What is it?

Incontinence: Incontinence or leakage occurs is the involuntary loss of urine, stool, or gas.

Even small amounts of leakage are abnormal.  

Even if leakage only occur during sport activities such as running and weight lifting, it is still considered incontinence. And even if you can live with it or have been told it is “normal” by the people around you, it is a sign that there is a disconnect between your core, pelvic floor, and your diaphragm.  Seek care earlier, because the treatment time and visits required to heal will likely be less! Incontinence typically only gets worse over time without treatment.

What types are there?

Incontinence is labeled as stress, urge, reflex or mixed.

Stress incontinence is due to an imbalance of pressure throughout the abdominal cavity. This can occur during coughing, sneezing, laughing, jumping, or lifting something heavy.  

Urge incontinence occurs when there is an inability to hold things back long enough to make it the bathroom.  

Urgency is a sudden sense of needing to go immediately, such as when you put your key in the door at home and suddenly need to pee - but cannot make it to the bathroom in time.

Reflex incontinence describes a form of incontinence where you are unaware that you are having leakage.  This may be that you are simply having poor awareness throughout the day or can be a sign of neurogenic bladder. Neurogenic bladder is when there is a disconnect between the brain the bladder, and the muscles that are normally under conscious control can't be controlled.  You will need to manage this with your medical team. 

How is it treated?

Treatment of stress incontinence involves training the pelvic floor muscles, the core, and the breathing muscles to coordinate and better manage the demands of stress placed on the pelvic floor.  Posture and appropriate form during sport activities are also a key to the puzzle. Sometimes weakness or stiffness in the feet in hips can affect your bodies ability to shock absorb, placing further stress on the bladder, and may also need to be address.  Urge incontinence can be treated by adjusting daily habits & routines, learning how to appropriate relax and breathing, and reducing bladder irritants.  Your physical therapist will work with you to develop and individualized and efficient approach to managing symptoms.

A Holistic approach: not just treating the symptoms

Pelvic floor dysfunction is strongly associated with breathing dysfunction and disorders, such as COPD, asthma, cystic fibrosis, COVID, a deviated septum, or even allergies. Altered respiratory patterns cause altered demand on the pelvic floor and can be a source of prolonged stress to this muscle group. Physical therapy can address some of the changes that occurs with these disorders.

The pelvic floor is also directly influenced by nutrition, how the GI system digest food, and how well fueled the GI system is. Chronic diarrhea or constipation affect pelvic floor function, as can chronic under fueling or disordered eating. Furthermore, pelvic floor function can effect GI function, and contribute to not just difficulty keeping things in, but difficulty emptying. Your physical therapist will discuss this with you, make some recommendations, but may refer you to another specialist if it indicated.

Abdominal and pelvic scars can can also effect pelvic floor and core function, and the ease of movement of any scars you have and the surrounding skin, muscle and fascia may also play a role in symptoms. Hands-on work can address this and physical therapist can also instruct you in self-massage.

Treating pelvic floor dysfunction often involves looking at many different body systems to get to an underlying cause. Choose a therapist that will help address the underlying cause of your symptoms and refer you to other specialists if it is indicated.

Should I stop fitness activities (such as weight lifting/running) if leakage occurs?

It depends.  If you have stress incontinence, where leakage is occurring during intense physical activity, seek a physical therapist to guide you.  Sometimes the activity can be continued with minor modifications.  Your therapist will determine whether you are meeting points of performance required for you to safely continue the activity.  In other cases, modifying the duration or dose of the activity is all that is needed until strength or coordination within the system can be built up.