Urinary Stress Incontinence

By Talli Rosenbaum PT

A common concern among women is a sense of incomplete bladder control. Women frequently complain that during activities such as dancing, or while coughing, sneezing, or laughing, they may actually urinate a small amount without intending to. This type of "leakage" is called urinary stress incontinence. It occurs because of weakness of the muscles of the pelvic floor, which support the pelvic organs and control the urinary sphincter.

While some women report that they have always felt a lack of complete control, most women begin to experience weakness during the childbearing years. Pregnancy, childbirth, physical activity, straining and heavy lifting, and chronic coughing all contribute to abdominal and pelvic floor weakness. Prevention of pelvic floor weakness involves maintaining optimal physical fitness, being aware of where the pelvic floor muscles are located, and exercising those muscles regularly.

The pelvic floor muscles (known commonly as "Kegels,") can be identified as follows: insert a clean finger in to the vagina. Inhale, and upon exhaling, think about closing the vagina and feel the muscles contract around your finger. It is important that you do not bear down; rather, pull upwards. You can use your lower abdominals to assist you, by pulling your navel in towards your spine at the same time.

Once you have properly identified the muscles, you can exercise them without your finger whenever convenient. Contract the muscles and try to hold this for ten seconds, then release for ten seconds. Repeat this ten times. It is important to incorporate these exercises into your regular exercise program, and to be aware that you contract the Kegels during abdominal exercises or impact activities such as dancing or power walking.

Often, episodes of incontinence occur during activities that may cause downward pressure on the pelvis. To prevent this, it is helpful to consciously contract the pelvic floor muscles just before coughing, sneezing, or lifting. Exercising the muscles on a regular basis will help both in becoming aware of these muscles and in strengthening them.

If the problem persists, then one should seek professional help. When dealt with early, physical therapy can improve the situation for many women. In extreme cases, surgery may be needed.