Urinary Leakage: Is it WEAK MUSCLES -or- is it a BLADDER PROBLEM? - And what to do about it.
Let’s talk anatomy and physiology first. Hang with me here.
The bladder is a muscle. As the bladder fills up with urine, it sends a signal to the brain. This prompts you to decide 1 of 2 things. 1: I am ready to go to the bathroom. 2: I’m not ready to go to the bathroom, I need a few more minutes to finish what I’m doing.
When you are ready to use the restroom, your brain sends a signal back to the bladder and it squeezes out urine. While the bladder muscle squeezes, the urinary sphincter relaxes.
The pelvic floor is a set of muscles that sit like a bowl at the base of the pelvis. Among its many functions, it acts as a second layer of protection against urinary leakage.
When you cough, sneeze, run, jump, etc. the pelvic floor engages (or tightens). This puts pressure on the urethra so that urine stays put. And that’s what we want!
So how can we tell if urinary leakage is a muscle problem or a bladder problem?
There are a few ways you can determine this.
**If your BLADDER is the problem you may notice:**
1. Needing to use the restroom more frequently than normal
2. When you feel the need to pee, the sensation comes on very quickly and strongly
3. You notice certain foods or drinks make you more likely to leak
4. You may notice that you can go several hours without having to pee (5+ hours)
**If your MUSCLES are the problem you may notice:**
1. Urinary leakage occurs with things like coughing, sneezing, laughing
2. Exercise causes you to leak
3. Your muscles feel tired because you recently had a baby
4. Things feel heavy in the vaginal or rectal area
5. You have a hard time relaxing and find yourself clenched (clenching the butt, pelvic floor, abs, thighs, etc)
What can you do to help yourself?
If the problem is your bladder, here are some things to try:
1. Track how often you’re using the restroom for 24 hours. The normal is 6-8x during the day and 0-1x/night (if you’re under 65).
a. If you’re going more than 6-8x/day, try to slowly increase your time between bathroom breaks. I would start with 10-15 minutes
b. If you’re waiting several hours to pee, make yourself go every 2-4 hours, even if you don’t feel like it.
2. Track how much you are drinking -AND- what you’re drinking for 24 hours.
a. Certain drinks are irritating to the bladder (some people are more sensitive than others). Things like caffeine, carbonated beverages, and alcohol can be bothersome to your bladder lining, which makes you more susceptible to leakage. Limiting these things can help.
b. It’s important to drink enough fluids, particularly water. Aim to have pee that is clear or close to it. I personally try to get at least 90 ounces of fluids each day.
3. Start to recognize if your bladder makes you rush to the bathroom.
a. We want to avoid rushing to the bathroom.
b. Try doing 3 kegels and then slowly making your way to the bathroom.
c. The bladder cannot be the boss of us!
If the problem is your MUSCLES, here are some things to try:
1. This one will sound weird. Make sure you are keeping your muscles RELAXED!
a. Tight and overworked muscles are inefficient and they cause problems
b. If you notice you are tense, try some breathing and relaxation exercises
2. If you feel like your muscles are relaxed, but you feel like strength is the problem, then let’s add in some kegels
a. DISCLAIMER - some people will tell you to do a million kegels. Some people will tell you to never do kegels. What’s the right answer? Doing the right amount of kegels for your body and your situation. There are times when I tell someone not to do kegels. But these are the people that need to relax their muscles.
b. Start with doing 10-20 quick kegels 3-4x/day
1. This is very generic but can be really helpful
2. Remember - A kegel is a LIFT and a SQUEEZE of the muscles.
3. Try the KNACK
a. Simply kegel before you cough, sneeze, laugh, etc.
4. Try prepping the pelvic floor before exercise
a. Do some kegels, 20-30
b. Do some light, quick hops - focusing on tension in the pelvic floor - 3x30 seconds
What else should you know?
It’s definitely possible to have a BLADDER and a MUSCLE problem. The simple solutions above can be helpful for both.
Pelvic organ prolapse (cystocele, rectocele, uterine prolapse) can also cause or contribute to leakage issues. I strongly suggest asking your OBGYN, PT, or Midwife to check this for you if you suspect it’s an issue.
Neurological issues such as a stroke or brain injury can impact the urinary system. Please seek out a Pelvic Health PT.
There are several things that can contribute to Urinary Leakage. If you have tried some of these easy things to help and nothing has changed, please reach out to your local Pelvic Health PT. We are specially trained to treat these issues and we tailor programs to fit YOUR needs.
Best wishes,
Cortney