Shhhhhh don’t tell anyone. Just hide it. It’s normal. I REALLY hope I don’t have to do Double unders today”
I work with women who have babies, teens, and grandchildren. Women who cross-fit, Ironman athletes, soccer moms and grandparents who just want to play with their grandchildren.
We talk about almost everything but no one talks about leaking. Leaking when they laugh or cough, leaking when they jump, run, or pick up a toddler.
IT IS NOT NORMAL, although sadly it is common.
I would love to open the door and discuss a topic that is so important but shied away from in conversation. So let’s understand the problem first in Part I and then later learn some basic tips in Part II
Part I – The Problem
I have friends and patients who go to the bathroom twice before they lift, jump or run. Some who wear the biggest pads they can buy when they have a cold, and others who are super dehydrated because they do not want to fill their bladder just in case.
I quote, “I thought that [Leaking] is just what happens after you have kids”, or, “It’s fine. It’s only when I exercise, or have a bad cough”.
Having children, old back injuries, sitting all day, lifting incorrectly, training incorrectly, can all put strain on the body. While our bodies are amazing in how they get us from point A to Point B pretty much no matter what, it may not be very efficient. People will compensate, then that compensation
creates bad movement habits. Over a period of time can result in injury, or dysfunction. A mirad of dysfunctions can occur but the one I want to address today is leaking when you lift, run, jump, cough, or laugh. This dysfunction is very common, but in no way normal.
My patient said to me the other day,” I didn’t know there was anything you could do about it”. YES! There are ways to address the problem and change it but first let’s understand this dysfunction.
Leaking urine is a muscular dysfunction. Imagine this; A beautiful ballet at the theatre where the prima-ballerina leaps gracefully in to the air and her partner (probably a very handsome prince ?), bounds over to catch her, but he is a millisecond too late… He doesn’t stick the landing without a bobble and a step back to catch her. So, while she doesn’t fall to the ground, it is not the graceful catch you’d expect. If the muscles in the body are coordinated in timing and sequence, he sticks the landing and the catch is flawless. If the timing is not there, it’s a stumble and regaining your balance to perform. That is essentially dysfunction and compensation.
From ballet to the muscular dysfunction in our body. Our body likes stability. Our stability system allows us to move our bodies into the position to be able to control our muscular balance. I am not just talking about balance that keeps your butt off the floor, but the balance of all the muscles moving supporting our skeletal structure, and keeping our bodily functions in control.
We have all heard about “the core”, but what really is “the core”? Most people think of it as the abdominals, a six pack. What I am referring to today is the deep core, a TEAM of muscles that must work together, the starting line-up. This line-up is composed of the diaphragm, pelvic floor, transverse abdominals, and lumbar multifidus. These muscles work synchronously, meaning they are team that are meant to fire in a specific sequence so the body can do what it is supposed to, like run, jump, lift your kids and hold in your pee all at the same time.
Julie Weibe ( www.julieweibe.com) explains this system by the visualization of gears. The gears must all move in a sequence to create force and stability. In the past few decades fitness and healthcare professionals have been teaching people to “hold the core” (navel to spine), or isometrically contract pelvic floor, called a Kegel, to strengthen the pelvic floor to help with incontinence. The problem with this is we are asking the muscles to just to “hold”, when really the goal is to move, (like in a kickboxing class or to chase a toddler). One example Julie Weibe gives is that would be like asking someone to hold the quad tight (lock out the knee) and still run.
This technique is in the same vein as “tighten” the abdominals and brace for a lift. New research has shown that static isolated bracing puts increased pressure on the pelvic floor, decreasing its ability to keep the urine in. The other big new discovery is that while for years people have been told to bring the navel to the spine, this “hollow” or “flat back” position puts the pelvic floor muscles in a poor mechanical position to fire. When these muscles are inefficient, dysfunction happens, and as I said before – this can result in many various symptoms that include not only incontinence, but also back, hip, shoulder, rib, and cervical pain, as well as decreased athletic performance.
