Do you leak urine when you sneeze, cough, laugh, jump, or run? This condition is called stress incontinence. All of those activities have something in common: they create physical stress in your body, whether it is through impact (running/jumping) or increased intra-abdominal pressure (coughing/sneezing). In an optimally functioning body, the pelvic floor muscles automatically engage to counteract the stress created by these activities. When this automatic action of the pelvic floor is lost or diminished, it can cause pesky leaks and other issues, like pelvic organ prolapse. Click here to review the function of pelvic floor.
Stress incontinence can happen to anyone, but it is most common in people who are or have been pregnant. This is because pregnancy puts additional strain on the pelvic floor. As the uterus grows, these muscles get stretched and may grow weak or uncoordinated. As a result, they may not be able to contract strongly enough or at the right time, causing leaks.
Contrary to what you may have heard, stress incontinence isn’t something you have to “just deal with” when you have kids. You aren’t doomed to “peeze” for the rest of your life! You can regain your ability to counteract physical stress in your body by retraining your pelvic floor. Here are three actions you can take to get started:
1. Learn to correctly engage your pelvic floor
A successful pelvic floor muscle contraction creates both a squeezing action and a lifting action. To get it right, imagine you are sucking a smoothie up through a straw; your lips close (squeeze) around the straw and simultaneously create an upward force (lift) to pull that smoothie into your mouth. Or, if you have female anatomy, imagine you are trying to pick up a marble with your vagina. You have to grab the marble (squeeze) but you also have to pull it up (lift).
To practice this, lie down and bring your awareness to your pelvic floor. Take a breath in and let yourself relax. Then, as you exhale, attempt to suck up that smoothie or pick up that marble—squeeze and lift your pelvic floor. Try to hold this engagement for the duration of your exhale, then as you inhale, relax completely. Don’t try another squeeze and lift until you have completely relaxed your pelvic floor muscles! This is important for relearning the coordination of your pelvic floor and preventing pelvic floor over-activity or tightness. All muscles need to rest in between work.
2. Learn to turn it on at the right time—squeeze to sneeze!
Now that you have learned how to correctly engage your pelvic floor, it’s time to practice in a real-life situation! The goal is to time your pelvic floor muscle contraction with the activity that typically makes you leak. An easy way to remember is the phrase “squeeze (and lift!) to sneeze.” The problem is that we don’t always know when a sneeze or cough is coming, so I recommend practicing with something more predictable, like blowing your nose. Squeeze and lift your pelvic floor right before you blow your nose. Remember, blowing your nose is just a big exhale into a tissue. If you can, hold the pelvic floor muscle contraction for the duration of that exhale. As you inhale to get ready for the next big blow, let your pelvic floor muscles relax completely. Then, re-engage them the next time you blow out.
Once you’ve practiced a bit with blowing your nose, it’s time to move on to sneezing and coughing. Try to remember, “squeeze to sneeze” and turn on those pelvic floor muscles as you sneeze/cough. Don’t get discouraged if it doesn’t happen right away—it takes practice, and it takes strength! You will likely need to build up the strength and the coordination over time before you see results.
3. Get help from a pelvic PT
If you feel like you can’t relax the pelvic floor muscles or that you can’t figure out how to squeeze and lift, I recommend getting help from a pelvic floor physical therapist. A pelvic PT will be to able assess your pelvic floor for weakness, lack of coordination, or tightness. They will teach you how to locate those muscles and properly engage and relax them. They will also be able to create a custom program to help you improve your pelvic floor muscle function.
If you’re struggling to find a pelvic PT in your area, here are some directories to help you locate a therapist near you:
Best of luck! You got this!
Rhea Physical Therapy provides at-home pelvic health care to women and children in the St. Louis, MO area and beyond. Rhea PT is owned and operated by Dr. Savannah Carlson, PT, DPT, RYT. Dr. Carlson is a pelvic health specialist who is dedicated to helping her clients overcome pelvic floor dysfunction so they can reach their full potential at home, work, and play. She earned her doctor of physical therapy degree at Washington University in St. Louis. The information provided on But First, Pelvic Health is for educational purposes only and should not be used as personalized medical advice.
But first, Pelvic Health. 