Stress Urinary Incontinence - Pee Leakage

Here at Recharged PT, we see a wide range of pelvic floor dysfunction and disorders. Every single person has a pelvic floor, so there is a good change that most people have some type of PF (pelvic floor) involvement. This month, we are starting a new series where we delve more specifically into some of those dysfunctions  – and we are going to start with stress urinary incontinence (SUI). 

The bladder is made up of the sphincter (which releases urine) and the detrusor muscles (bladder wall), and is supported by the pelvic floor muscles that form a type of hammock. These muscles are made to expand when the bladder fills with urine. Stress incontinence occurs when increased intra-abdominal pressure (IAP) causes the bladder to release small amounts of urine because your pelvic floor muscles are weak and/or tight. This can be a few drops or an involuntary flow – moderate to severe SUI occurs when more than a tablespoon of leakage occurs. Activities with increased IAP that may facilitate leakage include:

• Laughing or sneezing

• High impact sports or exercise (usually including sprinting, cutting or jumping)

• Heavy lifting

• Sexual intercourse 

Approximately 15 - 33% of women will experience SUI at some point in their lives. Risk factors for developing SUI include pregnancy and childbirth, menopause, low back and hip pain, pelvic surgery (e.g., hysterectomy or C-section), obesity, and uterine prolapse. Other risk factors include excessive caffeine or alcohol use (those darn pesky bladder irritants!), constipation, hormonal imbalances, and long-term participation in high impact activities. 

The good news is that SUI is relatively straightforward to diagnose. Your Pelvic Floor PT will take a history and perform a physical exam. You may be asked to keep a bladder diary for a few days to a week – noting fluid intake, symptoms, bathroom use and any activities that caused leakage. Additional testing can include urinary pad test (you wear a pad for 24h and it is weighed), urinalysis, bladder scan, ultrasound, urodynamic testing, and cystoscopy- which can be done with a Urogynecologist.

Treatment for SUI is usually multifaceted depending on the why it’s happening, activities that cause your symptoms, and severity of leakage. Lifestyle changes to help improve SUI include:

• Eating a high fiber diet and drinking lots of water

• Avoiding bladder irritants (which we talk about in this post here)

• Maintaining a healthy weight

• Managing conditions like high blood pressure and diabetes

• Going to the bathroom on a set schedule (bladder training or timed voiding)

One important thing to *note* here is that a lot of “Dr. Google” resources on SUI is that Kegels (tightening your PF muscles) will help with leakage by making the muscles stronger. But this is usually not the case!! The vast majority of people with pelvic floor dysfunction (and SUI) have have PF muscles that are too tight – NOT too loose. Because muscles need to be a certain length to work optimally, a muscle that is too loose OR too tight can be weak. 

Hence — getting in to see your PF Physical Therapist is an important step to SUI. Your therapist will be able to perform an assessment and formulate an individualized treatment plan to address the symptoms. 

Overall, SUI affects a significant proportion of women and there are certain risk factors that may make you more susceptible. The most important thing to note: if you have you even a bit of leakage – this is not normal!! And SUI is definitely not something you just need to *live* with. 

<3 The Recharged Performance Therapy

References

https://www.healthline.com/health/stress-incontinence

https://www.mayoclinic.org/diseases-conditions/stress-incontinence/symptoms-causes/syc-20355727

https://my.clevelandclinic.org/health/diseases/22262-stress-incontinence

https://www.urologyhealth.org/urology-a-z/s/stress-urinary-incontinence-(sui)