Overcoming Stress Urinary Incontinence: Practical Steps and Solutions

 Not sure where to start with bladder leaks? In this episode, I break down the first steps for tackling stress urinary incontinence, which is leaks that occur with coughing, sneezing, laughing, or exercise. You’ll learn why pelvic floor strengthening is the gold standard, how to make sure you’re doing Kegels correctly, and what over-the-counter options like vaginal weights, peri-trainers, urethral seals, and pessaries can do to help. Plus, I share the #1 technique that can stop leaks in their tracks. 

Free resources:

Vagina Coach

How to stay dry - MyPFM

Timeline:

00:45 Introduction to Tackling Urinary Incontinence

01:24 Understanding Stress Urinary Incontinence

01:55 Pelvic Floor Strengthening Basics

03:49 Advanced Pelvic Floor Strengthening Techniques

05:56 Using Devices for Pelvic Floor Strengthening

13:38 Exploring Over-the-Counter Devices

15:49 Final Tips and Resources

Transcript

 Hi there. One of the big steps in tackling urinary incontinence is knowing where and how to get started. This first step is such a big one and so many women just aren't sure who to talk to or even what to say. So to help make this a little easier for you, I'm going to tell you how to get started. If you have stress urinary incontinence.

This is from a podcast I did a couple years ago, but it's a good one and I think it will help you figure out where you need to start and what you need to do. So listen and learn. Hi there. Today I'm gonna be talking to you about things that you can do to help stress incontinence. So stress incontinence is leaking with coughing, sneezing, laughing, and exercise.

And this type of leaking often starts after a delivery, and it's very common in women. So I'm gonna be talking to you about strengthening your pelvic floor. And then some different devices that you can look at that are over the counter. So the first thing that we recommend is pelvic floor strengthening to help stress urinary incontinence.

There really aren't any side effects to this. It requires energy and effort on your part. Um, but unlike surgeries or procedures, nothing can really go wrong. So it's a great place to start. The pelvic floor muscles are a little bit of a mystery to most of us though. So let's just take a second and talk about these muscles.

So your pelvic floor muscles go from your left hip to your right hip, and then from your p pubic bone to your tailbone. They're shaped like a bowl and they hold up all of your pelvic organs and they're also connected to your sphincters, the muscles that help keep you dry, right? So these are the muscles that hold poop and pee in.

These muscles are always working. They frequently work without your thinking about it. Um, and they're super important muscles in the body. And when you contract these muscles, that's what we call a Kegel exercise. So to improve the strength of these muscles, you need to be able to do a pelvic floor contraction or a kegel con correctly.

And lots of women have trouble with this, and that's just because of the way we're wired. It's hard to tell if you're doing that contraction correctly. And also sometimes you can have muscle or nerve damage to those, um, to these muscles, and they may not be working correctly and you may not be able to tell.

If you're not sure if you're doing them correctly, you can check in with your GYN. You could check in with a physical therapist and they could tell you if you're using these muscles correctly. Um, and you can often see a physical therapist without a referral if you just wanted to go that route and you wanted some extra help.

So there is good data that tells us that pelvic floor strengthening with a pelvic floor physical therapist is the gold standard, and that it works in about 70% of women. So in 70% of women, it will either dramatically improve their leaking or cure their leaking. More and more data's coming out about strengthening without a physical therapist, and a lot of that is because of the pandemic.

Lots of us didn't want to go to a medical facility, didn't wanna go to a physical therapist, and were more interested in doing these things on our own at home. The data that's coming out tells us that strengthening on your own works as well, but there are a couple of big ifs here and these are super important.

So pelvic floor strengthening on your own works. If one, you can do a pelvic floor contraction correctly, and then two, you continue to do the exercises for three to six months because this is how long it can take to see an improvement in your symptoms. So those are two really big things. Sometimes women aren't doing the contractions correctly, and so it won't help.

And then continuing to do the exercises for that length of time on your own can be a challenge. One thing that often happens is your muscle strength will improve before your symptoms improve, and it's hard to keep up with that effort if you're not actually seeing a response. So you, you have to figure out a way to motivate yourself and keep doing it.

So I'm just gonna say this one more time 'cause I think that this is so very important. Pelvic floor strengthening on your own works. If you can do the contraction correctly and you keep doing the exercises for three to six months. So let's talk about different ways that you can strengthen your pelvic floor.

And I get asked about, um, different devices and different things that are on the market all the time. So let's kind of break these down. So one, you can do the exercises on your own, that is the cheapest. It definitely works. Um, you have to figure out a way to motivate yourself and to continue to. Do it, but it will work.

And in the show notes, I'll include a link to a handout on how to do these exercises and what kind of routine and regimen we're really talking about here. So two, you could get vaginal weights and then you can do the exercises with the weights. So the weights, um, give you a little bit of biofeedback. You can feel, um, the muscles contracting a little bit better.

And so for some women that can really help just that little bit, um, of added reinforcement in feel. The weights frequently, depending on which set you get, will frequently, um, have different sizes and so you can use heavier weights over time so you can make the program a little bit more difficult over time.

And so that is a good, pretty economical way to go as well. So thing number three, you could get a peri trainer. So a peri trainer is a device that fits in the vagina. It measures the pressure, so it measures your muscle contraction. Um, these devices are frequently connected to your smartphone. There are different apps, there are games you can play.

They have, you do, um, long contractions, short contractions, you know, maximal contractions, then some small contractions. Vary the programs. Um, they monitor your strength over time, so they will tell you if you are improving, and most of us do better with this kind of feedback. Um, the peri trainer just measures pressure, and so if you're pushing down instead of squeezing the muscle, it can't.

