Speaking About Leaking

Nothing can take the wind out of the sails of a breath and body practice faster than urinary incontinence.  I remember the first time I experienced this. I was at the gym in the middle of an aerobic workout when, “What the F?#**@? My first response was pure denial.  This must be some sort of freak accident.  Then it happened again, with jumping jacks and running.  This doesn’t make sense. I am in good shape. I exercise, work my core, do my Kegels.  So…..time out. Isn’t that enough? My current plan wasn’t working, so was it time to create a new plan? This started for me with some research into the issue from both the western and Ayurvedic perspective.

“A quarter to a third of men and women in the U.S. suffer from urinary incontinence.  That means millions of Americans. Studies show that many things increase risk. For example, aging, pregnancy, delivery and menopause increase the risk factors in women. “

-The Urology Care Foundation


How does it happen?

Brain, Bladder and Pelvic Floor Connections

Your brain and the bladder control urinary function.  The bladder stores urine until you are ready to empty. I am going to jump ahead (stay with me) and explain the muscle connection to your pelvic floor.  Believe it or not, you have 3 layers of pelvic floor muscles. The first layer is the most superficial and is home to the sphincter muscles.  Layer two is often referred to as the urogenital diaphragm. Layer one and two work together and intersect at the perineum. The third layer is the most internal and supports your viscera and internal organs (rectum, uterus and bladder).  These organs, rectum, uterus and bladder, are shapeshifters. They fill, empty and move in response to gravity and the position of your pelvis. Layer three is referred to as the pelvic diaphragm. Back to the bladder. When the bladder holds urine the sphincter muscles contract around the urethra.  When the sphincter muscles keep the urethra closed, you don’t leak. When you are ready to pee, the brain gives the bladder the go ahead and the sphincter muscles (layer 1 & 2) open. There are different types of incontinence. We will look at stress and urge.

Stress incontinence is when weak pelvic floor muscles let urine escape.  Leaking can happen with exercise, lifting, sneezing, jumping or coughing.  Any activity that puts pressure on the pelvic floor. Many time you are unaware until it just happens.

Urge incontinence is when your brain tells your bladder “hey buddy, time to go” even if your bladder is not full.  Just walking by a bathroom, your brain may say, “you should try” even if you don’t have the sensation.  The result is more brain-bladder-nuero connections that fire throughout the day with minimal urination.

How do I fix it?  You might be told to being with kegels.  It that doesn’t work your practitioner might recommend surgery — without educating you to fully exploring all options.

What is a Kegel?

I remember the instructions I was given.  “Just tighten it up down there like you are stopping the flow of urine.”  That’s it. No discussion or even practice to determine if I was even doing it right. I am sure the first time I engaged my pelvic floor I also gripped everything around it, held by breath and tightened my jaw.  I am sure that visual would have Dr. Kegel cringing. Yes Virginia, there really is a Dr. Kegel.  Dr. Arnold Kegel was born in 1894. He was the first American gynecologist to research exercise and strengthening of women’s pelvic floor muscles.  Dr. Kegel invented the perineometer to measure contraction strength. Today it is rare that a doctor will take the time with you that Dr. Kegel did. That is why it is important to be educated in order to be an advocate for your mom, sister, daughter or yourself.

Take Note of your Pelvic History:

When I sat down and wrote down my history – 2 pregnancies, episiotomy, 3 miscarriages and 2 D & C’s – it became real.  I was able to see where there could be muscle imbalance in my pelvic floor as after any surgery or event to an area, the muscles and tissue are healing.  Pelvic muscle imbalance can occur after the baby also. Many women carry their baby on one hip, which causes the muscles on that side of the pelvis to shorten to stabilize the baby.  This will affect their standing posture as more weight is on one leg. This, in turn, enables the pelvic organs to shift to one side, putting more pressure on each other, and the pelvic floor. From speaking with other women, it seems my story is fairly common.  I know that many women have a much more extensive histories which includes surgeries (Hysterectomy, C-Section, Leep Procedure, Uterine Fibroid Surgery and Ectopic Pregnancy), infections (UTIs, endometriosis and Pelvic Inflammatory Disease) and pelvic pain (pelvic fractures, IUD, and #Me Too).

What’s the next step?

“Body awareness is key to properly diagnosing ailments.  No doctor in the world will be able to tell you what it’s like for you to feel pain, tension or relief or any other sensation; this is information only you can access.  Yoga combines the external conceptual knowledge with the internal experiential understanding that only you can access”

– Leslie Howard

I have learned from practicing Body Thrive habits that I can be my own healer. This starts with looking at my habits.  Am I drinking something that is also a diuretic? What is my sitting/exercise posture like? What is my mental/emotional state when I am engaged in Breath and Body Practices? Being mindful during exercise to body position and breath is important. If you notice that you hold your breath during exercise, this is what is happening in your body: your respiratory diaphragm pushes down on the organs below it.  During normal exhalation (breathing out) the transverse abdominal muscle contracts and the pelvic floor lifts in response. Neither your respiratory diaphragm or your pelvic floor is moving but rather is held in a static position.  Holding a muscle in a static position can lead to imbalance. When you are exercising with a neutral pelvis, meaning your tailbone is not tucked or you pelvis is not forward with more weight one one leg than the other, your organs are supported by the musculature of the pelvis and hips. When your tailbone is tucked, the pelvic floor shortens, there is more weight on the lumbar spine and there is less room for the organs to be supported by the pubic arch.  If your pelvis is tipped forward, especially when running, your organs are resting against each other and applying pressure. The pressure and impact from running can shift the organs forward.  When this happens the pressure on the pelvic floor increases as the muscles are imbalanced and not supporting the organs. This forward pressure by the organs can contribute to stress incontinence.

A visit to a physical, occupational therapist or midwife that specializes in pelvic floor therapy will assist you in learning about the health of your pelvic floor.  Look for therapists that can offer a variety of treatment such as internal/external therapy, myofascial release, craniosacral therapy, as well as exercise. If you search the internet you will find many options for exercise, pharmaceuticals, and devices. I have explored a few online pelvic floor exercise programs with some success.  They review the anatomy and the exercises are aimed at a weak or hypotonic pelvic floor.  Recently I attended a pelvic floor workshop by Leslie Howard that put it ALL into perspective.  We discussed anatomy,diagnosis, hypo v hypertonic pelvic floor musculature, massage and yogic exercises.  As an extra bonus, our class was filled with wonderful women from all over the U.S. and Canada. These women were not only great problem solvers, but they were honest and open as we held the space for each other’s stories.

If something in this blog reaches out to you, I would encourage you to get more information for your mom, sister, daughter or yourself.