Have you heard of the term ‘Light Bladder Leakage’, or LBL? More correctly termed Stress Urinary Incontinence (SUI), this type of leakage occurs during exertion, like coughing, sneezing or higher load exercise.
This issue is very common, affecting one in three women, and even more in the populations who have had children and who participate in high impact exercise.
The common media message tends to be to wear an incontinence pad and accept that it’s just part of being a mother. But as I explain in the following article, with the right plan of attack, you can be empowered to fix this problem instead of accepting it as inevitable.
Why Do We Leak?
Leaking during exercise or other activities of exertion is all about pressures. Things like coughing, sneezing, jumping and running increase the pressure in the abdomen, which means an increased pressure onto the bladder.
We can usually stay continent and avoid leaks because we can keep a higher pressure in the urethra (the ‘wee tube’) than in the bladder. But if for some reason we can’t use the muscles and connective tissue in and around the urethra to close it adequately, then the pressure in the bladder can become too much for the system to handle, and urine leaks out.
As women, our anatomy unfortunately puts us more at risk of this imbalance happening. We have a wider pelvis to help with childbirth, and a shorter urethra. These things means that innately it is going to be harder to bring together the two sides of the pelvic floor, and create pressures in the urethra large enough to match and beat higher pressures in the bladder.
Why Can This Be Worse After Having A Baby?
In pregnancy, our body does a great job of preparing for a vaginal birth. Our pelvis doesn’t know if we are going to have a Caesarean section, so regardless of the mode of delivery, our body has prepared for a baby to pass through the pelvis by softening the connective tissue and widening the space between the two sides of the pelvic floor muscles.
Therefore, pregnancy alone can be the trigger for the system to be compromised and leaks to occur with coughing, sneezing or exercise.
Additionally, pregnancy is a time of increased pressure down on top of the bladder, with the increasing weight of the baby and the uterus, and therefore the urethral closure system has to work harder than usual. Add in regular vomiting, which pregnant women often unfortunately experience, and you’ve got an even more ‘perfect storm’ for pressure imbalances to occur, and SUI to happen.
Then of course, the process of the baby coming down through the pelvis during childbirth can cause direct injury to the tissues. If damage happens to the pelvic floor muscles, the supportive connective tissue, the urethra, the blood vessels or the nerves, this can all impact the ability for the system to stop leaks during times of increased pressure.
What Kind of Pelvic Floor Exercises (Kegels) Can Help This?
We know that pelvic floor training is the gold standard for treating SUI, but a very important thing to note is that one size doesn’t fit all with Kegel exercises.
Studies that have been done that show good effects have not involved simply giving women with SUI a brochure about doing generic pelvic floor exercises. Instead, they have involved the women having individual assessment of their pelvic floor muscles via vaginal examination with a specialist physiotherapist, and then an individualised program being put in place.
Many women need help with pelvic floor awareness, as they don’t know how to correctly contract or relax these muscles. They may inadvertently be bearing down to try to stop leaking, or they may be holding their pelvic floor muscles on constantly through the day leading to tired, overworked muscles that can’t increase pressure on the urethra when they need to. Sometimes improved awareness of that area of the body, and a recognition of how to completely relax as well as how to contract, is the key.
For other women, they need to work on increasing the strength of the pelvic floor muscles. A strength program involves working the muscles to fatigue, so a physiotherapist needs to determine what exercises are needed to achieve this in different women.
Sometimes what needs to be worked on is what’s called ‘The Knack’, which is the body’s ability to get the timing right of the pelvic floor contraction. Many women need to practice how to turn on the pelvic floor correctly, and then hold it on during the increase in pressure (like a cough) and then release it again afterwards. Eventually this should become a natural, subconscious process.
And in almost every woman with SUI, there needs to be a holistic approach to incorporating pelvic floor activation into more complex movements, activities and exercises.
Which Other Exercises In Addition To Kegels Can Help?
It is very rare that pelvic floor exercises alone are going to completely cure SUI.
It is very important for a physiotherapist to get the woman to move quickly from static, isolated Kegels into upright, functional positions and movements. For many women, leaking occurs during exercise such as running, changing direction, or landing from a jump. It is often impossible to achieve a conscious pelvic floor pre-contraction before doing these face paced, often unexpected movements.
Leaking might be being caused or worsened during these activities because of the way that the woman is moving, and often ‘doing something different’ can be a big part of decreasing symptoms.
Could she practice landing from a jump in a different way?
Could she be holding her breath each time that she changes direction, and would relaxing her breathing help her?
Could she be running with her chest and arms being held in a very stiff position, and would more movement through her trunk help to decrease leakage? Would leaning forward a little more help?
While the pelvic floor is being strengthened or optimised, an agility program or a graduated running program that tests the limits of leaking is important. There has to be a bridge to get back to the movements and load that the woman wants to do with her chosen exercise.
Can you insert anything in the vagina to help Stress Urinary Incontinence?
The other things that can help in addition to pelvic floor exercises are physical supports that are worn inside the vagina.
These devices are often helpful to those women who don’t just have pelvic floor weakness but who also have connective tissue damage, and can be seen like wearing an ankle brace. Ankle braces help to support the ligaments in the ankle, and allow a person to return to getting strong and fit, without risking increased damage, in the same way that vaginal support devices can allow a woman to get the benefits of exercise while decreasing leakage.
Like ankle braces, these devices are not a cure for SUI but rather a tool in the overall management.
The most basic version of this is wearing a maxi tampon during exercise, and seeing if this adds any urethral support and decreases symptoms.
More permanent versions of this are devices such as a ‘Contiform’, which can be purchased online, or a vaginal support pessary, which is used in cases where there is also some vaginal prolapse, and these need to be fit and managed by a physiotherapist or other specialist health practitioner.
So, in a nutshell…
SUI affects a lot of women due to our anatomy and the potential injuries that can occur during pregnancy and childbirth. Very good quality evidence has been shown that pelvic floor exercises can help to decrease or cure SUI, but it’s very important to note that this should be done in conjunction with a specialist physiotherapist, and possibly with adjuncts like agility drills, overall strength work, and vaginal support devices.
In the words of FitRight Physiotherapist Taryn Anderson:
“As a Mum, you shouldn’t just have to rely on black leggings to be able to exercise or play sport. Please don’t feel like your body has let you down – it’s done an amazing job and just needs a little support and TLC to get back to doing what you love.”