Why You Leak When You Exercise (Stress Incontinence Explained) - Episode 40
This episode of the Marrón Pelvic Health Podcast, hosted by Dr. Kari Roberts, focuses on stress incontinence— an involuntary urine loss during activities like coughing or sneezing. While many associate incontinence with aging or postpartum issues, it can affect women of all ages. The podcast emphasizes the importance of understanding incontinence and its risk factors, such as hormonal changes or high-impact activities. Dr. Roberts suggests that pelvic physical therapy can help by providing assessments and exercises to strengthen and improve coordination. Awareness and understanding are crucial for addressing stress incontinence effectively.
Book a call with Dr. Kari Roberts today.
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Dr. Kari: Have you ever coughed, jumped or sneezed and tinkled a little bit and wondered if that's normal or if you should seek out medical attention for that?
If so, then stay tuned to this episode because I'm going to get into it.
Dr. Kari: Welcome to the Marone Pelvic Health Podcast. Hi, I'm your host, Dr. Carrie Roberts. On this show, we will be discussing a variety of things regarding your pelvic health. These conversations will be a mix of education,
personal experiences, and a blend of tips you can apply to have a healthier pelvis. The goal of this show is to normalize conversations around pelvic health and help women stop suffering in silence.
Dr. Kari: And one of those things we're talking about today is leaking when you cough or sneeze or laugh real hard.
And we're just going to get into it. And as a friend, I'm going to talk to you girlfriend to girlfriend, friend to friend. I'm going to. I'm going to keep it a buck, but at the same time, I'm going to give you some education.
We're just going to start by normalizing what is real and normalizing what the proper terms of some of these things are.
So in the spirit of keeping it real,
you know, keeping it a book.
When you lose urine from your bladder, when you do not intend to,
that, my friend, is a form of incontinence.
I know a lot of people think that incontinence is when you actually wet your pants, pee yourself,
everything goes. Or you think it's for old people,
or you think this is what happens after you have a baby. But when you're out with your girlfriends or your cousins and you're cracking up and you just tinkle a little bit or you just have a couple of drops, that's not really incontinence.
It is.
It is. And when you lose some urine when you're coughing, sneezing, exercising, jumping,
all of those things, laughing,
that is called stress incontinence.
Fun fact, there are three types of incontinence. Stress incontinence is one of them.
And stress incontinence. I have my notes here.
I'm trying to give you guys really good stuff. I hope you appreciate my notes. Actually, matter of fact, if you appreciate the podcast, if you don't mind letting me know, because I'm taught it's just me,
this camera, this mic in these four walls, quite literally. So a little bit of feedback goes a long way. But anyways,
stress incontinence is an involuntary loss of urine when there is a Change in pressure.
I'm going to add a little hot sauce to that.
When you have voluntary loss of urine, when there is a change of abdominal pressure,
and the abdominal pressure is greater than the pressure that is created from the force of your pelvic floor muscles. So pelvic floor muscles, just as a quick, quick overview. When you're in a seat,
the pelvis, the muscles in between your sit bones, that's basically where your pelvic floor is. It has several jobs. One of its jobs is to make sure that you don't leak urine.
Or it's supposed to give you bladder continence because it's supposed to prevent bladder incontinence.
So when it is not working properly because of that change in pressure, that's when we call it stress incontinence. So if you get nothing else from this episode, please understand that.
Now,
why does stress incontinence happen?
And it's when the pressure. Because think if you're looking at me and I'm sitting, or you're sitting in this chair, you might be driving in the car, listening in a podcast, right?
In the car, listening to the podcast, right now,
you are sitting on your pelvic floor. It is at the bottom,
minus your legs, it is at the bottom. You've got pelvic organs on top of that, then you've got intestinal or abdominal organs. I'm sorry, I was thinking intestines, Your abdominal organs are on top of that.
Your lungs, rib cage is on top of that, your throat, your head, everything else, everything is above it.
So when we look at the abdominal area, specifically, so below the ribs, above your pelvic area, the abdominal cavity,
if that generates force,
then the pelvic floor should meet the same force. So you don't have any urine leakage. So when that abdominal force is greater than the force that the pelvic floor can create in that moment of time, it results in bladder leakage.
Quite simply, that's what happens.