So now what? The biggest point I want you to get from this article is don’t hide, talk about it. I will include links to find a pelvic floor Physical therapist or sports medicine PT who is educated in this area (not all are) to help you get awareness to re-coordinate your patterns, this is crucial. It will not get better with denial.
The anatomy: The “gears” that work in a sequence,
a. the anticipatory musculature is the pelvic floor (PF), the sling of muscles from front to back of pelvis. This is what is engaged in a Kegal exercise. It should be contracted dynamically not a static hold.
b. On to the diaphragm. Seriously, who thinks about strengthening the diaphragm, no matter how much I work that one it never gets ripped ?, but breath holding is one of the biggest contributors to leaking, and lowering athletic performance with regard to decreased speed and strength. As thediaphragm engages it dips down into the abdominal cavity to pull the air into the lungs. When the breath is held in, breathing with the chest vs the ribcage more pressure is pushing in to the poor pelvic floor. It’s just like stepping on a water balloon, just pushing the urine out. If we hold our breath the gears stop, it’s not dynamic movement.
c. The Transverse Abdominis: very low, low abdominals. Often when trying to contract this muscle people will bring the belly button to spine or flatten the back, that’s not quite right, instead it’s the muscle that engages with a cough or laugh. As I said before we (the fitness industry) have taught a generation to isometrically hold that muscle in the wrong position for effective stability.
d. Multifidus: Deep spinal musculature in between each vertebral segment this is the deep muscle that is so important for stabilization and correct positioning of the spinal segments.
2. The actions:
- The beautiful coordinated ballet goes like this: the Pelvic Floor is the anchor, it sets itself up for all movements before they happen. You go to reach for a door your PF is ready, you go to kick a soccer ball your PF is engaged.
- The Diaphragm: In the right alignment, you take a proper breath, the diaphragm should move down and out. A deep breath should feel like you are opening an umbrella upside-down in the bottom of your ribcage. As this happens the PF should descend into the pelvis and the TA (the belly) should be pushed out a bit. This action sets those muscles up for a recoil response. For example, think of a broad jump or a box jump. Squat down first (loading the muscles of the legs) to get a great burst of strength to jump. Same thing with the pelvic floor and TA we must first load them with breath then they recoil to hold the spine, pelvis and leg in a safe stable position to move.
3. Where the most common problems occur with poor posture or alignment:
Tucked in: Posture is slouchy, tush tucked under
Extended military: Chest is out and forward in front of hips
Lordosis: A huge curve in the low back tush pushed out.
When the alignment is off then the muscles are not in a good position to work effectively or efficiently. The muscles that control the stability system aren’t loaded or engaged correctly, leading to the compensation we spoke of at the very beginning of the article.
First find your neutral spine.
1. Ribs stacked on/over your pelvis
2. pelvis in neutral. Tailbone not tucked under nor tailbone reaching for the stars. A good thing to check is boobs should point forward not down or up.
In neutral spine, take a deep breath feel your lungs expand, belly pop out and then chest rise. IF your ribs are forward over the pelvis your chest will rise before your belly. Play with the breathing in various postures: feel the diaphragm push down then as you exhale the recoil of the abdomen and the pelvic floor.
IF you can’t feel your pelvic floor, the ski jump position is a great trick Julie Weibe uses to put the body in a place to automatically engage lower abdominals and pelvic floor. Stand in facing a wall or a desk, lean forward from your ankles keeping the trunk stable as you begin to lean forward from your ankles this will make your brain engage the pelvic floor and TA to stop you from falling over (stand in front of a wall so you don’t feel as if you are going to fall) just feel the muscles in the front of you pelvis turn on then lean back to center. See if you can find that muscle again.
Here’s a video to help
If leaking is an issue for you then this is just the beginning… I want to shine a light on this topic, but to make changes there is a lot of work to do. I would like to direct you to a few great videos to help find the issues. Now you can train to be stronger than yesterday!
Resources for further understanding and investigation
Use this link to find a women health or pelvic floor specialist near you.