5 Simple Changes to Avoid Leaking While Coughing, Sneezing & Exercising
If you’re reading this today, I’m guessing you either want to prevent yourself from leaking, or you are already dealing with it and want to know how to stop it. This guide was created with you in mind. 1 in 3 women have urinary incontinence.
Some of the questions we often hear are:
“Oh, that’s not normal?”
“You don’t have to have surgery to fix that?”
“I thought every woman dealt with that after pregnancy.”
The answers… “NO, that’s not normal…”
“NO, you don’t have to have surgery to fix that. Always do conservative treatment (find a women’s health physio) first…”
“NO, not every woman does, but if you do, you need to have it addressed as soon as possible.”
Did you know that women that are still experiencing incontinence 12 months postpartum will be incontinent FIVE years later? With that said, please don’t let this common issue become your normal. It can be and should be addressed. Our hope is that this guide will give you hope that you no longer have to worry about leaking with your activities. No more carrying an extra set of panties in your bag or needing to wear a panty liner. Our Women’s Health team at Body Logic Health are ready to help you get back to the activities you love.
First Things First: Understanding Your Core
When you think of core exercises, what do you think of? Sit ups, planks, bridges, etc…? Most think of the core as the abdominal muscles, however it goes well beyond that. Your core is composed of the diaphragm, your innermost abdominal muscles (Transverse abdominis), your pelvic floor, and your deep back muscles. Together they stabilise the back, hips, and pelvis. All five muscle groups make up what looks like a canister.
The pelvic floor acts as a sling to hold in our pelvic organs against gravity and increases in abdominal pressure through pregnancy, coughing, sneezing and laughing. They control the stop and start of urine and faeces, and also improve sexual function. It’s a major component of our core and plays more than one role in our everyday lives. One weak link, such as a tight or weak pelvic floor, or breath holding, can lead to leaking. Addressing these issues will improve your symptoms but can also improve back pain and pelvic heaviness.
Now that you have a better understanding of your core’s role, we can now move onto the 5 steps to avoid leaking while laughing, coughing, sneezing, and exercising.
Step 1: Uncross Your Legs and Address Your Posture
Part 1: Uncross Your Legs
This may “look” more lady like and feel a little more comfortable, however crossing your legs shortens your pelvic floor muscles. The problem here is that these muscles have lengthened over time, making them less efficient when they are in a shortened position.
To help you understand this how this might feel to the muscle, although the pelvic floor muscles are much smaller and move through a smaller range, if you stand up and lift your knee up in front of you first. It should be relatively easy to lift the leg, as the muscle is starting in a lengthened position. If you lift the leg while sitting, keeping your back straight, it will feel much harder. This is because your hip flexors are in a short position sitting and so it is harder for the muscle to work effectively. Hopefully that gives you a better perspective of what your body is trying to deal with. This is the same with your pelvic floor muscles.
If you’re sneezing with your legs crossed, therefore shortening your muscles, they cannot fully contract to close the opening of your urethra (where urine exits the body).
Part 2: Address Your Posture
Since you were young, you’ve always heard, “stand up straight!” Well, there is something to that. When you stand with correct posture (rib cage is over your pelvis) or sit with correct posture (rib cage is over your pelvis with feet flat on the ground) your core can work efficiently.
Standing: Stand with butt untucked, shoulder blades move up and down and find the mid-point. Try to find your centre: Move back onto your heels, then lean forward towards your toes, now find the centre. That’s where your end point should be!
Sitting: The same principles follow for sitting. You want your feet to be flat on the ground sitting at the edge of your chair. Now lean curl back on your sitting bones, then straighten forward, then find the middle point, you should feel comfortable but tall. When you are standing or sitting with improved posture, your diaphragm and pelvic floor will be able to ebb and flow together. This brings us to the next step: Breathe Correctly.
Step 2: Breathe Correctly
As you inhale your diaphragm lowers. While this is happening your pelvic floor and abdominal muscles should be relaxing or lowering/expanding. As you exhale your diaphragm raises back up while your abdominal and pelvic floor muscles should be contracting.
To better understand why you may be leaking when you’re doing those activities that cause you to leak, let’s envisage an inflated balloon. The top represents your diaphragm, the bottom your pelvic floor, the front your Transverse Abdominis, and the back your back muscles. If you push on the top of the balloon the bottom and the sides will expand.
Let’s do a quick breathing exercise based on this concept that is foundational to your success. 1st: Lay on your back, your side, or sitting upright in a chair with feet flat on the ground. If you’re pregnant, you may prop yourself up on some pillows so you’re not flat on your back. 2nd: Place one hand on your chest and one hand on your belly button. 3rd: Inhale through your nose. You want minimal to no movement in your chest while your abdomen expands. Envisage the bottom of your rib cage opening like an umbrella to get 360 degrees of expansion, so you should feel your lateral ribs expanding. 4th: Exhale through your mouth or nose (ideal for best practise). Again, your chest should have minimal movement and your abdomen should be lowering.
