscles and start noticing what they’re doing. We don’t usually need to pay attention to these muscles because they should do their jobs automatically.

Try lying on your back with knees bent or sitting on a yoga ball or hand towel rolled up and placed beneath your perineum. See if you can feel a gentle downward bulging when you breathe in and a slight recoil upward toward your head when you breathe out. This is a great way to start and might take some practice. Check in that your belly muscles are relaxed and squishy and your feet are supported.

Don’t worry, though. We can talk more about habits and behaviors that can make huge differences in frequency and degree of leakage.

The bladder is basically a puppy that can be trained.

One of these behaviors is teaching the pelvic floor to chill the eff out.

If you’re here, we can make the safe assumption that you or someone you know has a pelvic floor is somehow dysfunctional.

The pelvic floor can present in a variety of ways, but any kind of high-stress/physically demanding lifestyle or job is likely to be causing some amount of tension or guarding.

Other things like past trauma, stress, fear, anxiety, excessive exercise, or poor breathing, as well as any abdominal or pelvic surgery and corresponding scar tissue will impact how the pelvic floor responds to normal daily demands. You might think a lot of tension would be good to stop leakage, but if a muscle is held tight, it won’t be able to generate force and the tension might also override anticipatory muscle activation.

Symptoms of too much tension can include: pelvic pain, constipation, difficulty starting a bowel movement, pain with penetration, urinary frequency and urgency, leakage, hip pain, low back pain, tailbone pain, etc.

An extremely effective and totally unexciting way to help increase awareness and restore range of motion is with breathing exercises, detailed below.

The nervous system is the queen

There was a study that looked at the body’s response to seeing a threatening video clip and guess who had a strong reaction? Our friend, the pelvic floor (van der Velde & Everaerd, 2001).

Your brain and body can perceive threat from a million different things in a million different ways depending on your history, preferences, and cultural norms. Someone who once had a really bad allergic reaction to a bee sting would have a completely different threat response to seeing a bee vs a beekeeper who deals with bees every day and getting stung is just a minor inconvenience.

In order to get the pelvic floor to relax, we need to

• feel safe

• minimize gravity (lie down on your back or sit on a stable surface)

• let your belly soften

Breathing for pelvic floor relaxation

Or rather, breathing as an attempt to restore full range of motion in the pelvic floor muscles by tapping into the nervous system and normal physiology

Ideally, your rib cage will expand in all directions (360°), but let’s start simply. Try to breathe slowly and in through your nose if you can:

• place a hand on your belly, chest, or both, and feel the whole front of your abdomen rise when you breathe in

• if you can, cup the sides of your rib cage with your hands (almost in your armpits) and see if you can feel your ribs expand sideways into your hands, like an accordion.

• lastly, remember we also have ribs on the back of the body, so you can feel your back ribs expanding into the floor or the back of your chair.

• the respiratory diaphragm naturally domes down when we inhale and we want the pelvic floor to follow that same direction of movement. I like to imagine two giant water balloons (we are filled with water, after all). One in the ribcage sitting right on top of another one in the pelvis. If the top water balloon is pushed down by the diaphragm when we breathe in, the one on the bottom must also descend into the pelvic floor (because we can’t compress water). If you have trouble feeling this, go back to sitting on a towel roll like in pg. 5 or try placing a flat hand on your perineum and sitting on it.

Feel free to experiment with your body position and try to find something that feels good and relaxing.

More imagery ideas for pelvic floor lengthening when inhaling:

• sits bones widening

• uncurling your tailbone

• letting yourself pass gas

• a flower blooming

• butter melting

• turtle head poking out of its shell

• letting your breath separate your butt cheeks

Some of these may feel goofy to think about, but usually at least one will be effective!

Fun fact: the pelvic floor and jaw are often doing the same thing, so you can also imagine letting your jaw be soft and resting your tongue on the roof of your mouth (and still breathing in through your nose)

Good luck! Please reach out or book an appointment if you need more support.

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.