Peeing when you cough, sneeze, laugh or jump does not have to be the norm just because you have had a baby. It’s easy to brush off some mild leaking here and there, whether pregnant or postpartum, but it does have an impact on our overall health. If this is you, your first step is to get an assessment from a Pelvic Floor Physical Therapist, from the very first leak, who can diagnose the cause and treat you accordingly.

What is Stress Urinary Incontinence (SUI)?

Stress urinary incontinence (SUI) is the leakage of urine during moments of increased intraabdominal pressure (IAP), such as coughing, sneezing, jumping or lifting heavy. If your SUI is more severe, you may also leak with less forceful activities like walking, standing up or bending over.

Reasons You MAY Be Leaking

1) A weakness of the pelvic floor.

The pelvic floor, similar to other muscles in our body, has a range of motion that it moves through for optimal function. The pelvic floor can lengthen, relax and shorten (contract). A weak pelvic floor is a result of being stuck in an end range position, either really tight or really loose, and not moving in either direction when responding to demand.

Think of it like this: If you contract your biceps and hold it contracted, it would be really hard to make the muscle stronger because you’re holding it in a shorted position. To strengthen the bicep you must be able to relax the muscle, lengthen it, to then get a full, big contraction, like doing a biceps curl. The pelvic floor is exactly the same. When it’s tight (i.e doing a kegel all the time), it can’t get a good contraction and to build strength you need to generate force over the full range of motion.

If your pelvic floor cannot relax and lengthen, then when you cough/sneeze/lift heavy, your pelvic floor cannot move WITH the force and maintain control and because of this there is an increased force on your pelvic organs (bladder) resulting in leaking.

TO RELAX: diaphragmatic breathing drills are a great place to start. Including positions with your hips elevated if you are struggling to let go.

TO LENGTHEN: release the deep hip rotators, glutes and get your hips moving while practicing your breathing. Focus on deep inhales DOWN and OUT. As well as your belly moving, you should feel a gradual build of pressure in your rib cages and back body.

2) Incorrect breathing strategies during exercise

During the early postpartum period I would encourage exhaling through exertion. That being said, research has shown that using a valsalva movement does not harm the pelvic floor, but bearing down and straining does. Valsalva and straining are too very different pelvic floor activation patterns and for many, it’s more so your technique rather than the breath hold itself leading to pelvic floor issues like SUI.

Before you start breath holding to create tension prior/during to your lift, work through these steps:

• Have you spent the time to really utilize a 360 breath to really get your diaphragm to turn on your pelvic floor? The pelvic floor does not work in isolation and proper coordination is a crucial part of the core musculature system.

• Once you have mastered your diaphragmatic breath, in various position, add to movement. Inhale during the easy portion of the movement (e.g. as you descend into a squat) and exhale during the more challenging portion of the rep (e.g. rising from the bottom of the squat). Gently lift your pelvic floor during your exhale. The strength of your exhale and pelvic floor contraction will vary depending on the demand of the exercise you are performing. Once you have connected back to your core and pelvic floor, you will not have to be so intentional with your lift as your pelvic floor will reflexively contract with your exhale.
• If this technique doesn’t work, you can try initiating your exhale just before you begin the hardest part of the rep. For example, pause at the bottom of the squat, begin exhale and slowly rise or exhale through the entire rep (if your breath allows).
• It’s also important to note that during postpartum there is not a prescribed, one size fits all approach to your optimal recovery. The point is to find something that allows you to feel strong and supported during loaded/all movement.

Once you have mastered the basics, assess on HOW you start the reps

Focus on inhaling higher and wider (think breathing into your lats and bra line). This will help you avoid a shallow breathing pattern and bracing out or bearing down before beginning your lift. This applies to the valsava technique and breathing through the reps. If you aren’t sure what that feels like, trying some back expansion drills to practice breathing into your back body more

3) Clenching your glutes excessively, especially at the top of squats and deadlifts.

We’re likely already holding a lot of tension in our glutes, abs, pelvic floor after having a baby.

The squeeze at the top isn’t what’s building your glute strength. The glutes are under the most amount of tension during the pull of a deadlift and at the bottom of a squat. All that excessive squeeze is doing is encouraging you to ‘tuck under’ and compromising your pelvic floor. Positionally, it’s not the best at absorbing that load!

What we’re looking for is for the glutes to stabilize the pelvis at the top of the lift and not cause a tuck-under. A light ‘pinch’ or squeeze is totally sufficient. Just stand up tall!

4) The range of motion of your reps

Similarly, to moving your pelvis out of an ‘optimal position’ at the top of the rep, you can also do this at the bottom. For example, the ‘butt wink’ during the squat. If you’re noticing your symptoms of SUI increasing at the bottom of the rep, make adustments like reducing the range of motion by squatting to a box while building up depth and adequate lumbopelvic control.

5) Lifting too much weight for where your body is currently at

The load you’re using during certain exercises is more than your pelvic floor muscles can tolerate and therefore cannot adequately maintain continence. Your form breaks (this ties in with the above), or you hold your breath and strain to get out of the bottom of you squat pushing too much force downwards. Your pelvic floor needs to be progressively overloaded, which means you need to gradually build weight over time.