There are 3 main types of urinary incontinence:
1. Stress Urinary Incontinence: This is when you leak urine when you cough, laugh, sneeze, jump, run, lift, walk, etc. This is due to a pelvic floor that cannot respond to the increase in pressure in the abdomen with these activities.
2. Urge Urinary Incontinence: This is when you have a sudden urge to go to the bathroom so much that you sometimes cannot make it. This is due to a pelvic floor that is no longer able to manage your bladder. In a normal urinary system, your bladder will fill. Your bladder is a muscle and once it is full enough, it will contract. This sends the message to your brain that you must go.
Now, let’s say you are in a meeting, at the grocery store, or playing with your children and you cannot go to the bathroom right at that minute. Your pelvic floor should contract gently which in turn causes your bladder to relax. Essentially, your pelvic floor should be telling your bladder “Not yet”, allowing you to make it to the bathroom on your terms.
When your pelvic floor cannot give this feedback to your bladder, the bladder continues to contract earlier and stronger. Eventually, your bladder takes complete control, and you are constantly running to the bathroom and possibly leaking on the way. You should be able to hold your bladder for 2-3 hours without issues. You should be peeing no more than 8 times per day and once at night.
3. Mixed Incontinence: This is a mixture of both stress and urge incontinence.
**An interesting fact about these issues is that this can be caused by your pelvic floor being overactive or underactive and the only way to know for sure is to be examined by a pelvic floor physical therapist. **
- One way to improve urinary urge is by making sure the urine in your bladder is not irritating to the bladder.
- Make sure you drink enough water. Many people will limit their water intake due to the leakage. This will only make your problem worse because the urine that is in your bladder is especially irritating. A minimum of 64 oz is recommended.
- Certain foods and drinks can be especially irritating to your bladder
- Bladder irritant list
- Do not go to the bathroom “just because”, this trains your body to void too soon feeding into the bladder being in control.
Try modifying your diet and using these techniques. If you do not notice a change in 3-4 weeks, you should see a pelvic floor PT.
Pain with sex or dyspareunia is a very common problem affecting up to 60% of women at some point in their life. This pain can be with initial penetration, deep penetration, only with some positions, or even after intercourse or during or after orgasm. Due to how common pain with sex can be, it is sometimes thought to be “normal”.
We have many women who tell us that they thought sex was supposed to hurt because they had a baby, were post-menopausal, or were small statured. We’ve even had some women who were told sex is supposed to hurt for women. We are always surprised at the number of women who have just accepted painful, non-pleasurable sex as a way of life.
Some women are even told by their doctors that there is nothing they can do or to just use more lubrication. This can be devastating to women as painful sex can not only be frustrating for the woman, but it can impact her personal relationships. Some common causes of pain with intercourse are spasmed muscles of the pelvic floor, scar tissue, decreased lubrication due to hormonal changes, or weakness or atrophy of the pelvic floor muscles.
Physical therapy can help by using manual techniques to decrease spasming or scar tissue in the pelvic floor as well as giving you exercises to do at home that can also help the muscles to relax. We also can align the pelvis and ensure that the other muscles within your pelvis and abdomen are doing their job, so the pelvic floor does not have to work so hard. Ultimately, our goal is to teach your pelvic floor how to maintain the proper tone and strength to allow for pain free and pleasurable sex.
- Communicate with your partner about what positions are painful, which are not, and what you are feeling. Use a water based or natural lubricant as dryness can worsen the problem.
Pelvic Organ Prolapse:
Pelvic Organ Prolapse or POP for short is when one or more organs of the pelvis slip out of place. This is due to an imbalance of pressures within the abdomen resulting in symptoms such as heaviness in the vagina, a feeling of something falling out of the vagina, a change in sensation during sex, constipation, and incontinence to name a few.
Usually, the muscles and soft tissues of the pelvic canister work together to maintain the pressures in the abdomen. These muscles include: The pelvic floor, inner abdominal muscles, the diaphragm, and small muscles in your back called the multifidi.
If there is weakness or tightness in any of the structures, it will change the way the pressures are controlled and can contribute to prolapse symptoms.
Physical therapy can help as we will look at how the whole system is working and ensure that the necessary structures are strong enough, but also able to relax to allow for proper control of these pressures.
A recent study found that not only could prolapse symptoms be improved with a manual therapy approach, but the prolapse could be corrected as well. Which is amazing!
Pelvic Canister & Pelvic Floor Illustration
Diastasis Recti is the partial separation of a woman’s stomach muscles or “six pack” muscles during pregnancy. It occurs in many women during the last weeks of pregnancy, and for most women it will resolve by eight to twelve weeks postpartum.
A diastasis rectus that lingers after the first several weeks postpartum may be caused by increased tension in the pelvic floor or diaphragm, weakness in the inner core and pelvic floor, tissue laxity in the abdomen, and overuse of the rectus abdominis (six pack ab) muscles.
Due to these imbalances, increased force is distributed through the front part of the body (similar to POP) and can result in pain, difficulty working out, and difficulty doing daily activities.
Physical therapy can help with this by ensuring the muscles and structures of the abdomen and pelvis are all working as they should – contracting, relaxing, and coordinating together to prevent increased pressures moving through the abdomen and increasing the diastasis recti.
Illustration of Diastasis Recti
One of the main jobs of the pelvic floor is to stabilize the pelvis and sacrum. Your spine sits on your sacrum and if there is instability throughout the pelvis or the sacrum, this can contribute to problems up the spine as well. Also, the pelvic floor does not function alone. It works very closely with your inner core muscles, multifidi muscles, and diaphragm to support and stabilize your mid-section. Any dysfunction here can result in increased stress through the spine and result in back pain, hip pain, and leg pain.
If you have had long standing back, hip, or leg pain, have tried PT, chiropractic, massage, etc. with only temporary relief, there is a chance your pelvic floor is contributing to your pain.
Pelvic Canister & Pelvic Floor Illustration