Are you peeing your pants when you sneeze?

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If you said yes, it’s important to know that any urinary leakage is not normal! 

There is a lot of talk about “Kegal exercises” and the pelvic floor muscles… in 1948 Arnold Kegal, a gynecologist practicing in California, was the first to report that pelvic floor muscle training (PFMT) was effective in treating urinary incontinence (UI), and it's still the first choice of treatment today! (1,2,3)

A recent article reported, “The prevalence of UI was high in a national sample of the US adult population, with almost 1/2 of  women and 1/6 of men reporting urinary leakage.”

Delivering a baby is stressful for the pelvic floor. If we consider all the anatomical structures involved during a vaginal delivery, then we can start to look at other reasons for incontinence. (4)

These are potential suspects:

  • vascular system, especially “the venous plexus around the urethra,” JP Barral, P.T., D.O (5) 
  • pelvic nerves going to the pelvic muscles and organs
  • bladder and urethra can be injured during delivery
  • pelvic fascia and ligaments of the organs
  • pelvic floor muscles

During labor and delivery these structures can become overstretched, compressed and torn, resulting in pelvic floor dysfunction.

Incontinence has been linked to forceps use, duration of labor and the number of previous deliveries. There also appears to be a relationship between epidurals during labor and the severity of pelvic floor injuries. (6,7)

What should you do if you have leakage?

  • Visit a pelvic floor therapist, incontinence is a symptom and can be treated
  • Kegals are helpful! Contract the pelvic floor muscles before coughing, sneezing or laughing. This is called the “knack”
  • Yoga and Pilates are good for core strengthening, make sure you are using the “TA” muscles
  • Hydrate, women reduce their water intake to avoid leaking!
  • Wearing pads are only a short term solution


References

  1. Kegal A. H. 1948. Progressive resistance exercise in the functional restoration of the perineal muscles. American Journal of Obstetrics and Gynecology 56:238-249

  2. Hay-Smith E, Bo K., Berghmans et al 2001. Pelvic floor muscle training for urinary incontinence in women (Cochrane review). The Cochrane Library, Oxford.

  3. Wilson P D, Bo K, Nygaard I, et al 2002 Conservative treatment in women. In: Abrams P, Cardozo L, Khoury S et al (eds) Incontinence. Plymbridge distributors, Plymouth, UK, p 571-624

  4. Koelbl H, Mostwin J, Boiteux J P et al 2001 Pathophysiology. In: Abrams P, Cardozo L, Khoury S et al (eds) Incontinence. Plymbridge distributors, Plymouth, UK, p 203-242

  5. Jean Pierre Barral, New Advanced Urogenital Manipulation, Copenhagen, October 2017

  6. Cutner A, Cardozo L D, 1992 The lower urinary tract in pregnancy and the puerperium. International Urogynecology Journal and Pelvic Floor Dysfunction 3:312-323

  7. Francis W J A 1960 The onset of stress incontinence. The journal of Obstetrics and Synecology of the British Empire 67:899-903