Now, is it because the muscles are weak?
Is it because the muscles are out of coordination?
Is it because some muscles are overworking, some muscles are underworking? It could be all of those reasons, but just in the most simplest terms, when the abdominal pressure is greater than what the pelvic floor is generating in that moment in time, that's when results, that's when you result in stress incontinence.
What are some of the risk factors?
Some of the risk factors?
I don't.
When I was doing my research for the notes for this, some of the risk factors, I just I mean, they're true, but I don't want to villainize things that happen naturally, like childbirth or pregnancy.
Yes. That can give you a risk of.
Of having some changes with that, that abdominal, that pressure control. We'll call it pressure control.
Another one is your hormones. You know, hormones change. As a woman, we have a natural hormonal cycle. I just talked about that in the last episode. Check it out. If you haven't listened to it, I believe that's episode 29.
But you have a normal hormonal cycle.
Women, they say on average is 28 days.
So that's doing its thing. When you go in through puberty, that's a hormonal change that happens in young girls, you know, between 9 to 13.
Then you've got your perimenopausal, which could be anywhere from like, I'm roughing numbers,
35, 45, 38, 50. Somewhere around in there you've got hormonal changes. Then you've got postpartum.
That's a hormonal change. So there are all sorts of things that happen with a regular.
The maturation of a female body and the hormones will wax and wane and fluctuate. And again, though, it's not a lot we can do. It is what it is until you have medical intervention.
And that's why I kind of with the risk factors, because I just feel like it almost is like villainizing things that happen regularly. But I digress. I guess I'm getting on my soapbox.
Getting back to the risk of the risk factors. Other things is high impact sports or high impact activities, especially if they are repeated, that can put you at risk.
Other things, which is what I kind of like to think about because some things are just the way they are and you shouldn't villainize it, but just bladder dysfunction. Maybe you've picked up some irregular habits because you hold your breath, or you don't empty your bladder when you're supposed to,
or maybe you empty it too much. It could be a variety of things, or sometimes things just get kind of out of sync.
So bladder dysfunction. And another reason is mechanical imbalances.
So remember when I was saying when the force of the abdominals is greater than the force that the pelvic floor is producing in that moment, that really can be a mechanical issue.
It could be a coordination issue as opposed to a strength. It could be strength. But what if everything's equally strong but it's just not turning on when it's supposed to?
Then that's when it's more of A coordination thing and a little bit less of a strength thing.
Now this issue of stress incontinence, it can be affected by those high impact sports that I just mentioned, repetitive activities.
So you're thinking your hiit, your high intensity interval training, you're thinking jumping rope jumping jacks, plyometrics, jumping on the box, you're thinking distance running,
jumping on a trampoline,
trying to think, lots of laughing,
coughing. It's springtime right now in Georgia. The pollen is coming like any day now.
So yes,
coughing.
So I do get an influx of patients this time of year in the springtime that might, everything might have been getting better. And then they have a little bit of a relapse because they're coughing so frequently.
So frequently. That's that change of that high impact. That's changed. Excuse me, not high impact. That high pressure has changed over, over, over with that sneezing, with the allergies. I also see it a lot in the wintertime when people are sick with the cold and flu.
All that coughing, repetitive,
repetitively, all of that coughing, coughing, coughing, change of pressure, change of pressure, change of pressure. And sometimes the pelvic floor just kind of gets out of sync.
Something else is the pelvic floor muscles, legit could be weak,
that could be a thing.
Or the pelvic floor muscles could legit be not coordinated with the abdominal muscles. That's also a thing.
So, so that stress incontinence is affected by those things and also fatigue. Maybe someone is a distance runner and they can run four or five miles, but when they're getting into 12 and 13 and 14,
that's when they're starting to notice the leakage. So that's more of a fatigue situation as opposed to a purely strength thing.
And so can you start to see the examples I'm giving? These are everyday things. People cough, people sneeze, people laugh. Right. People have good times with their friends and family,
people exercise.
And so you're thinking those day to day activities, this can be a very common thing. Which is why I said initially,
if you are losing urine involuntarily when you don't want to, that is technically incontinence because we need to understand what is normal. So then we can understand what is abnormal, normal.
