EEEEP! I’ve just peed on myself!

Rest assured, Mama, you are not alone. Your pelvic floor was under some serious strain during pregnancy. Experiencing bladder leakage in the postpartum period is extremely common. This condition is called stress incontinence, and it affects nearly 40% of women who have been pregnant.

The strain and downward pressure of the growing baby from pregnancy stretch the pelvic floor beyond its control. It is interesting to note that delivery via c-section is not a Golden Ticket to escape pelvic floor issues. Studies report that rates of stress incontinence are statistically the same for women who birthed vaginally vs. cesarean section. I point this out so that those moms who delivered via surgical birth and are experiencing stress incontinence know that it is common.

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If you have ever experienced peeing when coughing, peeing while laughing, or felt dribbles of urine leak while running or jumping, read on. There are ways to approach dealing with bladder leakage that offer both temporary and permanent improvement.

What is the pelvic floor?

Stress to the pelvic floor is the main cause of bladder leakage. This condition is called stress incontinence.

The pelvic floor is like a hammock. It hangs within the pelvis and is the base of the core muscles.  The job of that hammock is to help keep organs like your bladder, uterus, and rectum where they should be. The pelvic floor is responsible for closing off the urethra and anal sphincter to keep bodily waste inside until you relax them for elimination.

Without the sphincter control of the pelvic floor, you experience stress incontinence. Stress incontinence means peeing (even just a tiny bit) on yourself when you laugh, cough, jump, or run. And while it is extremely common, it is not normal!

This belief that bladder leakage is just part of being a woman is wrapped up in the incontinence myth. Time to bust that myth!

How can I stop this annoying bladder leakage?

There are lots of options for temporary, daily management of stress incontinence. Some women opt to use panty liners that are specially designed for incontinence. If that doesn’t offer enough protection, leak-proof underwear is a great washable and reusable option.

For women who experience bladder leakage while running or other high-impact exercise (like Cross Fit), wearing a bladder support pessary — essentially an incontinence tampon– can work. It puts pressure on the bladder and urethra to stay closed even when jarred from jumping.

All of these options work fine. While it may seem funny at first to say things like “I’m crying down my leg!” imagine how you are going to feel 10, 20, 30 or even 50 years from now. Do you really want to still be peeing on yourself? No!

Finding a permanent solution that heals your body is a much better option!

How can I stop peeing while coughing or laughing or sneezing?

If you are peeing while coughing or laughing or sneezing, your pelvic floor is weak. The good news is that pelvic floor exercises are easy to do on your own.

Depending on the severity of your pelvic floor trauma, you may regain strength by performing kegels. As you exhale, lift the pelvic floor and squeeze the vagina; inhale to release. Keep your breathing deep and even. Repeat for 10-15 lifts at a time.

Remember, though, that your pelvic floor is also responsible for the integrity of the anal sphincter. When doing Kegels, make sure to get your anal sphincter is getting in on the coordinated lift and squeeze action.

Training your pelvic floor is no just about the lift and squeeze of the Kegel, though. Think about how your body works in daily life and how you need your pelvic floor to be strong to stop bladder leakage. If you’ve ever peed on yourself while lifting something heavy, practicing squats with coordinate breath work (exhale as you stand) is a good place to start.

Moving your legs through natural ranges of motion help to dynamically strengthen the pelvic floor because you are challenging it to work in different planes. That’s how you move in everyday life!

One of my favorite activities that works the pelvic floor without you really realizing it is ice skating. The out-and-back push of each stroke stretches the pelvic floor. It’s a great option for women who can’t load their knees with weights. You can mimic the skating motion on a slide board or even just in your living room (but it’s just not as much fun!).

I’ve tried all kinds of pelvic floor exercises. They don’t work for me. What else can I do?

If you are more than six months postpartum (even if that means six or sixteen YEARS postpartum) and have been doing pelvic floor exercises regularly and are still experiencing leaking, a pelvic physical therapist can help.

These trained professionals are experts in identifying where the breakdown is in your body that is causing the bladder leakage. Even better, they know how to teach your muscles to start talking to each other again so that you can stop peeing on yourself!

There is no need to be shy or embarrassed about going to a pelvic physical therapist. Stress incontinence issues are incredibly common. There is no shame in asking for help to get your body back to working well again.

Severe pelvic floor trauma

Extreme pelvic floor dysfunction can lead to prolapse. Prolapse is when internal organs like the bladder, cervix, uterus, rectum, or vagina are not in their correct place inside the pelvis. Instead, they have “slipped” and can be protruding out of the body.

If you think you have experienced prolapse, do not delay making an appointment with your healthcare provider. This is not something you can “just live with” and it is likely to worsen over time without intervention. (Thanks a lot, gravity!)

Without attention, a weak and traumatized pelvic floor will likely lead to pelvic organ prolapse. A prolapse is when one or more of the pelvic organs protrudes from the body– basically, your insides are on the outside. It is neither comfortable nor healthy.

Can a pelvic organ prolapse be fixed?

First of all, if you’ve suffered from a prolapse—whether silently or with proper medical help—know that you are not alone! It is extremely common in postpartum women.

If you think you might have a prolapse but aren’t sure, read this article by Dr. Brianne Grogan, pelvic physical therapist and author of Lady Bits. It will help you have a clear and informed discussion with your health care provider. With the right treatment plan, a prolapse can be rectified and you can regain your active lifestyle.

My doctor said I have a diastasis. Is that why I have bladder leakage?

Could be! Diastasis recti is the separation of the abdominal muscles along the midline of the body. Often, women who experience a diastasis also have stress incontinence. This is due to the hammock of the pelvic floor being suspended from where the abdominal muscles meet at the pelvis. So if the abs are stretched out of their proper position, it’s likely the pelvic floor is affected, too.

Not all women who experience a diastasis suffer from stress incontinence. Likewise, you may experience bladder leakage even if your abs are in the right place.

Just curious: Is it possible for my pelvic floor to be too strong?

Actually, yes. A hypertonic pelvic floor indicates that muscles are too often held in the contracted (lifted) position. While this may sound like a good thing—no leaking EVER!!—it has serious ramifications. First, women with a hypertonic pelvic floor often develop bladder issues. They are unable to fully void the bladder, which means bacteria doesn’t leave the body as it should. Also, a too tight pelvic floor can cause painful sex.

Tightly Wound is a short documentary about one women’s experience with a hypertonic pelvic floor. If you are experiencing similar symptoms, please see a pelvic physical therapist right away. In the meantime, Dr. Isa Herrera’s book Ending Female Pain could be helpful to you.

I’ve never been pregnant, but I’m noticing a bit of bladder leakage as I’m getting older…

You’re not imagining things! Lowering levels of estrogen during perimenopause cause laxity in the pelvis that can lead to stronger urges to urinate and greater incidences of incontinence. Even if it’s just a dribble here and there, it’s worth noting. If you can address the issue now, you’ll be more likely to have long-term success with reducing or even eliminating the leaky episodes.

The Well Balanced Women blog is for educational purposes only and is not medical advice. Please discuss your health issues with a licensed medical practitioner.