5 Steps to Improving Bladder Control
If you experience leaking or have problems with bladder control, you are not alone. However, just because this is a common problem does not make it normal and it can be addressed! You can make immediate changes to your bladder control during a pelvic floor physical therapy session. You can learn many different exercises and lifestyle modifications that can help you make a a big impact to your life.
If you live in the Portsmouth, NH and would like learn more about how pelvic floor physical therapy could improve your bladder control or incontinence, we would love to speak with you.
What Causes Bladder Incontinence?
Incontinence (or leaking) happens due to a pressure management problem. Think of the pelvic bowl where our bladder sits as the center of a soda can. When there is too much pressure coming from the top and sides of the can, and not enough support is happening at the bottom of the can (which is the pelvic floor), then this pressure will squeeze the bladder. The release of the pressure in this scenario is the release of urine.
There are different factors that can predispose you to an incontinence issue.
Pregnancy and postpartum changes in the body
Menopause or perimenopause
Excessive bearing down: this can happen for weight lifting and some sports
Being a female: the shape of our pelvis, length of urethra, and mechanics of the pelvic floor muscles are at a disadvantage compared to the male pelvis
Diet: bladder irritants such as caffeine and alcohol can effect leaking
UTIs
Constipation: stool in the rectum can put added pressure on the bladder
To learn more about what the pelvic floor is and what pelvic floor physical therapy is, you can read our blog Pelvic Health Physical Therapy: Why Everyone Should See a Pelvic Floor Physical Therapist.
Types of Incontinence
Incontinence typically shows up in 2 different forms:
Stress incontinence is associated with certain activities – you may experience leaking with running, jumping, coughing, sneezing, or laughing
Urge incontinence is when you feel an unexpected, sudden strong urge to use the bathroom, which is accompanied by a contraction of the bladder muscle and can result in leaking
The good news: Both stress and urge incontinence can be addressed! There are some lifestyle habits that can be changed to help, and addressing the pelvic floor itself is crucial. When addressing the pelvic floor, the challenge is to figure out if the pelvic floor is weak, overly tight, poorly coordinated, or a combination of these things.
To Kegel, or Not to Kegel?
A common recommendation to treat urinary incontinence is to do Kegels (pelvic floor contractions) to help with strengthening the pelvic floor. If the pelvic floor is just weak, Kegels can be very helpful if performed correctly. However, if the pelvic floor is tight, Kegels can actually make the leaking problem worse.
If the pelvic floor is tight, we need to get the pelvic floor to relax first.
Think of it this way – If you had your hand clenched in a fist and I asked you to pick something up, you would not be able to pick it up if you kept it clenched. Your hand has become less functional if it is always balled in a fist. You would need to relax and open your hand first. And if your hand has been clenched for a long time, it would feel difficult to straighten the fingers out. Similarly, it can take some time and focus to help the pelvic floor relax.
Can You Relax Your Pelvic Floor?
Lets try to connect with your pelvic floor.
Take a small towel and roll it up.
Sit on the floor or on a firm chair, place the towel between yourself and the floor, slightly to the right or left of center. You can shift slightly forward or slightly back on the towel to see if the front or the back feels more tender, focus on the tender spots – tender spots are usually tight.
Think about sitting heavy on the towel. As you take a relaxed breath in, see if you can feel your pelvic floor gently sink into the towel more.
As you gently breathe out, feel the pelvic floor slightly decrease pressure on the towel.
You should not be contracting your pelvic floor and trying to pull it away from the towel.
Also, make sure to get both sides! We have right and left sided pelvic floor muscles, sometimes one side can be tighter than the other.
Other positions that you can try to feel and connect with the pelvic floor are:
Adductor rock back
Childs pose with pillow support
90-90 Hip Stretch
Can You Engage Your Pelvic Floor?
Once you know you can relax your pelvic floor fully, we can incorporate some strength. To perform a Kegel correctly, you should be able to gently lift and tighten your pelvic floor without any other muscles engaging.
It should feel like you are trying to lift your bladder, or pick up a pea with your labia, or drink through a straw with your vagina – if one of those cues resonates with you, think about that when you try a Kegel!
Things to notice:
Do you tighten your butt muscles?
Do you tense your thigh muscles?
Or can you gently lift the pelvic floor by itself without other muscles trying to “help”?
Try “The Knack”
When you cough, sneeze, laugh, and jump, the pelvic floor should automatically engage to help protect from leaking. If you are experiencing leaking with these activities, the pelvic floor may be not coordinating well and we can re-train that response.
After making sure you can perform a Kegel correctly, try this:
You feel a sneeze or cough coming on
Intentionally engage the pelvic floor right before it happens
Then sneeze/cough while maintaining your pelvic floor contraction
Relax the pelvic floor afterwards.
Doing this intentionally will help to retrain the pelvic floor to automatically engage when needed.
Lifestyle Changes
With leaking, sometimes there are things we can change in our daily activities that can help support more optimal function.
Drink enough water: If you are dehydrated, this can actually make incontinence worse. Dehydration leads to concentrated urine, and concentrated urine actually irritates the bladder, so the bladder wants to get rid of it faster. Dehydration can also make constipation an issue – constipation causes the bowels to back up, which can push on the bladder so it has less space, which makes it more irritable. To read more on constipation, see our constipation blog.
Stop peeing “just in case.” The bladder has a natural cycle – as it fills, it sends small signals to the brain to remind it that it is filling. It is normal to feel that signal when the bladder is filling. The bladder can hold about 16 oz of fluid when completely full (a grande Starbucks drink!). When the bladder is nearing fullness (this usually takes between 2-4 hours), we should get a stronger signal that it is time to use the bathroom. The problem with peeing “just in case” is that over time, the bladder starts to think it needs to empty before it fills up, and it starts sending strong urge signals when it is only partially full – as you can imagine, it’s a cycle that makes the problem worse!
No “Power Peeing!” When you use the bathroom, the pelvic floor should relax and the bladder should contract, emptying itself without extra force. “Power peeing,” or forcing the urine to come out faster, strains the pelvic floor and can lead to problems like prolapse, hemorrhoids, or other issues that come from poor pressure management. Instead, sit and relax and breathe, and simply let it go.
Get Stronger
Doing bigger strengthening movements like squats, hinges, lunges, and core exercises well with good form and good pressure management strengthens the muscles that help to support and protect the pelvic floor.
Postpartum considerations: Motherhood requires a lot of strength. You are constantly holding a growing baby, lifting car seats, carrying groceries, getting on and off the floor (and much more!). Increased strength in the larger muscle groups will support your hips, back, and pelvic floor and make you feel a lot more comfortable in your body.
Menopause considerations: aging makes it harder to gain and maintain strength and muscle mass. Strength training is an important aspect of fitness that should be integrated into your routine in order to help feel better in your body, and take pressure off of the pelvic floor.
Physical Therapy and Urinary Incontinence
At Anchor Physical Therapy, we look forward to helping you get back to doing what you love without limitations or fear of leaking. If you need support going through any of these steps, as always we are here to help.
We can assess if your pelvic floor is more weak, tight, or not coordinating well (or a combination of these) and help guide you in the most efficient course of treatment to help your symptoms.
You can be leak-free!