Step 3: Don’t Hold Your Breath
Breath holding and bracing your abdominal muscles (think of squeezing the balloon in the middle) increases the intra-abdominal pressure, resulting in pressure on your diaphragm (do you experience reflux?) or to your pelvic floor (this is why you’re here). This is common for people who have a deep weakness in their core, so is an indication this needs to be addressed too. We will discuss this later in more detail. The main point here is to focus on making sure you are breathing while completing day to day activities and any forms of exercise.
This is also not beneficial to issues such as diastasis recti or pelvic organ prolapse. We often don’t realize we’re holding our breath. Activities like jumping (on the trampoline or box jumps), heavy lifting (weights, our kids or grandkids, groceries), walking, jogging, running may cause leaking. When you’re doing these activities, you want to breathe as you perform the movements.
Step 4: Stretch Your Pelvic Floor
Your pelvic floor muscles will not be able to contract as well as they are capable of when they are tight or in a shortened position. For them to fully contract, they need to be able to fully relax. Relaxing the abdominal and pelvic floor muscles is important, so the openings to the urethra, vagina, and anus can close, therefore prohibiting any unwanted leaking of urine, gas, or faeces.
So how do you stretch your pelvic floor muscles? One of my favourite stretches is Child’s Pose. It helps to stretch out your inner thigh and pelvic floor muscles. Take 10 breaths during this posture and feel yourself sink into Child’s Pose and relax. Strengthening tight or short muscles will only make them tighter or stronger in that shortened position. This is not effective for good muscle function, so it’s important to stretch and release them prior to strengthening.
Step 5: Strengthen Your Core/Pelvic Floor
Once you’ve stretched and have your correct breathing pattern in place, we can move onto the next step…strengthening.
The first step is engaging your innermost abdominals, the Transverse Abdominis muscles. I would suggest you start with lying on your back with your knees bent, feet flat on the floor. To engage your transverse abdominis place your fingertips on the lateral bones that are along your belt line (ASIS). Now bring your fingers towards your pubic bone about 5cms and gently sink your fingers into your lower abdominals. Inhale while expanding your rib cage and allowing your abdominal muscles and pelvic floor to relax.
Exhale and engage your Transverse Abdominis muscles by imagining you have a line from one ASIS (the anterior pelvic bone) to the other and gently pulling them closer together, you are working at no more than 25%. You should feel a gentle tightening across your belt line. You will automatically engage your pelvic floor and transverse abdominal muscles together. When there is a dysfunction/disconnect with your system (babies, trauma, surgery), we need to re-learn how these muscles should contract.
To contract your pelvic floor muscles, inhale while expanding your rib cage and allowing your abdominal muscles and pelvic floor to relax. As you exhale, envisage you are engaging around a marble and lifting it up towards your head, again only about 30% maximum contraction at this stage. If this seems difficult, first try squeezing the marble with your anus. Then try it with your anus and vagina.
There are a number of different methods to engage this area, it is about finding the right one for you that you feel comfortable completing and is giving you the correct sensation. We would suggest trying them all and working out which one is the easiest for your to complete. Another way to think of it is pulling your tailbone and your pubic bone towards one another or maybe pulling your sit bones towards one another. Both ways engage the pelvic floor, but sometimes we just need different cues!
When working on strengthening your pelvic floor muscles you’ll want to practice holding the contraction for a few seconds for about 5-10 good breaths. If it is difficult for you to feel this contraction, try different positions following this progression:
● Sidelying with a pillow between your knees
● On all fours (Quadruped)
● Sitting with a rolled-up washcloth perpendicular to your sit bones
● Standing *Remember good posture with each position.
In sitting and standing, you want to make sure your rib cage is above your pelvis for optimal breath patterns and muscle recruitment. Another contraction you’ll want to practice is short bursts. Think Inhale (relax), Exhale (contract-relax), with no holding. This is to get your muscles to contract quickly as when you are coughing or sneezing. A good way to practice this is to cough while bringing your elbow to cover your mouth while contracting your pelvic floor.
BONUS: Putting it all together!
Alright, now it’s time to put all of this into practice! You’ve learned crossing your legs won’t prevent you from leaking, what optimal posture looks and feels like, why you should stretch and relax your pelvic floor, why you shouldn’t hold your breath, how to breathe efficiently, and how to contract your innermost abdominal and pelvic floor muscles.
Once you feel you can perform the deep abdominal muscles and pelvic floor muscle contractions well in all four positions, you can start incorporating them into your everyday activities. Think squatting (unloading the dishwasher, using the toilet, picking up toys, lifting at the gym), lunges, going up and down stairs, jumping, running, yoga… As you’re performing these activities, you want to exhale (or blow out) as you perform the movement. Inhale as you squat down or lower into a lunge, and exhale as you stand back up. Now you are engaging your pelvic floor correctly and retraining the muscles to start to complete this task automatically for you. It will take time so stick to the training plan and complete the exercises at least 2-3 times a day to build the pathway to make this an automatic process again.
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