At least 1 in 3 women experience stress urinary incontinence at some point in their life.  It can be leaking with a cough, sneeze, or jumping on a trampoline. Anything that creates a sudden increase in pressure to the core muscle team.  And although the first thing to be blamed is pelvic floor weakness, it could actually be something quite different.  Timing.

Let’s break down what the pelvic floor and core muscles are getting wrong, how they are SUPPOSED to work, and how you can start fixing this issue.

What’s going WRONG?

When a person coughs or jumps and they experience leaks, often their pelvic floor muscles are just not ready for the task and are delayed.  This could be due to the muscles already being tensed up, slow to activate, or just completely disconnected.  If these muscles attempt to contract at the exact time of the demand, they will already be too late and we will leak pressure from the intra abdominal canister.  These muscles include the diaphragm located just under the lungs to the pelvic floor and all of the abdominals that wrap around.  And the timing of things SHOULD be happening on auto pilot.  Unfortunately, there are life events that can throw this auto pilot program off it’s game and then we are stuck in a place where these muscles no longer are ready for the task in terms of timing.  This can include abdominal or pelvic surgery, pelvic pain, chronic muscle tension, and more.

How are the core muscles supposed to work to stop leaks?

Milliseconds BEFORE any stress to the core muscles occurs, they should be anticipating the demand by LIGHTLY activating in an upward and inward direction.  This light muscle activation gets the ball rolling so that the muscle fibers are already doing their thing as the stressor hits the system.  When this happens correctly, the pelvic floor and core muscles are already going in the right direction as they increase their activation with the cough, sneeze, jump, or even laugh.

When it happens correctly, we shouldn’t really notice that they just did their job.  We only notice that we didn’t leak urine if we are thinking about it.

Notice that I mentioned that these muscles prepare by LIGHTLY activating?  That’s right.  There is no need to consciously grip, clench or hold back the flood gates so to speak.  They just need to anticipate the demand by activating lightly.

So how can a person work on this timing?

First, the issue with timing needs to be identified by a pelvic physical therapist with a thorough core and pelvic floor assessment.  We will screen for many things including breathing, alignment, coordination, strength, endurance, tension, and timing.  But at home, you can identify if your muscles aren’t ready for the demand by doing a cough test.

• While laying on your back with knees bent, place your hand gently on your stomach to monitor for movement, then cough.  If you felt your stomach bulge outward into your hand, your deep core muscle team is not activating properly and did not draw inward as it should, to help manage pressure.

• Imagine that the act of coughing or even clearing your throat gently is an upward movement where the belly and entire canister (diaphragm to pelvic floor) move up.

If you find that your belly bulges outward, try to see if getting onto your hands and knees helps.  First, take a belly breath and let your stomach relax with the inhale.  Then cough.  For many, getting into this position helps the core muscles activate in the right direction and with the proper timing.  You could start to practice by getting into this position and take a breath in and then cough or clear your throat 5-10 times in a session.  You can even cough softly or with more force as a way of scaling the exercise up or down based on how your core muscles do.

If this does not work for you, try laying on your side with knees bent.  Place a yoga or Pilates ball in front of your stomach.  Take a breath IN to prepare and then press the ball down with your top hand, lightly squeeze your pelvic floor and then clear your throat.  You should feel your stomach activate right along with your pelvic floor with the ball press and then even MORE when you clear your throat.  You should not feel your pelvic floor bulge down again. Do this 5 times on each side.

This can take practice to learn how to scale the force of clearing your throat or coughing so that you can find the difficulty that your pelvic floor muscles can manage.

The goal here is to retrain your deep core and pelvic floor to prepare for the demand and get used to what that feels like so that it becomes a habit again.  It will take focus at first before it turns into muscle memory.  As this becomes easy and feels natural, then you can scale this to upright postures and into exercises that include jumping or hopping.

Other things to note:

• If you have a history of pelvic pain or know that you have tension in your pelvic floor, it will be important to FIRST learn how to release this tension and be able to lengthen these muscles.  Your potential power and strength comes from this lengthened position.  Not from an already shortened and contracted position.

• If you are struggling to feel or sense your pelvic floor and are not sure what a contraction is supposed to feel like, then we would strongly encourage you to consult with a pelvic floor therapist as they can help you reconnect with your pelvic floor.  We are used to helping many patients with this… it happens quite frequently.

If you are feeling like kegels have not been helping you with resolving those occasional or too frequent leaking episodes, timing may be the bigger issue for you.  Feel free to connect with us as we would love to help you solve your issue once and for all.