You are a tired new mom, finally out for a run. This is your time - you get a small break - a little time alone. It’s finally fall and beautiful out. You tie your shoes and start down the block. All is right with the world, UNTIL - hard stop. Wait….Was that PEE??
This is such a common scene. Peeing your pants happens a LOT (just check how many commercials there are for adult diapers). I’m thrilled the advertising world is letting us know how common it is - we sure don’t talk about it much. What they’re missing, though, is that it can often be fixed, not just covered up.
How? Well, that depends on the cause. There are lots of things that can lead to leaking (aka urinary incontinence, aka peeing your pants). One is childbirth - hence, the example above. Not everyone who has a baby will leak, but a lot of them do. Other potential causes include hip or back pain, abdominal or pelvic surgery, overactive bladder, hormonal changes, age, diabetes...the list goes on. Let’s just say there are a bunch of people who can develop this...not just new moms and old ladies!
But really, just how common is this? It’s estimated that approximately 17-37% of women (that’s around 15 million women!) and approximately 3-10% of men in the United States will develop leakage at some point in their lives. I’d say that’s a lot!
So what to do? Well, the treatment depends on the cause, but here are some of the options:
Cover It - Yes, this is of course an option. I call them ‘wearables’ and there are many of them. For example, there are pee-proof undies, loads of pads and diapers, a space-occupying thing to help support the bladder, even a little stick-on doo-dad that you place directly over the urethra (pee-opening). None of these fix the problem of course, but depending where you are in the process, it’s peace of mind to know they’re there. I could go in depth on each of these options, but that’s too much to cover right now - we’ll get back to that later.
Medicate or Sew It - On the other end of the treatment spectrum is medical - injections, medications and/or surgery. There are bulking injections - these plump up the area around the top of the urethra to keep pee from escaping. Medication can help keep the bladder from contracting all the time. And there are many surgeries - the main goal here is to give some support to the urethra or bladder. All of these are best described by the MD’s - urologists and urogynecologists in particular. A good pelvic PT should be able to direct you toward the right MD for your issues.
Not ready to wear a diaper or go under the knife? Good News!! Pelvic physical therapy has been proven to take care of it in many cases! See here for proof.
“Wait - PT for my lady bits? I don’t know about that... Besides, kegels don’t work. I’ve tried a zillion of them - they don’t help!” I hear this every day. The simple truth is that you’re absolutely right - kegels don’t work….at least not by themselves. Yep - I said it.
Sometimes pelvic floor exercises are part of the answer. But there is so much more. Sometimes (more often than not, actually) you may have to learn how to LET GO of the pelvic muscles. Anyone who has ever felt that drip knows the feeling - like “maybe if I just hold it all..the...time…” But how can you contract something for support if it’s already contracted? We have to consider the full body to really get to the main issue - whatever that means for you.
Depending on what the cause is (remember, there are LOTS of different causes), what other things are going on (like do your hips hurt too? are you constipated? have you had surgery?), what your goals are (sitting on the couch a bunch or getting back to CrossFit?) and what’s going to help you stop leaking may be something completely different than Kegels!
Look at it this way - if you have a shoulder injury, would you only do biceps curls to rehab it? No! You use all of the muscles around the joint to get it back in working order. The same goes for the pelvic floor. It’s not always about just squeezing! The pelvic muscles work with all of the muscles in the pelvis, hips, back, abdomen, etc. Seriously - take a look at the few muscle groups shown here and how interconnected they are! We can use all of them to retrain the pelvic floor (and bladder) to do what they’re supposed to do.
Let’s take it one step further. Using that shoulder example, do you think the shoulder would ever recover fully if every time you raised your arm, your hip hurt? Would you be able to reach that top shelf in the pantry? Nope. Same goes for the pelvis. It’s connected to everything above and below. What happens in one place affects what happens in another. While the bladder and leakage may be the thing yelling at you, the real driving issue may be something completely different.
Put simply, leakage is a symptom - something is not working right and it shows up as peeing your pants. Our job is to help you find out what that is and how to fix it.
THIS is how we are different. We are not just “pelvic floor” therapists, we are therapists who specialize with all-things-pelvic! We believe the pelvis and all it contains (read: bladder, bowel, etc) are part of the whole body.
At Activcore, we figure out (and treat) what’s causing YOUR type of leakage using a full-body approach. Treatments may be (in part) what you expect - pelvic exercises, biofeedback, and hip exercises. But there’s so much more! We use a combination of Redcord Neurac, manual techniques and/or dry needling, gadgetry when needed (biofeedback, perineal electrical stimulation, vaginal weights). Click on the links below to find out more about all of the ways we help you get rid of leakage once and for all.
Thanks for reading and we look forward to meeting you soon.
If you are having signs and symptoms of pelvic floor dysfunction or you’ve had unsuccessful treatment in the past, click here to find an Activcore location near you.
You can learn more about this topic by visiting our Pelvic Health page.
2001 - Prevalence of Urinary Incontinence
2016 - UI reported by women in primary care
2019 - Physical Therapy and UI treatment
ABOUT THE AUTHOR:
Beth Kemper is a physical therapist and double board certified Women’s Health Clinical Specialist (WCS) and Pelvic Rehabilitation Practitioner (PRPC). She has more than 20 years of experience in the study and practice of pelvic health.
Beth works as the Lead Physical Therapist at Activcore in Atlanta, Georgia, located just 2 miles from Emory University. She also serves as Activcore's National Director of Pelvic Health.
With an extensive clinical background and education, Beth is uniquely qualified to handle more complex conditions like pelvic floor dysfunction, including bowel, bladder and sexual health problems. She holds a double Bachelors degree in Biology and Chemistry from Meredith College, as well as a Masters degree in Physical Therapy from Emory University, ranked among the top 10 PT schools in the country. She also has advanced post-graduate training in manual therapeutic interventions and pelvic rehabilitation for all genders and throughout the lifespan.
Beth is the founding physical therapist member of Emory Hospital's Pelvic Multidisciplinary Team. She also co-founded a PT clinic in her hometown of Asheville, NC before returning to settle in Decatur, GA. She is a mother, dancer, hiker, wife, friend, runner and physical therapist, passionate about pelvic therapy.
Beth goes beyond the pelvic floor and looks at the whole body to help you recover from pain and injury, and safely return to a fulfilling life of sport, activity and wellness. She is among less than 1% of all physical therapists across the United States who possess dual board certification as both a Women’s Health Clinical Specialist (WCS) and a Pelvic Rehabilitation Practitioner (PRPC) for all genders. These designations make her exceptionally equipped to treat you from head to toe. Additionally, she is recognized nationally as a leading authority in the application of Redcord, a suspension exercise system designed to help you develop a smarter, balanced body through the power of neuromuscular activation. [READ MORE]