Tell the difference. It's not quite that smart. Um, so that's just one thing to be careful of. So there are lots and lots of different peri trainers, um, on the market. One has not been shown to be better than another. Um, so I would tell you to look at them. Pick the one that is, you know, kinda suits you best.

Um, you know, some of them are more game oriented. I mean, there are, there are just different variables there. So you should look at them, see which one appeals to you the most, and then I would tell you to buy the one that's on sale because one is not better, um, than the other. Some of the Perry trainers also have Facebook groups, and so if you're someone who wants a little bit of peer support, that can be helpful.

As well. Um, you can also work out with an athletic trainer or an online physical therapist to work on the pelvic floor. So in in this situation, no one is really monitoring your pelvic floor muscle strength directly. And that may appeal to you more if you're working out with the trainer and your. Really focusing on the pelvic floor.

Um, you can also focus on other exercises as well. And so that may appeal to you because there are a lot more health benefits there. You could also do group classes, um, and there are a lot of social benefits there. The thing with exercising is you need to keep doing it, and that's true for the pelvic floor too.

So you wanna find something that appeals to you, but even if you're working. Out with an athletic trainer or a physical therapist online, that too is a situation where you need to know that you're activating your pelvic floor correctly and doing those contractions correctly. Otherwise, it won't work as well.

And then the last thing is physical therapy. So physical therapy is the gold standard here. Lots of insurances will allow you to see a pelvic floor physical therapist, um, without a referral. Pelvic floor physical therapy is intimate. They do check your muscles, and so it has to be a provider that you like and a place where you feel safe.

I do think women get the most benefit from a pelvic floor physical therapist, and that is because they're directly checking your strength. They're doing other exercises. They're working your pelvic floor in different ways, but they're also providing that reinforcement that makes you keep doing the exercises.

Right, so you're more likely to do the exercises if you need to check in with someone and they say, Hey, have you been doing this? Are you doing your homework? That's just kind of the way that we all work. So I think of physical therapy sometimes, as you know, kind of having a professional nag to keep you working.

But, but that works for most of us. Um, if you can supply that on your own, then you may not, you may not need that type of reinforcement. There are also some devices, and I'll just mention these briefly, that activate the pelvic floor without your doing anything and they work by different, um, mechanisms.

There are some electrical stimulation devices. I know it sounds like torture. It is not. And there's also a way to get the pelvic floor muscles to contract with basically a magnetic signal. Those devices work and you don't have to put anything in the vagina. And so that appeals to a lot of women. So there are some shorts that you can wear.

Um, there's a pad that you can wear. Um, the chair is frequently called ela. That's the brand name. Those things will all work. And strengthen your pelvic floor. They're not teaching you to use your muscles correctly. One thing that pelvic floor physical therapy really focuses on is contracting the muscles at the right time.

And so that's one of my concerns about using those devices is it's just not teaching you to use your body in the most optimum way. So that's just something to consider. But those devices do work to strengthen your pelvic floor. They're also a little bit more expensive, sometimes much more expensive, and I think that's because most of us want something that works without a vaginal insert.

So they, they are. More expensive once you have a strong pelvic floor. The, the number one technique recommended by, um, pelvic floor physical therapy to stop leaking is something called the knack. And this has been studied quite extensively and you can think of it as squeeze before you sneeze. Right. So in this technique, you would squeeze your pelvic floor right before you do the activity that makes you leak.

So coughing, jumping, laughing. When you do this over time, you start reflexively doing it. You don't even have to think about it. And this technique really minimizes leaking. It can be difficult to do at first. It does take a little bit of practice. The stronger your muscles are, the better it works. For some women who are doing techniques or exercises that generate a lot of pressure, so lots of jumping, maybe CrossFit, you have to be really strong to counteract that pressure and keep the urine in.

But this technique can work a lot, so definitely work on the knack as well. So that is my information on pelvic floor strengthening for stress urinary incontinence. And then I just wanna talk to you about a couple of over the counter devices that you can try to minimize leaking. So the first is something called a urethral seal.

So the urethra is the tube that goes from the bladder to the outside and the opening to the urethra. So the pee hole, for lack of a better word, is the opening to the urethra. There are devices that you can put on the urethra. So a little seal that will keep you from leaking. These work well with low volume leaks, um, but it's definitely something that you can try.

You can't empty your bladder with them in place, so you have to take it off and then put on a new one if you need a new one. So I think they work the best during, you know, isolated activity. Like if you find your leaking during an exercise class, I think that this could be. Something that's really helpful.

And then the second thing that you can look at is a pessary. So a pessary is a device that fits in the vagina. There are different types of pessaries. There are pessaries for prolapse, but there are pessaries that are specifically designed. To help stop leaking and they fit in the vagina. They put a little bit of pressure up on the urethra.

It's something that you put in and you take out. There are reusable ones that we fit patients for in the office, but there are also some disposable ones that you can try. And the disposable ones that are available on the market right now in the United States are the Impreza. And the revive. So again, those can be really helpful for leaking with coughing, sneezing, exercise.

There are other pessaries available in other countries and there are more and more coming to the market all the time, but those are the ones that are available over the counter in the US right now. I really like the idea of a pessary. I think that a pessary, you know, for exercise can be just considered to be a, um, an another athletic support that we need sometimes.

And, you know, if it stops leaking, I think it's great. So. If you're struggling with stress urinary incontinence, you should be working on your pelvic floor strengthening. There are lots of different ways to do this. Gold standard is a pelvic floor physical therapist, but you can do it on your own as long as you can do a contraction correctly.

So a Kegel contraction correctly, and you continue to do the exercises for three to six months. And then there are other devices that are out there that can help with leaking, and the ones that I talked about are a urethral seal and pessaries. So good luck and let's get started. If you need help doing kegel exercises or pelvic floor physical strengthening, I've included some resources for you in the show notes, so take a look there.

Okay.