It happens to so many women. One in three to be exact (one in two over 50). I laughed so hard I almost peed my pants turns into I laughed so hard I actually peed my pants. Or you sneeze and there’s a little unwanted surprise. You can blame pregnancy, menopause, or a weakened pelvic floor (most likely a combo of the three).
We chatted with Evelyn Hecht, an NYC-based Master Clinician of Pelvic Physical Therapy, about all things incontinence. From the physiological reasons why it happens to things that you can do to stop it (and, no, kegels are not the answer for all).
Simply put, incontinence is when urine leaks out when you don’t want it to. There are two types. Stress incontinence happens when you’re doing something physical – laughing, coughing, lifting weights – that increases the abdominal force pushing against the pelvic floor. When the pelvic floor lacks the ability to counteract that force, it cannot keep a tight hold around the urethra, so leakage happens.
Urge incontinence occurs when the detrusor muscle (which facilitates the contraction of the bladder) sends a signal too soon that you “gotta go”. Usually the urge to go happens when the bladder is filled up to a size of a grapefruit, but if the nervous system is overly sensitive, you may get the urge to go when the bladder fills to a smaller size, like a clementine. (If the nervous system is being over-sensitive, getting you in a faulty pattern of feeling the urge to go even though you just went).
The Root Of The Problem
The pelvic floor is a diamond-shaped group of muscles that sit at the base of the pelvis – from the pubic bone to the tailbone – and controls urination, bowel movements, sexual function, and core stabilization.
First things first: See your doctor to rule out a medical condition. Then head to a pelvic floor therapist, who can increase its functionality through breathwork, stretches, relaxation, and core stabilization. Been doing kegels religiously and not seeing any improvement? That’s because it’s not always about strengthening those muscles to address leaking; often a person needs help softening or relaxing them instead. Everyone is different, and there is no one-size-fits-all fix for incontinence. That’s why a pelvic floor therapist can really help.
The Other Warning Signs
Women commonly present with incontinence, but oftentimes, they’re also experiencing things like painful sex, constipation, or a history of lower back pain. That’s because the pelvic floor plays a part in all of these functions! Makes total sense.
What If It’s Not That Bad?
If you don’t address incontinence, it’ll get worse over time in terms of more leaks and/or increased frequency of your urge to go. People often tend to rack up coping strategies without even realizing it: Knowing where every restroom is at the office, wearing pads “just in case”, and stopping drinking liquids after a certain time.
Pregnancy & The Pelvic Floor
The pelvic floor supports the weight of the baby during pregnancy, so it’s greatly affected by those 9 months. Add to it the fact that giving birth – whether vaginally or via C-section – is considered a trauma to the pelvic floor, and it’s no surprise so many women experience incontinence post-birth. With the right guidance, it’s entirely possible to heal it, but that education just isn’t the norm in our country, so women have to be proactive.
Menopause & The Pelvic Floor
During menopause, women lose a lot of estrogen, which is the hormone that keeps your bladder and urethra healthy. This loss can also weaken the pelvic floor. The combo results in leakage, but it doesn’t have to be like this! Physicians (specifically OBGYN’s) are well-versed in hormone replacement therapies that work for some people. If the problem still persists or that’s not an option for you (not all women are candidates for this), a pelvic floor therapist can be immensely helpful.
Evelyn recently launched a pelvic healing at- home program that’s accessible completely online. Pelvic floor therapy is expensive and patients can’t always travel to see a specialist, so she came up with this step-by-step regimen that can be done on your own and in combination with your pelvic floor therapy. Evelyn has a private Facebook support group and one-on-one Zooms to help you on your healing journey. Women who have completed the 3 month program have successfully reversed pelvic pain, lowered anxiety about pelvic issues, and decreased incontinence.
Evelyn is offering Hazel readers a 10% discount to her Silver, Gold, or Platinum Pelvic Home Program with code PELVIC10.