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Bless You!

Many women struggle with leaking urine with sneezing, coughing, laughing etc.…  Often this occurs after we have had babies, but it can happen if you haven’t had children too.  By design, our pelvis has a vagina, leaving a structural weakness.  This weakness is a tradeoff to allow for some pretty important functions…sex and delivering our children.

Our amazing vagina leaves an area of structural weakness that pressure can find.  Unlike the anal and urethral openings, which have sphincter muscles that help to close them off, the vagina does not.  This leaves it susceptible to high levels of pressure, particularly when you cough, sneeze, laugh or exercise. Incontinence or prolapse can arise during activities like these that increase abdominal pressures. 

Childbirth is not an excuse though!  You don’t have to deal with leaking urine just because you have had a baby.  There are exercises and techniques to utilize that can help the system recover and allow you to trust your body when you sneeze or cough.  Here is how:

Initially, you need to reconnect you diaphragm and your pelvis.  You can do this with 10 minutes daily of diaphragmatic breathing.  Get into a comfy spot, lying down to begin with.  Inhale, allowing your abdomen to rise and widen with your breath, nice and slow.  Don’t let your chest rise, all movement comes from the belly.  Exhale, allowing abdomen to fall. 

Now you can add in the next step, connecting with the pelvic floor muscles.  In the same position, lying on your back with knees bent up and feet flat, engage your pelvic floor muscles by imagining you are picking up a blueberry with your vagina.  This visual works for most women, because when the pelvic floor contracts we get a squeeze and lift of the perineum. Do this for 10 reps: pick up the blueberry, and let it go.

Next, we will add coordinating the abdominal wall with the pelvic floor.  Same position, pick up your blueberry and as you do that, draw your belly button up and in GENTLY.  You should feel your abdomen firm under your hands, and your waist should slim. Think of the work as moving up from your pubic bone to your sternum.  Perform 10 reps.

Last, let’s begin to work our endurance fibers too.  Because these muscles are postural, they are required to maintain some low-level activity for longer periods during the day.  WE can work endurance by performing the same Pelvic Brace: pick up your blueberry, lift belly button up and in and now hold this.  Your goal is 10 seconds, but likely you aren’t there yet, so start small. 2-3 second holds for 10 reps and work up to being able to hold for 10 seconds, 10 reps.

These need to be done daily.  These are specifically to coordinate the diaphragm and pelvic floor and begin to regain improved motor control and ability to take increased pressure in the abdominal wall. You need to perform these for 4 weeks before you decide if they are helping or not.  If you don’t find any improvement with these exercises it would be a good time to schedule and appointment with a pelvic specialist in physical therapy who can assess your body and help guide you with an individualized plan of care. 

A few other items that can help use the pelvic brace before you sneeze or cough!  This way you are retraining the muscles to fire before the pressure increase, preparing the system for the quick change in pressure.  Make sure you are emptying your bladder at least ever 2-3 hours during the day. Holding your bladder too much causes the system to struggle and is stressful for your pelvic floor.  Make sure you are drinking a lot of water, and limit caffeine, carbonation, artificial sweeteners and alcohol.  These are all bladder irritants and can worsen incontinence symptoms.

Lastly, seek help from a pelvic specialist!  You will be surprised how much progress you can make and how strong your core can be with an individualized plan for you!  Don’t use babies as an excuse to tolerate leaking.  You don’t have to wear pads, or just deal with it.  Our clients find reduced leaking in 4-8 weeks of therapy!

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