Why Am I Leaking?

Urinary Incontinence is one of the most common reasons people seek the advice of a pelvic floor physiotherapist. In this three part blog post, my aim is to help you understand what incontinence is, what types of incontinence there are and how to stop leaking!

So first off, there are three types of urinary incontinence (ie. leaking). The first is stress incontinence, where there is a force or a load exerted on the pelvic floor (think a cough, sneeze, laugh or jump) and the result is a leak. The second is urge incontinence, where the signal from the bladder to the brain is so intense that we are unable to stop it, resulting in leaking. Finally the third type is mixed urinary incontinence where there is, you guessed it, a mix of the two.

How to stop leaking from happening, this is the million dollar question! This is my goal as a pelvic physio to help you answer so you can get back to all the activities that you love to do or simply improve your confidence in not having to scout out every bathroom, wonder if your pad is large enough, or if you smell like urine.

Lets look at an example of stress incontinence first. Take the person who leaks when jumping on a trampoline. What happens to the bladder when we jump? As we bend our knees and press our weight into the downward part of a jump before we spring up, the connective tissue (think skin, muscles, tendons and ligaments) stretch the same way that trampoline you are on does. So there is a big stretch with the force of the body going downwards. Now what should happen ideally is that as we rebound and sail in the air, the pelvic floor muscles should take all that energy from the downward stretch (think about pulling back an elastic band before you let it go) and contract to close the urethra opening. If our pelvic floor is a thick elastic band and we pull it back it will generate lots of force and close up the urethra. If the band is more compliant (ie. more stretchy, you can pull the elastic band back a lot with little force) we are less able to control closure of the urethra. So that snap back of the muscles and connective tissue is important for stopping leaking. What affects how ‘snappy’ our pelvic floor is? The biggest contributors are: Hormones (estrogen specifically), muscle coordination (think ability to relax and lengthen the muscle as well as shorten and contract), and biomechanics (the position of our center of gravity affects how efficiently load is transferred through the body).

Often my first question to tease out how to help someone stop leaking is to ask ‘when do you notice leaking the most’. For stress incontinence this is typically fairly obvious. If you leak when you cough, we are looking at optimizing your body position during your cough, timing a voluntary pelvic floor contraction to help meet the force of the abdominal muscles contracting, and considering overall the state of your hormones and wether this is playing into your connective tissue health.

So stress incontinence is common, and totally manageable if we can first identify when it is happening and start looking a bit closer at what is happening in the body. I hope this has been a helpful post and that you keep reading to learn more about urge urinary incontinence.