Contrary to popular belief leakage does not just occur to the Grannies in the world.

Research says 1 in 2 women all ages have leakage including teenage girls, new Moms and not so new Moms, athletes and the menopausal crew.

Some folks try to downplay it, or act like its normal because they “have had kids” or “it’s just part of aging.”

So let’s set the record straight. Peeing on yourself is NOT normal, and yes there is treatment available that does not involve going under the knife. Not saying there wouldn’t be cases where surgery would be appropriate, but in my book surgery should ALWAYS be the last resort!

And it doesn’t get better by itself either folks! Unfortunately leakage in most cases can and will become worse.

So understanding what is going on can be a huge help in finding the right solution.
And some of these are ones you may not have even thought of….

1. Do you ever find yourself keeping those vaginal muscles clenched throughout the day? Just like some people carry stress in their neck, others carry stress in their pelvic floor. Maybe you have had surgery in the pelvis or abdomen, and have developed the habit of keeping those muscles “engaged” throughout the day as a protective reflex. Maybe you have interstitial cystitits or another panful bladder syndrome where pelvic pain has started a cycle of muscle tightness and bladder pressure, which can make it harder for the pelvic floor muscles to relax.

One result of this could be leakage or “dribbling” after initially going to the bathroom. You sit down, urinate, and then when you stand up and fasten your pants you notice a few drops of urine escape. The pelvic floor muscles have to totally relax in order for the bladder to empty. If the muscles are unable to relax, urine cannot escape as it should. This could also be a sign of a potential prolapse, in which the bladder has shifted downward and is bulging to some extent in to the vaginal area.

So make sure you are aware of those muscles! One way is by when you are on the toilet try and do a kegel, then relax. Then imagine doing another kegel up a flight of steps, so you will squeeze a little harder, a little harder, etc until you are on the “4th or 5th floor” then, reverse it going “down” the stairs again, so squeezing less and less with each step down until you are relaxed all the way or in the “basement.” This is known as the elevator exercise.

When you go to the bathroom try the elevator exercise to see if you are fully letting go when you urinate. You want the muscles to be in the “basement” as you are peeing. Don’t stop the flow of urine a lot, just try a couple times and see how it feels. The goal is to be totally relaxed when you urinate so the bladder can empty. If the pelvic floor muscles are contracted and not relaxing, it will be that much harder to empty, which could be why you have a little dribble when you come off the toilet. Also no squatting over the toilet, muscles can’t relax that way either.

Try the elevator exercise throughout the day as well, to see where those muscles are! Go to the bathroom every 2-4 hours, and don’t try to hold your urine for long periods of time. That could result in leakage as well!

2. Have you had your hormones checked lately? If your estrogen is low, this could be affecting your pelvic floor strength. As estrogen drops, the pelvic floor muscles can become weaker and thinner. Part of estrogen’s job is to keep the urethral opening smaller (this is the hole we pee out of) by promoting more bulk to the muscle that supports the urethra. As this support that surrounds the opening gets bigger and weaker, it doesn’t have the capacity to hold back the urine as it once did. Estrogen creams may be helpful in this case along with pelvic floor muscle strengthening.



3. You have developed some bad habits at the gym. Yes in this picture that is urine on a step from a cross fit gal. Leakage can result from a combination of things here. Perhaps you are a new Mom recovering after having a baby, but have gone back to Cross Fit too fast and are having leakage with your box jumps. Maybe you have never had a baby but overtime have learned strategies that are promoting increased abdominal pressure, resulting in that pressure exiting downward through the pelvic floor, resulting in leakage. How you keep your form during activities such as jumping rope, box jumps, lifting weights and how you breathe during those activities can go a long way to avoid peeing on yourself!

For example when you are lifting weight, don’t tuck your butt under,and imagine your upper body is a coke can that you don’t want to kink. Since our diaphragm and pelvic floor works together, it’s important to exhale while we do the resistive part of the exercise, while engaging the pelvic floor at the same time.

When doing box jumps, as you jump up on the box and land, exhale while engaging the pelvic floor. Same thing when you jump back to the floor, exhale and engage the pelvic floor with impact. No kinking the can, keep the back straight so the diaphragm and pelvic floor can do its job efficiently.

4. If you have that gotta go feeling with leakage-be aware of bladder irritants. Certain beverages are known to irritate the bladder, resulting in a more frequent need to urinate. Our bladder gets used to going to the bathroom a lot, resulting in the message between the bladder and the brain going into overdrive. So when we have that gotta go feeling, we panic thinking we may leak on our self, and then do leak, and the cycle repeats.

Examples of bladder irritants include caffeinated beverages such as coffee, tea and soda, including decaffeinated beverages. Artificial sweeteners found in some beverages such as aspartame or saccharin can also be an irritant. Certain juices such as grapefruit or orange are on the list as well. Milk is also considered a bladder irritant. If you suspect one of these may be a culprit, stop drinking the beverage for a week or so and see if you notice a difference.

I once gave advice to a lady that was having leakage at night while sleeping. Looking at what she ate, I noticed that one of her “late night snacks” was oil and vinegar salad dressing on lettuce wedges. I suggested that she stop eating that at night, and sure enough the leakage at night stopped. The vinegar is another example of a bladder irritant, and was triggering her bladder at night.

5. Manage the amount of fluid you drink. This is where I get the most resistance. I know how much people like to drink a crazy amount of water every day, like their body weight plus their neighbor’s body weight like 3 times a day! However this can lead to that gotta go feeling and leakage over time because the frequency of going to the bathroom from drinking all that water trigers the bladder to empty often and not hold like it should, thus the leakage cycle begins.

Try spreading fluids throughout the day instead of drinking a large amount at one time. Average consumption should be somewhere between 48 and 64 ounces a day. Do not dramatically decrease the amount of fluid you drink, as this can actually irritate the bladder. You will know you are drinking enough when your urine is a clear color, not dark yellow.

So I hope some of these tips are helpful. There is simply no excuse to live or accept peeing on yourself.

I was in a situation last week where I heard a nurse tell a group of women, “Yeah once you have babies you will have leakage, it all goes downhill from there.”

Unfortunately I wasn’t in the right setting to rebuke her statement, but man did I feel a little anger along with the red hives on the neck thing going on.

Those kinda moments just reinforce my why.

My why is to inform women that they do not have to accept these conditions as “normal.”

I am offering free discovery sessions the month of July for anyone wanting to come to my clinic, check it out, and spend about 20 minutes with me to brainstorm ways we can help and see if I am a good fit to help you with your goals!


Owner Indy Women Physical Therapy