What is stress urinary incontinence (SUI)?
Stress urinary incontinence is when there is an increased demand, such as jumping or an increase in intraabdominal pressure (IAP), that causes urine to leak out when you don’t expect it. It can be common when jumping, sneezing, laughing, or lifting heavy.
All of these activities can cause a huge pressure increase in the abdominal cavity, and if the pelvic floor cannot counter that pressure, we may see leaking urine.
First, let’s remember that SUI can be complex.
Reasons for leaking could include:
- Weakness of the pelvic floor (but it’s not loose = weak, it is more likely too tight)
- Coordination issues of the pelvic floor (how the pelvic floor can respond to increased demand which is often more than a pelvic floor issue)
Our postnatal fitness programs include an educational course that covers breath to movement coordination to help the pelvic floor better coordinate with demand, to hopefully prevent leaking!
Two Reasons You May Be Leaking
1. Weakness: Too TIGHT of a Pelvic Floor!
Weakness does not equal leaking, and weakness may not be what you are thinking when you think weak. Our muscles are strongest in the midrange positions where they can move in either direction to respond to demand. If we are stuck in an end range (aka really tight or really loose), then our pelvic floor could be “weak”.
Strength is the amount of force someone can generate over a range of motion. If I only squatted 1/4 of the way but bragged about a huge PR, it wouldn’t be looked at as a feat of strength. But, if I could squat that same weight to parallel or below (aka full range of motion), then it would be looked at as a feat of strength!
If we only squeeze our pelvic floor with Kegels, and maintain a contracted and tight pelvic floor, that is not strength. Rather, it would be like those 1/4 squats. If I had any increased demand or needed to squat lower than a 1/4 squat, I would likely fail the lift. This is the same with our pelvic floor.
So, when we think weakness it’s not necessarily loose, but rather the ability to move through a full range of motion. If our pelvic floor cannot release and lengthen, then when there is an increased demand pushing our pelvic floor into a lengthened state, it doesn’t know what to do to recoil and maintain continence. Or it cannot lengthen and there is increased force on our pelvic organs (aka your bladder).
Breathing drills are a great place to stay with MOVING the pelvic floor.
When we breathe, we want to focus on inhale OUT and DOWN. You should feel the ribs and back expand and stretch, and then the pelvic floor lengthens and stretches DOWN.
When we exhale, focus on exhale to relax if we are trying to release tension in the pelvic floor.
Watch the all-fours breathing drill video below to see an example and talk through of finding length to release tension in the pelvic floor!
2. Coordination
In addition to being able to move your pelvic floor through a full range of motion (lengthen, relax, and shorten), we also need to coordinate it with the rest of the deep core musculature that helps to maintain stability of the spine and manages intraabdominal pressure. The pelvic floor, like every other muscle in our body, does not operate in isolation. It is a component of a larger system that works together to achieve movement and overall function.
There are times when it can be helpful to focus on learning how to turn on or off a muscle in isolation as a part of a rehabilitation process, but ultimately that muscle needs to learn how to work with the rest of the system for overall function.
If the pelvic floor is either not moving at all (stuck in a tight or contracted position from the 500 Kegels you were told to do every day), then it is not moving in response to the rest of the core canister system. This can cause issues in how we manage intrabdominal pressure (too much pressure on the pelvic floor), and this mismanagement of pressure could cause leakage.
Another instance is when the pelvic floor does move but is not coordinated with the rest of the system, such as the pelvic floor moves down or lengthens when the rest of the core canister is activating/ increasing muscular force with a contraction.
This could put extra pressure down on the pelvic floor and may feel like bearing down.
Learn more about how to manage and prevent leaking urine in our upcoming webinar with Hayley Kava, Pelvic Floor Physical Therapist.
The recording will be available for download following the live webinar.
3 Solutions to STOP Leaking During Exercise
1. Find Midrange: Set Up the Core
Step one is to step up the pelvic floor in a position so that it can better respond to demand!
Our muscles operate best in midrange position, which means that the muscle can lengthen or shorten depending on the demand. The response capability is much higher in midrange!
Think if someone was throwing a ball at you; you would set yourself up in a way so that no matter how the ball needed to be caught, you could react and absorb the shock of catching the ball.
Same for our muscles (and our pelvic floor in this situation).
Our ribs stacked generally over our pelvis is midrange position for our core canister, of which the pelvic floor is the foundation.
Remember, the pelvic floor works as a part of a larger system!
Understand how to approach training clients throughout pregnancy, prepare for birth, and then recover in the postpartum as they return to fitness!
- 12.5 hour of on-demand videos
- 6 Guest Lectures from Pelvic Floor PTs
- Lifetime Access of Program
- Earn 1.3 NASM CEUs and 13 AFAA CEUs
Thoracic spine mobility requires flexion/extension, lateral side bending, and rotation. If we are restricted in the thoracic spine, we may find it harder to stay the ribs over the pelvis! Watch the thoracic mobility video below to release the spine to find a more midrange position!
Another consideration for postural set up is to release the BACK. Typically, we have a tighter posterior pelvic floor that can make it challenging for the pelvic floor to move in coordination with demand.
Try some back expansion breathing drills to release the posterior pelvic floor and you may find that it helps with heaviness during running or jumping and could relieve leaking!
2. Pelvic Positioning: Setting Up the Pelvic Floor
Next, we can focus on how the pelvis is positioned. The pelvic floor attaches to the pelvis, so the positioning of the pelvis influences the pelvic floor’s tension.
Many of us favor a right-stance posture (or favoring one leg over the other more often), and it can contribute towards uneven tension within the pelvic floor.
Common pelvic positioning tends to be:
- Left half of the pelvis is oriented more forward, externally rotated, and abducted
- Right half of the pelvis tends to be more posterior, internally rotated, and adducted
So, how can we work to re-position the pelvis?
For most of us, it will be to find the opposite positions as listed above: left hip crease drives backward, or right knee drives forward. See the video below for a breathing drill that is focused on helping reposition the pelvis and release tension in the pelvic floor.
3. Strengthen Your Glutes!!
If we have “weak” glutes (remember weak is more about limited range of motion of a muscle), it may cause our pelvic floor to compensate for our glutes.
If our pelvic floor is working overtime for our glutes, it may not be able to do its actual jobs (aka maintaining continence).
Having strong glutes and hip control can prevent leaking!
One of our top tips to strengthen your glutes is to find INTERNAL ROTATION with your single-leg movements! This will move your glute through a longer range of motion = stronger glutes!
Here is an example of a great glute strengthening exercise that you could do that incorporates internal rotation! We incorporate tons of exercises like these in both our prenatal and postnatal fitness programs to keep you strong AND dry throughout your workouts!