What is Urinary Incontinence?
Female urinary incontinence refers to the involuntary loss of urine, whether it be a small drop or complete emptying of the bladder. It is often experienced during pregnancy and after childbirth as well as later in life with menopause, but it should NOT be considered normal. Statistics show that between 10-30% of women between the ages of 20-55 have experienced urinary incontinence and 1 in 5 women over the age of 45 suffer from urinary incontinence, but only 1 in 12 are known to health care workers. Women are frequently advised to do Kegels or pelvic floor strengthening exercises when these symptoms occur. These exercises are effective when done properly, but the location of the muscles makes it difficult for us women to judge on our own if we are doing the exercises correctly. The exercises may not be as effective, despite best efforts, for several reasons including:
Tightness issue: The pelvic floor muscles may be too tight. Muscles, to activate or contract optimally need to be relaxed and at a good length. If we participate in pelvic floor strengthening exercises or Kegels with a tight, non-relaxed pelvic floor or participate in the exercises incorrectly, the muscles may become even tighter. This can lead to more issues with leakage as well as the development of pain.
Activation and symmetry issue: The muscles are not being activated at all, or only some of the muscles are contracting while the others are underperforming or not activating at all , despite best efforts. This can occur as a result of a tear or an episiotomy or even as a result of hip, low back and/or dysfunction of the pelvis whether it is due to tightness or weakness. This lends itself to asymmetrical activation. Participating in pelvic floor exercises in this situation often strengthens the already strong muscles promoting further asymmetry and potentially, further dysfunction.
Timing and/or sequencing issue: Leakage may be due to a timing issue, not necessarily a strength issue. The pelvic floor muscles may not be activating quickly enough or in proper sequence with the other core muscles to balance the change in intra-abdominal pressure that occurs with activities such as coughing, sneezing, laughing, heavy lifting or jumping. Participation in Kegels alone, often does not address this issue.