Your pelvic floor muscles and their role in causing urinary incontinence

I was in a writing workshop yesterday and while introducing myself I mentioned that I was writing about the pelvic floor muscles and their role in urinary incontinence in women.

During the lunch break, I was surprised to see at least 4 women in a group of 14 speaking up about their brush with incontinence- as care givers, sufferers, and yoga therapists. 

Incontinence is not that uncommon as we women like to pretend- it happens to both women and men- especially after a certain age. But, it also afflicts children and office goers. 

A person’s lifestyle -eating, drinking, sitting- are also related to urinary or bowel dysfunction. 

Often times, habits such as drinking coffee too often, eating fried food, exercising too vigorously, or sitting at a computer for long periods of time can also strongly influence a woman’s pelvic floor.

What’s alarming is that most women have no idea that painful sex, back or hip pain can be due to a pelvic floor issue. So, they don’t seek treatment for it. 

What are pelvic floor muscles?

The pelvic floor is a kind of a muscular sheath spread under your undercarriage. The pelvic floor muscles run around the opening of your urethra, vagina and rectum. 

The best way to assess your pelvic floor muscles is via an internal examination which is performed with one gloved finger inserted into the vaginal or rectal canal by a trained pelvic physical therapist. 

The therapist can also evaluate your pelvic floor muscles through an external evaluation using biofeedback. 

Weak pelvic floor muscles and urine incontinence

Urine is stored in the urinary bladder and emptied via a tube called the urethra. 

What happens during urination is that the muscles of your bladder wall contract, forcing urine from the bladder into the urethra. Sphincter muscles surrounding the urethra relax and release urine from the body. 

Urinary incontinence occurs if bladder muscles suddenly contract or sphincter muscles are not strong enough to stop the urine from leaking out.

Urinary incontinence (UI) in women

Men have incontinence but women have a lot of leakage problems. They talk about it less, though.

In particular, studies show that some degree of urinary incontinence is reported by 25-45% of women worldwide.

Pregnancy, childbirth, and menopause all contribute to UI in women.

A woman can also suffer from urine and bowel incontinence due to medical reasons like Alzheimer’s for example.

UI in older women

Older women experience UI more often than younger women. 

Weak bladder muscles, an overactive bladder, and nerve damage, these three can cause UI or leakage in general. 

There are different types of urinary incontinence in women, including stress incontinence or a leakage of urine during physical movements which put pressure on the bladder like coughing, laughing, sneezing; urge incontinence or an unexpected leakage of urine which can occur after suddenly feeling a strong urge to urinate; an overactive bladder which occurs when bladder muscles squeeze without warning, to quote a few.

Many women experience all these three types of UI. 

Older women usually suffer a lot from stress incontinence and have a lot of trouble keeping urine and faeces in when they laugh, sneeze or have sex. Well, they still do that.

Obesity increases pressure on the urinary bladder, worsening incontinence. Weight loss can reduce the severity of UI.

UI in older women can range from slightly bothersome to totally debilitating. The risk of public embarrassment due to leakage keeps many post-menopausal women from enjoying normal activities with their family and friends. 

But incontinence is not inevitable with age. UI is a medical problem and your doctor and therapist can help you find the right treatment.

UI and new moms 

One in three women suffers from some kind of incontinence after a delivery. They can also have other issues due to weak pelvic floor muscles like pelvic organ prolapse- a condition where the pelvic organs lose their structural support, pelvic pain, painful sex, Diastasis recti, and back, hip, sacrum or coccyx pain.

UI after childbirth is common because a vaginal birth can injure the pelvic floor, vagina, ligaments or the structures supporting the bladder. 

The pelvic floor has to accommodate the birth of a baby, and some degree of muscle tearing and nerve damage frequently results. This causes the bladder to move downward, preventing the sphincter muscles which hold the urine back in the bladder, from squeezing shut as tightly as they should, thereby leaking urine. 

During pregnancy, the weight of a growing baby puts a hell lot of pressure on the pelvic floor musculature and connective tissue.

Hormonal changes throughout pregnancy also result in softening the pelvic floor muscle group in preparation for childbirth. These changes can lead to a pelvic floor that is more vulnerable to dysfunction.

While pelvic floor issues like incontinence, pain, and prolapse are common, they shouldn’t be considered inevitable consequences of becoming a mother. 

Going ‘against’ the flow

Urinary incontinence can happen due to different reasons. But do remember that UI happens due to a failed system, not just a failed muscle.  

If you are leaking urine, you may sometimes need more than just Kegel exercises for pelvic floor strengthening like a treatment for the origin of the dysfunction like well-functioning pelvic floor muscles, abdominal muscles, hip muscles, diaphragm and low back muscles to treat UI. 

If you have a shortened, irritated pelvic floor, you may have just as much difficulty holding back urine as a woman with a weak pelvic floor. You will also not benefit from pelvic floor strengthening exercises like Kegels in this case. 

It is thus important to trust your physical therapist to prescribe tailored exercises necessary to help YOU, as well as improving your dietary habits and re-training body movements to get rid of UI.

About the Author

Shikha Gandhi