Female bodies are such wondrous creations (able to construct whole human beings from two simple cells!), but they can also be achy, creaky, and yeah, even leaky. You know what we’re talking about. You let out a satisfying sneeze and, whoosh, there’s a mortifying trickle between your legs—or, as the joke goes, you laugh so hard the tears run down your legs. It’s funny/not funny for the 25 to 50 percent of women with stress urinary incontinence, who worry they’ll wet themselves every time they cough, run, or lift a heavy bag of groceries. Happily, research shows there are effective ways to stem the tide. But first, some background on this type of leakage.
You can blame, at least in part, your pelvic floor muscles—the trampoline-like tissue that stretches from the pubic bone to the tailbone and includes the urethral sphincter (that thing you clench when you hold in pee). When they are weak, you could leak.
“Your bladder is like a water balloon, and your urethral sphincter and the pelvic floor muscles that surround the urethra are the bottom parts that need to be strong,” says May M. Wakamatsu, MD, director of female pelvic medicine and reconstructive surgery at Massachusetts General Hospital in Boston. “If they’re loose and you apply pressure, some fluid may escape.”
Why It Happens
Here are a few factors that cause this vital muscle group (that you can’t see—and might not even know you had) to lose strength.
Hormones: “If you look at a graph of the prevalence of stress urinary incontinence, the peaks are right around childbirth and menopause—a good indication that hormonal changes play a role,” says Cindy L. Amundsen, MD, program director of the female pelvic medicine fellowship at the Duke University Medical School. “However, if we treat women with estrogen, it doesn’t cure the problem, so the mechanism is more complex than that.”
Giving Birth: “When a baby’s head goes through the vaginal canal, it stretches, and can even tear, the connective tissue and muscles that support the urethra,” says Dr. Wakamatsu.
Extra Weight: “The average woman carries around about 50 pounds of food, fat, water, and organs in her abdominal cavity, so when she coughs or sneezes, it’s like a 50-pound bowling ball coming down on her bladder—and the more you weigh, the heavier your abdominal mass is,” says Dr. Wakamatsu.
Exercise: In one of the true ironies of this condition, doing high-impact activity on the regular—aerobics, dance, running, tennis, basketball, volleyball—could actually increase the risk of pelvic floor weakness, probably because the repetitive impact stresses or exhausts the muscles. “Although activity-related leakage is more common in older women, it happens in college athletes, too,” says Carol Figuers, professor in the doctor of physical therapy division at Duke University School of Medicine. “When we evaluated female runners, we found that those who leaked the most were the ones who put in the most miles.”
The first line of treatment is pelvic floor strengthening—something all women, even those who have never experienced stress urinary incontinence, should be doing. “Just as you train your biceps and core, you should train your pelvic floor,” says Figuers.
It’s a good idea to do your initial pelvic floor training with a physical therapist, who can assess your muscles’ strength and identify any underlying problems, like scar tissue. PTs also have access to training tools, like biofeedback, that can assist women who are having trouble performing the exercises correctly. “Look for a PT who is a women’s health certified clinical specialist (WCS), because they specialize in pelvic floor rehabilitation,” suggests Jill Boissonnault, PhD, associate professor of physical therapy at Shenandoah University.
Want to do pelvic floor muscle exercises—a.k.a. Kegels—at home? Many women do them wrong, so try this to get them right: Start by lying down, to avoid working against gravity. (You can gradually advance to doing Kegels sitting or even standing.) Hold a hand mirror between your legs, and contract your muscles as if you were trying to stop peeing midstream. You’ll know you’re doing the exercises correctly if your clitoris drops toward the opening of your vagina and your anal sphincter retracts. Don’t clench your abs, thighs, or butt.
Once you have the technique down, hold each contraction for several seconds. Try five reps at first, and work your way up to 10–15 several times throughout the day. (Apps such as myKegel will send you reminders to keep you on track.)
For an extra challenge, you can insert small tampon-like weights, called Kegel cones, into your vagina; then sit or stand, contracting your pelvic floor muscles to hold them in. Cones can be effective for women who feel like they’re fairly strong but need a little additional help to prevent leakage, says Dr. Amundsen.
Be patient. It can take six weeks to strengthen your pelvic floor, and an ongoing effort to keep the muscles in shape. But it’s worth putting in the work. Up to 75 percent of women see a substantial improvement in leakage. When your commitment flags and you need a dose of motivation, consider this: A strong pelvic floor can also intensify orgasms.
Aside from doing your Kegels, avoid drinking more than 10 to 12 ounces of fluid with meals, or more than 4 to 6 ounces between meals. A full bladder increases leak risk. And when you’re about to cough or sneeze, tighten the muscles of your pelvic floor—a tactic known as “the knack.” (A physical therapist can help you learn to do it properly.)
“I had a patient who was an avid golfer and only lost urine when she drove the golf ball, so I taught her the knack along with pelvic floor exercises, and she was able to prevent the problem entirely,” says Boissonnault.
If you’re still struggling, ask your doctor for a referral to a urogynecologist who has a good track record with mid-urethral sling surgery, a minimally invasive procedure. “My colleagues and I have found that about 90 percent of patients get 90 percent better,” says Dr. Wakamatsu. “Many women see leakage as a fact of life that they just have to live with. It’s important for them to know that that’s not true.”
On The Down-Low
These discreet products can offer peace of mind until you regain control.
- Icon Undies: The multilayer crotch in these panties is designed to wick urine (so you don’t feel damp if you dribble) and absorb liquid (so it doesn’t seep through your clothes). One layer has antimicrobial properties to keep you odor-free. A volunteer tester reported that the undies felt like “wearing a diaper.” But another raved about her pair: “At first I only wore them to work out. Now they’re in my regular rotation.” (From $28; amazon.com)
- Finess: These tiny, disposable foam cones attach with adhesive over your urethra, providing a temporary seal that stops urine from leaking out. You need to take the cone off to pee, so it’s probably best for times when the risk of leakage is high, like when you’re going to a HIIT class, or to see a comedy. ($25 for 36; havefiness.com)
- Poise Impressa Bladder Supports: You insert this soft, flexible product with a smooth plastic applicator, like a tampon, but it’s nonabsorbent and shaped more like an hourglass to prevent leakage by lifting and supporting your urethra. (From $15 for a box of 10; amazon.com)
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