Is Urinary Leakage Normal?

The most important thing to understand is that urinary leakage is common but it is not normal.

Urinary leakage is the involuntary loss of any amount of urine without intention to empty the bladder. This can range from a small drop to full loss of bladder which can be a sign of pelvic floor dysfunction. Urinary leakage, or sometimes referred to as incontinence, affects 50% of adult women but can also affect men.

Most causes lead to short-term urinary incontinence, but if left untreated or is not addressed can become long-term problems. 

Types of urinary leakage

The two most common types of urinary leakage are stress and urge urinary incontinence. Stress urinary incontinence is often experienced with exercise, coughing, sneezing, laughing, running, blowing your nose, etc. If you experience leakage with double unders, you are experiencing stress urinary incontinence.

Stress urinary incontinence happens when the sphincter muscles in the urethra relax, allowing urine to be released. The increased abdominal pressure from high-intensity movements like jumping rope or jumping jacks can lead to urine leaks. 

The pelvic floor and urinary leakage/incontinence

The pelvic floor is the floor of the core and much like a soda can. These muscles aid in maintaining pressure and containment of the contents inside our trunk. When we apply pressure to our trunk, (cough, sneeze, laugh, exercise, etc.) we are applying a compression force to that “soda can” which if not appropriately “packaged and closed” can lead to incontinence. 

Urge urinary incontinence is most often associated with when the bladder is full and leakage occurs before you reach the toilet. Other types of urge urinary incontinence simply occur when there is a great and sudden urgency to urinate and leakage occurs almost immediately. People can also experience a combination of both types of incontinence.

Women experience urinary leakage more than men due to having unique health events, such as pregnancy, childbirth, and menopause, that may affect the urinary tract and the surrounding muscles. The pelvic floor muscles that support the bladder, urethra, uterus (womb), and bowels may become weaker, damaged, overused, and or painful. Because these events affect most women, urinary leakage has been stereotypically labeled as something normal that happens with age or after having babies. This is simply not true. Urinary leakage can be experienced by men and women at any age and it is never normal.

The pelvic floor muscles are made up of 70% endurance fibers and the other 30% are strength/power fibers. It is important to understand that these muscles don’t just need to be strong, but they need good endurance so that no leakage occurs with any sort of activity or when the bladder is signaling that it is time to empty. The pelvic floor muscles should not necessarily be felt or contracted all day long. They hold a specific tone/tension that keeps continence but it is not an action that we voluntarily keep track of or contract constantly. Certain factors can increase the chances of urinary incontinence such as pregnancy and vaginal birth, weight gain, damage to the bladder or nearby tissues, certain medications, and neurological conditions that affect the brain and spinal cord (Parkinson’s and Multiple Sclerosis). 

How can leakage, especially stress urinary leakage, be prevented and or stopped?

It is not a simple answer when it comes to addressing pelvic floor dysfunction due to the many factors that influence the pelvic floor, but there are some great foundational principles that can help prevent future or further dysfunction.

1. Do not hold your breath or strain when performing any activity (rising from a chair or floor, lifting a heavy object, getting out of bed, exercising)

   Instead, breathe out as you perform an activity and engage the core.

2. When you are coughing, sneezing, laughing, or blowing your nose:

   • Tighten up the core and contract the pelvic floor muscles right before these activities and maintain that contraction until the activity is over

   • Breathe out

   • This is not as easy as it sounds so make sure to practice before a real situation

3. Breathing during heavy exercise or jumping can help prevent leaking

   You are allowing pelvic floor to move with the diaphragm to provide stability to the core when engaged (especially when breathing out)

4. Use a voluntary pelvic floor contraction with movements or activities in which you are leaking with (transfers or exercise)

   • Make sure to tighten up the core and contract the pelvic floor muscles right before performing the activity but keep breathing

   • Keep them activated until the activity has been completed

   • Again, do NOT hold your breath

5. If any leakage is occurring regularly with an activity, do not continue doing this activity and “push through” 

   Urinary leakage is a sign of pelvic floor dysfunction and should be addressed

   Not addressing or ignoring this symptom can lead to further pelvic dysfunction, compensation, and worsening of symptoms

6. Seek out the help of a pelvic floor PT to aid in finding the root of the problem

   Many people falsely believe “Kegel” exercises at home will solve urinary leakage. These exercises may be one element of a larger treatment plan or may not be recommended for your condition in the first place. When a person does a pelvic floor contraction incorrectly or without other treatments, their symptoms won't improve or could even worsen. If you are experiencing any of these issues, it’s time to see a pelvic PT.

Where to find pelvic floor physical therapy

At Samson Strength and Performance Physical Therapy, we offer pelvic health physical therapy to those in the Jacksonville Beach area and beyond. To get started and to ask any questions you have about pelvic floor physical therapy, book your free call now!

Next on your reading list:

1. What does a pelvic health physical therapist do?