Urinary leakage that happens with coughing, sneezing, exercise or heavy lifting is called stress incontinence. Stress incontinence occurs when the muscles and other supporting structures of the bladder, the pelvic floor muscles, and the muscles that stop leakage out of the bladder, the urinary sphincter, weaken. These muscles may already be weakened from childbirth, prostate surgery, or high impact sports over time. We tighten these muscles by imagining stopping the flow of urine. Anything that exerts force on the abdominal and pelvic muscles can put pressure on the bladder and cause urine leakage.

To simplify, the pelvic floor muscles are part of your core support along with your abdominal muscles, the muscles of the back, and your diaphragm. Think of the core as a can of soda with the top of the soda can being the diaphragm underneath your rib cage, the sides of the can being the abdominal and back muscles, and the bottom of the can being the pelvic floor muscles. When you breathe in, as prior to a sneeze or cough, the diaphragm lowers down toward the pelvis to allow the lungs to expand. This increases the pressure on the other parts of the soda can pushing down into the bladder and stretching/bugling the pelvic floor muscles. (Think of a soda can that has been left to chill in a freezer for too long and the bottom of the can has bulged downward from the pressure of the freezing soda.) If this pressure exceeds the pressure of the pelvic floor muscles, leakage occurs. Contracting the pelvic floor muscles (a Kegel exercise) during stressful activities, can help counteract this pressure.

A daily exercise regimen of Kegel exercises designed to strengthen these muscles can restore urinary continence and keep these important muscles strong for the future. So, Kegel away when sneezing, coughing, or lifting. If the exercises are not helping or if it is difficult to know how to squeeze these muscles, find a certified pelvic floor specialist, like me, to make sure you are doing the exercises correctly.

Jennifer Hinkle PT, Certified Pelvic Specialist
Kramer Physical Therapy