Oh you leak pee? Stop exercising & do 10,000 kegels a day. Forever. Sound familiar?

Thankfully, there's a better way. If you want to know the latest research on how #physiotherapy can help those pesky #leaks, aka #incontinence, while still continuing the exercise you LOVE, read on.

Whether you leak on occasion with a cough or sneeze (stress urinary incontinence or SUI) or while running to the loo because your sudden urge caught you off guard (urge urinary incontinence or UUI), there's a high possibility you've been told to #kegel or do your pelvic floor exercises to 'fix' it.

1 in 3 women experience leaks, the most common - 50% - have SUI. The next most common is actually both UUI and SUI, followed by UUI on it's own. All of which are quality of life limiting whether you say you're bothered by it or not. If you did your 'google' research or were one of the BRAVE ones to mention it to your GP, it's likely you actually didn't know you had pelvic floor muscles, let alone how to train them or if it will help you achieve YOUR specific goal. If you did try them, did they actually work?

The other dilemma is that you've been told to stop running or lifting or you decide yourself to stop exercising because you're embarrassed and feel you might make things worse if you continue. If exercise is the only thing that makes you leak, then it's a quick fix really, a small sacrifice...right?

Let's focus on Stress Urinary Incontinence

What is physically happening 'down there' that is making me leak during a cough, sneeze, lift or run?

The most common accidental urinary leakage occurs during physical activity or with effort (stress) on the bladder. This effort exceeds the current capacity of the support systems below to counteract it.

It was for a long time thought that SUI was a result of pelvic floor muscle (levator ani - deep pelvic floor muscles) weakness. This is because studies for a long time proved that pelvic floor muscle training and strengthening, cured or significantly improved leaks.

It was not until even better studies were completed, that we learned the most important factor in keeping someone continent or essentially keeping the wee tube (urethra) closed, is the amount of pressure that can be generated by the muscles surrounding the wee tube - the external urethral sphincter - to close it at the same time extra force is exerted on the bladder.

What does this mean for management?

A study in 2022 aimed to see if the inability to perform a pelvic floor contraction would influence the severity of stress urinary incontinence in women. They found that women who could perform an effective pelvic floor muscle contraction had NO difference in leakage severity compared with women who couldn't contract them at all.

So, TRUTHBOMB....Whether you have the strongest pelvic floor in the world, or zero contraction at all, you can STILL improve urinary incontinence with pelvic floor training. All because the external sphincter, is actually part of the pelvic floor muscle group and is supplied by a different nerve to the rest of the floor.

Don't get me wrong though, pelvic floor muscle training DOES WORK for SUI, UUI and mixed urinary incontinence, however, it is not ONLY the levator muscles getting stronger, the sphincter does too. Ultimately, it explains why some people improve with pelvic floor muscle training and some don't. There are multiple factors at play...

So what can Women's Health Physiotherapists do to help you improve leaks with coughing, sneezing, running, jumping, laughing and lifting?

As discussed above, there are 3 main systems that keep someone #continent:

1. Pelvic Floor Muscles (PFM)/Muscular system

2. Fascia &

3. Urethral Closing Pressure (how well the wee tube closes in response to stress placed on it) and Urethral Mobility (how much movement the wee tube has)

All 3 of these systems can be INFLUENCED conservatively (i.e without surgery) with these 5 strategies:

1. Lifestyle enhancement.

2. Pelvic floor muscle training

3. Optimising Stool Form & Emptying Position to Prevent Constipation.

4. Optimising & Adapting Current Exercise Regime to Suit Current Tissue Loading Capactiy

5. Pessaries!!

You know the BEST THING though? Thanks to COVID, research completed on women who undertook a pelvic floor training programme with little to NO face to face contact with a pelvic health physio, still made almost the same improvement as those who did the opposite, a supervised, individualised face to face training programme.

This means that ANYONE can access help for their incontinence which is why I've made it my mission to create the most up to date, evidence based DEFEAT THE LEAK programme to promise women a way of being able to LIVE again all by using an online digital platform. But I digress....

Gen, tell me, what's the chance you'll stop leaking if you do a 3 month intensive pelvic floor muscle training programme from a specially trained pelvic health physiotherapist?

Based on the most current research in #pelvichealth #physiotherapy,

research suggests approximately 1/3 to 50% of all women can completely stop their leaking and that 75-80% will experience some, if not major improvement.

Somewhere between 1 in 4 and 1 in 5 women have changes to their pelvic floor that means pelvic floor muscle training on its own will only result in a very small difference if any at all.

If after 6-12 weeks you're not seeing change, discussing other options that you might like to consider is a good idea.

For some women, reducing leaks from 7x/week to 1x/week or only with certain activities is their ultimate goal. For others it might be never leaking during a run again. Others may leak a lot every time it happens and want to only wear one pad a day for the small just in case leaks so they can go out and socialise again. ALL OF THESE ARE POSSIBLE AND VALID GOALS THAT CAN BE ACHIEVED!!

Surgery is a very real and effective option for managing SUI specifically. However, you should feel empowered to choose this option and understand what extra benefits it may have for your specific case rather than scared that it 'might not work'!!