Urinary Incontinence - What can I do to strengthen my pelvic floor?
Women with osteoporosis and osteopenia are often worried about falling and breaking a bone. Did you know that urinary incontinence is a risk factor for falling and sustaining a fracture?
This is a topic we sometimes skip over, but for many women, leaking and the need “to go right now” is a problem. For some, it may be the occasional dribble. But for others, it is “I need to wear a pad at all times” or even “I gave up going to yoga/running/hiking”.
I want to start by saying that one exercise, one breathing technique is not going to solve your issue. Just like building any muscle in any other part of your body, your pelvic floor has many components and it takes time to turn things around.
The pelvic floor is complicated. It is connected to your abdominal muscles, how you breathe, your hips, and your lumbar spine. Coordination of the entire system is needed for continence. If Kegel exercises alone could “fix” us, we would all learn them, do them and this wouldn’t be a problem.
If you have been doing your Kegels and they aren’t helping, you are not alone. Between 15-40% of women experience stress urinary incontinence (SUI) and roughly 1/3 of women with SUI do not perform pelvic floor contractions correctly (Henderson et. al., 2013).
Learning the anatomy of the pelvic floor is the first step in figuring out what part of your system is in need to attention.
Let’s start with the bladder itself.
The bladder is a muscle, not just a passive holding tank. When your bladder, the detrusor muscle, is relaxed, it fills with urine. When your bladder fills a certain amount, a signal is sent from the detrusor muscle to your brain saying “Hey, let’s find a bathroom”. Sometimes, the signal is sent when the bladder is not full. We respond to this signal, run to the bathroom, even when we know we went not all that long ago. We get to the toilet and out comes a weak stream and not much urine. We know that we should have been able to hold off going for a while more but we really felt we needed to use the bathroom.
Why does this signal get sent?
There are several reasons. One, we may have fallen into the habit of going to the bathroom “just in case”. In other words, we had no indication from our bladder that it was full, but we anticipated a shortage of bathrooms in the future, so we overrode our system and used the bathroom anyway. The unintentional effect is that we have now trained our bladder to tell us it is full when it is not. This results in more frequent bathroom trips, and an inability to hold a good amount of urine in your bladder. This change in our nervous system gets passed on to the muscular system, the detrusor muscle.
Second, we find ourselves with a weakening or overactive, bladder, the detrusor muscle. When we respond to the urge to go and run off to the bathroom, rather than letting the urge pass, our bladder gets “smaller”. It doesn’t tolerate larger volumes of urine. Again, we have unintentionally trained our bladders to hold just a small amount of urine. This often shows up at night, when we can no longer get a full night’s sleep because the urge to go comes on strongly and wakes us up.
This night time urge and running to the bathroom is when most falls occur. If you can strengthen your bladder and reduce the number of times you go to the bathroom each night, you will reduce your odds of falling.
Why do you get these faulty signals? One reason could be your diet. Bladder irritants, such as coffee, alcohol, spicy foods, and carbonated drinks, can all cause your bladder to be irritated. If you drink and eat these irritants every day, over time, you may find yourself with a bladder that likes to get your attention frequently. You become less and less able to hold more urine, and your pelvic floor muscles weaken. A history of urinary tract infections (UTIs) may also be a contributor to your bladder health, and your unwillingness to hold off running to the loo.
A few terms that are used to define urinary symptoms:
Stress urinary incontinence (SUI) - defined as a sudden unintentional loss of urine during normal day-to-day activities, and is commonly referred to as bladder weakness or a weak bladder.
Overactive bladder - defined as a sudden urge to go to the toilet to pass urine which is difficult to ignore, with nocturnia - getting up to use the bathroom at least two times at night. It is sometimes called an unstable or irritable bladder or detrusor overactivity. It means that your bladder wants to contract, even if it’s not full.
There are more conditions that affect our pelvic floor functioning, and finding out the root cause is beneficial for really solving the problem. Combining anatomy knowledge and the right exercises can be very helpful in getting these problems moving in the right direction. Exercises, such as Goblet Squats and Bridge Pose with a Kegel can help strengthen the pelvic floor by engaging the large hip and leg muscles. Breathing is also helpful, as our breathing diaphragm and our pelvic floor move together. And of course, meditation can help calm our revved-up nervous system.
I address issues related to the pelvic floor and how to breathe correctly in my Strong Women, Strong Bones program. Subscribe to my newsletter or check out the home page to find out when my next 4-week program is scheduled. Building strong bones, muscles and improving your pelvic floor strength are important to me, and I would love to keep you healthy and active for years to come.
Stay strong and retire active,
Andrea Trombley PT, DPT
References:
Henderson, J. W., Wang, S., Egger, M. J., Masters, M., & Nygaard, I. (2013). Can women correctly contract their pelvic floor muscles without formal instruction?. Female pelvic medicine & reconstructive surgery, 19(1), 8–12. https://doi.org/10.1097/SPV.0b013e31827ab9d0
Zou M, Lu R, Jiang Y, Liu P, Tian B, Liang Y, Wang X, Jiang L. Association between toileting and falls in older adults admitted to the emergency department and hospitalised: a cross-sectional study. BMJ Open. 2023 Jun 1;13(6):e065544. doi: 10.1136/bmjopen-2022-065544. PMID: 37263694; PMCID: PMC10254614.