"I Leak a Little When I Sneeze"

Written by Dr. Fiona Callender, ND

That’s normal right? Let’s talk about urinary incontinence

Urinary and bladder problems are much more common than you might imagine - we just don’t talk about them openly. We might even normalize them for some people. More than ¼ women experience some form of incontinence - with prevalence increasing with age. This is huge! Often those who don’t speak to their healthcare provider assume it is a normal part of aging, having a baby, or they feel embarrassed to talk about it. Regardless of your stage of life… there’s support for your symptoms.

What is considered incontinence?

Incontinence is the involuntary leakage of urine. We typically think of these leaks as fitting into one of 3 categories: related to urgency, stress or a combination of both. Having to go pee more often, urgently, and sometimes not making it in time is what we call urgency urinary incontinence. This happens when, for various possible reasons, the signals that tell us our bladder is full happen earlier and more often than is needed. 

Experiencing leaking when you sneeze, jump or exercise, on the other hand, is what we call stress urinary incontinence. This type of incontinence happens when the pressure inside the abdomen becomes too high for the sphincters of the urethra and pelvic floor muscles to hold against.

We can also experience a mix of both conditions at the same time - we call this mixed urinary incontinence. 

Why does this happen?

There are a few key events that happen in our body that keep us from peeing our pants - a well orchestrated interplay between our anatomy and nervous system. The bladder, urethra, pelvic floor muscles as well as our nervous system, work together to coordinate our urinary habits. The bladder has two functions - storage and emptying. It is made up of an involuntary muscle (one we can’t control) that relaxes to allow filling, and contracts to help us void. Your urethra has an internal and external sphincter - the inner is not in our control but the external is to some degree. As the bladder relaxes to allow filling, the urethral sphincters contract to prevent leaking. This is important so you can hold your pee until you get to a place that makes sense to void. Past a certain point, the bladder starts to send signals to your brain that it’s full. When everything is well coordinated, your sphincters can maintain this pressure until it’s time to go. Your pelvic floor plays a key role in providing support to both the bladder and the urethra, helping control sphincter tone and managing the pressure changes as your bladder fills. Incontinence can happen when either the pressure becomes too much and the pelvic floor is too weak, or when there is a miscommunication or issue with coordination between the bladder, the brain and the pelvic floor.

Would kegels help strengthen the pelvic floor so it can hold everything in?

As you read above, preventing leaks is about so much more than strength - it’s often more about coordination. Yes, the pelvic floor needs to be able to respond to increased pressure through the abdomen - say, in a jump or heavy lift - but it also needs to be able to relax. When someone has an overactive bladder - which can happen for various reasons including our habits, stress/mood, bladder irritation, microbiome changes - it can become a bit of a cycle. Often, when signals are sent that the bladder is full again, the pelvic floor contracts to help prevent leaks. The problem is that when this happens chronically, tension can then lead to other symptoms. Chronic activation can also lead to fatigue, making it harder to hold in that pee until it’s an appropriate time. Hello, leaks!

That said, sometimes strengthening is what’s needed. We need coordination and strength. Strengthening may start with kegels, but we want to progress you beyond this. We don’t want you stuck with just kegels forever! Like any muscle we train, once you can manage the movement with good coordination, adding more functional movements is usually the next step in building strength that is useful for your life. An assessment can be really helpful in helping your practitioner know how to treat you, but it can also be helpful to give you the feedback on what relaxation and contraction feel like. It can be a bit more (or a lot more) challenging when it’s a group of muscles you can’t see!

Beyond the pelvic floor: Lifestyle and other factors that contribute

Urinary symptoms are complex and it often takes looking at the whole picture to build the right plan for each individual patient. Bladders habits, stress, activity levels, and hormones, can all play a role. A proper assessment is important as there can be other underlying causes for urinary concerns - history of pelvic surgery, pregnancy history, health history (diabetes, pulmonary or cardiovascular disease, urinary tract infections), cognitive ability, and medications, can all impact bladder function. You deserve a proper work-up.

We offer pelvic floor therapy at Crafted Balance with both a Physiotherapist and a Naturopathic Doctor. Not sure which makes the most sense for you? Give us a call or book a meet with one of our practitioners.