Drivers of Leaking Pee

Alrighty… so you leak pee!

And you are here because you have probably already tried pelvic floor specific rehab but it left you without the results you wanted. You still leak and you cannot figure out why.

Let me tell you there are many things that contribute to leaking and it’s often a combination of multiple factors.

I call them ‘drivers of dysfunction’, what is the root cause of why you accidentally pee yourself during certain activities.

There are many drivers byt let;s group them into 6 different categories:

1. Pelvic Floor stiffness

2. pelvic floor weakness

3. lack of core coordination

4. Poor pelvic stability

5. Poor Alignment

6. Non optimal breathing strategy

Let’s dive deeper into each one.

Pelvic floor stiffness

The pelvic floor does not like being rigid and stiff. In the case of too much pelvic floor tension we see lots of rigidity in the pelvic floor that is really bad for absorbing forces. When we move around the pelvic floor experiences forces from above and below. If the pelvic floor has too much stiffness it cannot absorb force well and can result in accidental leaking urine. This is not only a problem for a pelvic floor that has too much tension or is diagnosed as tight, but also important in the case where you excessively squeeze the pelvic floor hoping it’ll save you from leaking. Women who squeeze and contract their pelvic floor during skipping or running or even sneezing will expereince leaking not from weakness, but from lack of flexibilty. SO if you are a pelvic floor clencher, STOP DOING THIS. Seems counterintuiative, but it may solve your problems!

Pelvic floor weakness

The pelvic floor needs enough strength to cope with demands of activities. A high demand activity will generate lots of pressure inside the abdominal cavity (we call this intra-abdominal pressure), and this pressure will be exerted down onto the pelvic floor. If the pelvic floor is not strong enough to bear the pressure you loose closure force around the urethra and get leaking. So in some cases the pelvic floor needs more strength to meet the demand of the exercise. However building this strength is not about doing Kegels. It is about correctly recruiting the pelvic floor in full body exercises that stimulate enough adaptation in the pelvic floor to increase its strength.

Lack of core coordination

Research shows us that muscles have appropriate activation patterns when it comes to movement. The pelvic floor (and deeper abdominal muscles) are anticipatory in nature. It should activate before bigger muscles in anticipation for increases in intra-abdominal pressure. Research has shown that women who experience incontinence can have a delayed activation pattern of the pelvic floor compared to larger muscle groups that are driving the movement. We need to establish the anticipatory nature of the pelvic floor and core muscles such that they recruit in preparation for movement and load. This is part of the rehabiliation process. Re-training the pattern of activation of the deeper abdominal muscles.

Poor pelvic stability

If the pelvis lacks good stability this can add to the demands placed on the pelvic floor and can impact how well pressure in the abdomen is managed. This is because good pelvic stability requires optimal muscular balance around the pelvis that allows the pelvic floor to sit well inside the pelvis. If you follow my content you will know that muscular imbalance is a huge problem for pelvic floor weakness and tightness. If the pelvis is not stable we can also see poor ability to manage pressure in the abdomen and as a result accidental urinary leaking.

Poor alignment

Research tells us that certain postures and body alignments contribute more to pelvic floor dysfunction than others. Forward head postures, rounded shoulders or excessive pelvic positions can be driving leaking. These postures contribute to a poor alignment of the diaphragm over the pelvic floor which is required for optimal pressure management and pelvic floor function. When experiencing leaking in certain activities we often see changes to whole body alignment where the diaphragm and pelvic floor are no longer optimally aligned. Next time you leak in an activity check in with your rib and hip positioning. Are they alinged over the top of each other or is the rib cage trhusted forward compared to the pelvis?

Breathing strategies

Breathing is the key for pelvic floor function, and this is because the diaphragm is in coordination with the pelvic floor to provide stability in the trunk and manage pressure. The way you breath can change the way the diaphragm moves, but also contribute to changes in pressure in the abdomen and where this pressure is directed. Breath holding is the biggest driver to leaking urine as it can increase pressure in the abdomen and make it a lot harder for the pelvic floor to match these demands. If you are notorious for breath holding during your exercise, this could be the main driver of your leaking. avoid breath holding and focus on maintaining your breathing throughout exercise next time you catch yourself in the act. It has been one of the biggest game changes to many of my clients symptoms in exercise.

Now this is all such great information to have in the back of your head, but it is useless if you don’t action any of it.

If you feel like addressing these drivers would be helpful for you then let me help you navigate your pelvic floor journey.

We can work together inside 1:1 consultations - fill out an inquiry form here

Or you can get started through one of my online programs by clicking HERE

If you are not sure which program is best for you, email me at hello@herexercisephysiology.com.au and i’ll be happy to help guide you with the best option.

The life to pelvic floor freedom and complete control is one click away.