You may have seen this video that CrossFit highlighted during regionals in 2013. If not, take a pee-k. https://www.youtube.com/watch?v=UKzq1upNIgU You may have had other women warn you that motherhood or any amount of aging will make box jumps and double-unders a more humid activity for your spandex. But no matter what Miranda Oldroyd, other women, or even Billy Madison taught you, it isn’t cool or an indication of your intensity or an inevitable part of active womanhood to pee your pants. It’s a common problem that many women whisper, joke, and complain about amongst themselves, but very few do anything about it.
Stress Incontinence or stress urinary incontinence (SUI)
If you pee a little while lifting heavy things, doing box jumps, laughing, sneezing, coughing, or doing double-unders, you are probably experiencing stress incontinence. Stress incontinence happens when sudden pressure is exerted on the abdominal cavity and involuntary leakage occurs.
For many people, the culprit is a weak or uncoordinated pelvic floor, the hammock of muscles on the bottom of the abdominal cavity that supports the bladder and allows the colon, urethra, and vagina to pass through. Many women sustain injuries including nerve damage to the bladder, urethra, birth canal, and pelvic floor muscles during childbirth; but moms aren’t the only ones who struggle with this issue. Other women who have never given birth and even some men suffer from pelvic floor weakness or an inability to engage muscles of the abdominal cavity properly for a number of different reasons.
I experienced stress incontinence before I was pregnant whenever laughed really hard, did a lot of box jumps, or sneezed unexpectedly. After a difficult pregnancy and long hard labor, my bladder prolapsed, my urethra was damaged, and I lost the ability to control the muscles of my pelvic floor and abdomen. At 3 months postpartum, I often peed my pants doing nothing but standing around and always peed when sneezing, coughing, or making any sudden movement. Working out was primarily restricted to a bike and walking because any sort of impact or lifting weight heavier than my baby was impossible. Now, at 16 months postpartum after extensive physical therapy, I am capable of doing box jumps, lifting about 75% of my pre-pregnancy one rep maxes, and doing small hops without peeing myself! However, I’m still not running. My injuries and issues may be more extensive than some, but it has given me the opportunity to learn about a broad spectrum of incontinence issues and solutions. That’s right, there are solutions. When did all the females decide to just give up on holding their pee? You can do something about it. Stop peeing your pants!
I will warn you on your quest to find a solution, it might take a while to find a doctor who won’t shrug and mutter vaguely sexist things like “welllll, you are a mother…you can’t expect your body to be the same as it was.” Thanks dumdum, I wasn’t asking for you to make me look like Barbie and function like Wonder Woman, I just want be able to hold my pee when I blink (maybe someday double unders) and not have my bladder threatening to fall out the bottom of me. Many doctors told me that I was being impatient as a first time mom. I went through a couple doctors before one agreed that I shouldn’t be peeing my pants just teaching in my high school classroom at 3 months postpartum. She gave me multiple options including physical therapy. My physical therapist and doctor both emphatically reassured me that stress incontinence is not something that moms or any other women should just live with. For some women, addressing incontinence issues may require a multidisciplinary approach involving OB/GYNs, urologists, and women’s health physical therapists. (Cichowski, 2011)
In order to determine the cause of SUI and be able to pursue solutions, you should speak with your doctor. I can’t help you determine the cause, but I can share a number of solutions I learned about from specialists.