We can understand what does not have to be tolerated. Or you can make the choice, you know what, I tinkle, I pee a little bit when I'm with my girlfriends and it's not that big of a deal because I always wear panty liner and I change it Every time I go to the bathroom.
I don't know. Or maybe you've just gotten in the habit of it and you thought it was normal and never thought anything about it. But when you are educated and when you have the knowledge now, you can make the decision.
And is this a big deal or is it not a big deal? Okay. Is it a deal that you want to get treatment for, or is it something that you just want to deal with so you get to make those decisions as opposed to just being, you know, throw your hands in the air?
It just is what it is. It's not.
You have choices.
So what can pelvic physical therapy do to help if you are dealing with stress incontinence? Well,
we can do a lot,
but one of the things we can do is we can do a proper assessment of your pelvic floor and the tissues that attach to the pelvic floor. So your abdominals, your hips, your legs, all of that can have an impact on what's going on at the pelvic floor.
And so if we find true weakness, then we can do true strengthening. If we find a true lack of coordination, we can do tons of coordinating exercises to help those muscles fire together and work together.
Then there's this whole other thing with lifestyle changes. Are you having leakage? Because maybe you are overloading your fluid intake at certain times of the day,
and when it's overloaded, then you leak. Okay, so let's look at changing how you're taking in that liquid and changing the types of liquid you take in. Maybe certain things are triggering more than others.
And then you think about, are you getting enough water? Are you not getting enough water? We can assess that. And then if you're getting enough water,
maybe we need to space out how you get it. Or if you're not getting enough water, maybe we need to increase some so your urine is diluted a little bit.
So all of those things play a part.
Also, when we're thinking about the mechanics,
what's your posture like when you're jumping? Jumping that rope, jumping on the boxes,
doing your jumping jacks when you're actually running? How's your posture when you're running uphill? How's your posture when you're running downhill? How's your posture at mile 12, 13, 14,
as opposed to 1 or 2? All of those things can make a difference. And all things we can make a difference through proper assessment and treatment with pelvic physical therapy.
So what can you do to prevent stress incontinence?
One thing is, if this is exercise related. You can do a proper warmup and a proper cool down.
I'll be honest, I'm not the greatest at warmup and cool down either. You're like, I'm, well not. You're like, I'm here for a workout. I want to get it in, I want to get it out, I want to move on to the next thing.
But your body will thank you.
Maybe your body does need to be warmed up properly. Maybe your body does need to be cooled down properly. Maybe you just need to tweak your exercise routine. I was just talking about it with a friend of mine over the weekend and she was saying how her running improved when she really leaned into more strength training.
So, you know, you might have to switch up your exercise routine a little bit to get the results that you want.
If you are following a workout program or a running program, maybe you don't go from 0 to 60 real quick.
Maybe you gradually increase the intensity or you're gradually increasing the distance or you're gradually increasing the duration. Those things you have complete control over. And maybe as you're making gradual changes,
then you won't get that stress, incontinence.
And if you have leaks when you're doing heavy lifting, heavy pushing, heavy pulling. Now, heavy lifting is not just at the gym, friends. Heavy lifting is also when you are that person.
I'll raise my hand. I'm guilty.
You don't want to do all those trips back and forth with the groceries and you're pull, you're picking up everything in their mother at one time. Or you're carrying cases of water in.
Possibly you have to go up a set of stairs or two.
That is heavy lifting, my friend. Okay,
so maybe when you're doing the heavy lifting, you need to adjust your mechanics and make sure you're not holding your breath. Or if you are doing lifting,
weight training, if you will, at the gym or working out at home,
changing your breathing pattern can help so that you don't build up so much pressure. So then that way that pressure is not overloading your pelvic floor.
Let's say you start this episode, you've listened to it a couple of times, you're coming back a couple weeks later, you're like, okay, Carrie, I did XYZ and I'm still having some leakage and I'm not really cool with it.
Call me. That's what I'm here for. I want to educate people, but I want to help people. So. So give me a call,
jump on my website, click the link below that says book with Dr. Carey. Let's have a conversation and let's see if I can help you so that you can cough, sneeze,
laugh, enjoy life, exercise, carry groceries, and do all of that without leaking.
Until next time, my friends. I'll see you next week with another episode.
Thank you for listening to this episode
Dr. Kari: of the Marron Pelvic Health Podcast.
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