Stress urinary incontinence causes and treatment details
If you’re experiencing leakage when you cough, sneeze, or exercise, otherwise known as stress urinary incontinence (SUI), you might assume that you have weak pelvic floor muscles. And while pelvic floor muscle weakness could indeed be part of the problem, there are actually many different causes for urinary incontinence. In this post, we’ll dive into the main culprits I see that cause leaking of urine.
Pelvic floor anatomy and incontinence
First, let’s start with a quick lesson on how the pelvic floor functions.
The pelvic floor muscles are unique in that they are shaped like a bowl so they function a little bit differently than the long and straight muscles that are on your arms and legs. The pelvic floor muscles actually function a bit like a trampoline.
They should “bounce up and down” in the sense that they should descend when they’re relaxed and lift up to support your pelvic floor organs (aka the bladder, the uterus, and the rectum) when needed (as in when you are coughing, sneezing, or exercising!).
Image Credit: Pelvic Global, LLC & Pelvic Guru, LLC
But often, something goes awry and these muscles that control whether the tension and relaxation in the pelvic region don’t function as intended.
That’s when symptoms like urinary incontinence, pelvic pressure, or pelvic pain occur.
So what happens that causes the pelvic floor muscles to misbehave?
As a pelvic physical therapist, I see three main issues that contribute to leakage (ie urinary incontinence). Pelvic floor muscles that are leaking are often muscles that are:
Too weak
Too tense
Or not well coordinated
Sometimes patients are dealing with just one of these, but more often than not, they fit in more than one category. Below, I’ll dive into more details on each as well as treatment for stress incontinence, which, believe it or not, is much more than just Kegel exercises.
Stress urinary incontinence when pelvic floor muscles are too weak
Like I wrote above, most people assume that their pelvic floor muscles are too weak. And there are indeed times when this can be true. For example, if you:
Are early postpartum, and your pelvic floor muscles are still recovering from birth
Have not exercised in quite some time so tend to be in weaker in general
Are recovering from an illness or surgery and you have had to be less physically active than you usually are for a time period
If any of these are true, then you likely do have some pelvic floor weakness.
And if the pelvic floor muscles are weak, they will not be able to contract properly to support the bladder and the urethra (the thin tube that carries urine out of the bladder), which means that when you sneeze or jump or do anything that puts additional pressure on the pelvic floor, those muscles will not be able to give proper support and some pee can escape.
Think of what happens when you squeeze a hose - it stops the flow of water - the pelvic floor muscles can stop the flow of urine in a similar way.
The good news is that if this is the cause of your urinary incontinence, strengthening the muscles of the pelvic floor is relatively simple (I said simple, not easy) and that can help your symptoms. There are many pelvic floor exercises that can be done to help eliminate incontinence symptoms.
Stress urinary incontinence when the pelvic floor muscles are too tense
This one is a bit trickier because it might not be immediately obvious.
But just like other muscles in the body, the pelvic floor muscles can be too tight.
And if a muscle is too tense, then it won’t be able to work optimally.
The analogy I usually like to use with patients to demonstrate this concept is to think of a tense pelvic floor like a balled-up fist, with the hand tensed up and the fingers curled under. This is good if you wanted to punch something, but if you wanted to use your hand to pick something up, and your hand muscles were so tense that they were stuck in the fist position, then you could see how that could cause some issues, right?
The same thing can happen at the pelvic floor.
If the pelvic floor muscles are too tense, they will lose their trampoline function I described above, and they won’t be able to function properly, which means symptoms like urinary incontinence can result.
A pelvic floor physical therapist will be able to assess your pelvic floor muscles and tell you whether or not they are tense.
Stress urinary incontinence when pelvic floor muscles are not well coordinated
Sometimes, the pelvic floor muscles are not too tense or too weak, but they’re simply not working when they need to be.
You see, our pelvic floor muscles should automatically lift up when we cough, sneeze, or jump to help support the bladder and urethra and therefore prevent leakage. Think of this as a reflex!
But sometimes this doesn’t always happen smoothly. It’s like if a punch was thrown but you ducked after it hit you - that wouldn’t be helpful at all! In a perfect world, we would see a punch coming and duck in anticipation of it.
And in that perfect world, our pelvic floor would instinctively sense that you are about to sneeze and activate just ahead of time.
But we don’t live in a perfect world, so sometimes we lose a little coordination in our pelvic floor.
The good news is that a pelvic floor physical therapist can help you retrain your pelvic floor muscles to improve their coordination.
Stress urinary incontinence summary
So as a quick recap, your pelvic floor muscles might be too weak, too tense, or not well coordinated, or some combination of the three. But the good news is that we can work on improving muscle strength, length, and coordination in physical therapy, which can then lead to reduced leakage!
Other causes of urinary incontinence
This blog focused primarily on a form of incontinence known as stress urinary incontinence, which is when leakage occurs during coughing, sneezing, jumping, etc. (basically any time a stress is placed on the bladder).
But before I end this blog, I do want to briefly mention that there are other causes of urinary incontinence, including:
Constipation: If stool is backed up, it will put more pressure on the bladder and pelvic floor, which means that your muscles will have to work harder than usual to give you support.
Bathroom habits: This one could be an entire blog post in itself, but a quick example would be that if you are waiting several hours in between bathroom breaks, your bladder might be overfilling, which again puts more pressure on the pelvic floor, and can cause the bladder itself to work against you.
Hormonal changes: There are physiological changes that happen with hormonal fluctuations (most notably, while postpartum or in menopause, but can also happen at certain points within your cycle each month) that can make you more susceptible to leakage.
Certain medications: Again, these do not directly cause urinary leakage but can make you more prone to it.
Certain foods and drinks: Could be another full blog post, but there are foods and drinks (and unfortunately, they’re the fun ones: coffee, alcohol, chocolate, and more) that can stimulate your bladder and again put you at risk of leaking.
And honestly, that list is not all-inclusive.
There are quite a few other factors that can contribute to urinary incontinence. However, the ones listed here are the most common causes so this blog is a good guide to the most likely culprits behind incontinence.
And if you happen to have another cause to your incontinence, a good pelvic floor physical therapist should be able to help you determine what that cause may be, and direct you to another specialist if your incontinence is not a pelvic floor muscle problem.
And more often than not, urinary incontinence is multifaceted.
It’s not just that your pelvic floor is weak, or you’re constipated, or you just drank 2 cups of coffee, but it’s all of those together that lead to a leak.
Where to get help for stress urinary incontinence in Durham
I hope that you’re feeling more aware of the potential causes of incontinence after reading this blog. But if you’re feeling a little overwhelmed, please take a breath - I’m here to help.
Helping patients sort out what the root cause of their incontinence and then learn how to overcome it is something that I love to do!
If you’ve been wearing pantyliners on a regular basis or are rushing to the bathroom because you’re unsure if you’ll make it before you leak, please reach out!
If you’re local to Durham, NC or the surrounding areas, I’d highly recommend making an appointment for pelvic floor therapy so we can dive deeper into the potential causes (and solutions!) of your specific symptoms and to ensure that we assess your specific pelvic musculature and presence of leaking.
I’d love to help you live without needing to wear panty liners and black pants.
You can reach out by completing a contact form here, scheduling a complimentary discovery call here, or by clicking the button below.