MEDICATION: For many reasons, I opted to not take medication, so I can’t share my personal experience in this matter. There are a number of medications prescribed for various situations. The Mayo Clinic has a great article summarizing types of medications and in what situations they are often prescribed. http://www.mayoclinic.org/diseases-conditions/urinary-incontinence/in-depth/bladder-control-problems/art-20044220?pg=1
PESSARY: Designed to help patients with pelvic organ prolapse, this little silicone disk initially sounded awful to me. But it has turned out to be one of my best friends. The silicone disk is like a mini hammock for traumatized pelvic organs. They are quite a bugger to get fitted properly, but when I received the correct size, I didn’t feel it once in place. There are a number of different sizes and styles depending on a patient’s needs. Pessaries are designed to be inserted into the vagina and once in place, they actually prop up the bladder and urethra, through the vaginal wall. They can be worn for days in a row or inserted/taken out as needed. Read more here. http://www.webmd.com/urinary-incontinence-oab/vaginal-pessaries
PHYSICAL THERAPY: This is my strongest recommendation to anyone (especially athletes) who experience stress incontinence. Many physical therapy clinics have a women’s health or pelvic floor physical therapist who has gotten their PT degree plus extra coursework and training in order to treat pelvic floor issues. You might be thinking, “but I do kegles, and they’ve never helped! Why should I try physical therapy?” Many women do kegles incorrectly, and doing them may be somewhat helpful for strengthening pelvic floor muscles, but not necessarily functionally applicable to a CrossFit workout, sneezing, or snatching a 35lb toddler out of the street. Do you practice varying lengths of static holds while sitting in the car at red lights? How would only practicing a static hold while sitting in your car help you engage muscles the way you need to engage them while in the bottom of a heavy squat clean, doing double-unders, or picking up a child? Pelvic floor physical therapy is much more than kegel training.
Women’s health PTs will do a full pelvic exam and medical history to help determine the cause of SUI and make a treatment plan. They can help patients strengthen related muscle groups, gain control of contractions, coordinate muscle group contractions, breathe properly through movements, and maintain better alignment through daily functional to more athletic movements. Read this article for a more thorough explanation of the issues that physical therapy can address. http://pelvicguru.com/2013/08/05/10-common-misconceptions-about-pelvic-physical-therapy/
An article in Contemporary OB/GYN sites a 1993 study in which “Sixteen percent of the women receiving pelvic muscle exercise training reported cure compared with 3% of controls. In addition, 44% of the pelvic muscle exercise group reported a 50% to 99% improvement in symptoms. Other studies have reported approximately 60% improvement in SUI symptoms after pelvic floor training.” (Cichowski, 2011) Pelvic floor physical therapy might not cure everyone, but it has been shown to be an effective tool in improving symptoms. After just one month of physical therapy, I saw gains in my pelvic floor strength and control as well as a considerable reduction in leakage in day to day function. Now at 16 months postpartum with my pelvic floor muscles much stronger, I’m focusing on coordinating my diaphragm and pelvic floor through both daily and more athletic movements. This is a really important factor that some women miss. It could be that the female athletes (some of whom have never had children) depicted in the video above have weak pelvic floors; however, I find it more likely that they are just not regulating their abdominal pressure system well. Want to learn more? Check out these links.
SURGERY: Depending on the cause(s) of SUI, there are some surgeries available to help women. Physicians may be hesitant to recommend this option to women who are not finished having children. Speak with your OB/GYN or a urologist.
OTHER OPTIONS: Some practitioners may also offer two other therapies. Electrical stimulation is a process in which the area of the pelvic floor is hooked up to a gentle electrical current causing contractions of muscles in the area. It is more routinely done in other countries for postpartum women. Read this article for more info. http://www.webmd.com/urinary-incontinence-oab/electrical-stimulation-for-urinary-incontinence Another new option is vaginal laser therapy. Whaaaat? Lasers for vaginas? Yes. The laser stimulates collagen growth which strengthens the walls of the vagina. The strengthened vaginal wall is then able to better support the other structures in the area including the bladder and urethra. This therapy was offered to me, but I’m hesitant. Because it’s on the newer side, there hasn’t been much time to report success and possible side-effects. Approach with caution.
Solutions with significant proven results exist, and new solutions are on the market now. If no one talks about this problem or pursues solutions, there won’t be much advancement for women’s health in this area. I’ve met so many women who go through life peeing themselves because they have no idea that there’s help available. Ladies, let’s not perpetuate the idea that peeing during daily events or workouts is inevitable and hopeless. Please feel free to reach out to me with questions. Good luck and may your pants be ever drier.
Cichowski, S. B., MD, & Rogers, R. G., MD. (2011, December 01). Beyond Kegels: When do gynecologic problems call for physical therapy? Retrieved from http://contemporaryobgyn.modernmedicine.com/contemporary-obgyn/news/modernmedicine/modern-medicine-feature-articles/beyond-kegels-when-do-gyneco