Healthy Bladder Habits for the Active Woman: Understanding Causes and How to Change

Scenario 1

For sale: Skinny jeans. BNWT.

It’s time for a night out. The skinny jeans are calling. The form flattering fabric is just hanging there in the closet, brand new with tags (BNWT). So why is the black leggings and shirtdress of choice the 10th time?! Because the shirtdress-legging outfit covers for laugh, cough, lift and sneeze leakage. It’s also convenient for pads or panty-liners. tight-jeans

The type of bladder leakage described above is stress urinary incontinence (UI). Stress UI is common among women, but that doesn’t mean it should be considered normal.  Coughing, sneezing, laughing and lifting are just a handful of activities that put pressure on your bladder.  If this describes you, research has shown that training the muscles down there can help!  Training your pelvic floor muscles reeducates them to turn on at the right time, and in turn strengthens too. The best pelvic floor muscle training results come from those who were evaluated and taught by a skilled pelvic physical therapist.  However, that doesn’t mean you can’t try it yourself first! The quick healthy bladder tip I have for you is to try to contract your pelvic floor muscles right before you cough, lift or sneeze. To be sure you are doing it right, try it out now while you are sitting in a chair. Tighten up. This should feel like you are trying to pick up a jellybean with your vagina, or like you are stopping urine midstream. Now cough. You should feel your pelvic floor lift off the chair. If instead you feel it pushing down into the chair, stop and talk to your pelvic floor physical therapist! If you’re holding up just fine with this test, try this exercise out for a couple days. If things get better, keep it up! If things get worse or stay the same, then it might be time to find an expert to get you on the right track and back into skinny jeans – care free!


Scenario 2

Coffee and the Car

Typical workday: wake up, go to the bathroom, get ready, coffee, bathroom again-just-in-case, get to work, more coffee, forget to drink water, pull in the driveway, dig out keys and suddenly the bladder is a balloon ready to burst.


With nearly two cups of coffee per day as average consumption for over half of American adults, it’s no surprise that bladder urgency is one of the most common types of urinary incontinence. Urgency urinary incontinence AKA overactive bladder (OAB) can be defined as any unwanted leakage occurring with a sense of urgency. A “ready to burst” bladder may also be followed by a void smaller than the bladder’s capacity. The scenario above brings to light four common catalysts for this feeling of urgency. Firstly, coffee is diuretic and it’s acidic. That means it’s bladder-irritating: it will dehydrate and concentrate urine. Concentrated urine agitates the bladder wall, contributing to a sense of urgency. Secondly, going “just-in-case” fosters a cycle of faulty communication between the bladder and the brain. The bladder begins to tell the brain “I need to go now, even though I’m only ½ full.” Thirdly, drinking less water will actually concentrate urine, which in turn causes bladder irritation, urgency and ironically more frequent trips to the restroom for smaller voids.


Finally, the urge and leakage that comes when taking keys out of bag stems from a conditioned body-brain pattern, similar to the automatic salivation that occurs when walking by a bakery. Clearly there are a lot of factors working against your bladder, but there are some solutions. The first and third catalyst can be remedied by drinking less coffee and more water throughout the day. The second and fourth require some reconditioning to establish a better relationship between you bladder and brain. Techniques to recondition or retrain the bladder- brain connection can range from a bladder diary, to quick contractions of the pelvic floor muscles, to mental imagery. These modifications all have the ultimate goal of reducing urge of less-purposeful urination and lengthening the amount of time between bathroom visits.


Scenario 3

The RUN turned WOG + Urge

running-_-feetThere are many reasons why people don’t exercise. Some of these are legitimate health concerns, but for the majority of people this is not the case.  Many female runners struggle with continence, limiting their workout. Their runs starts off with flowing endorphins but then are stilted by their bladder pounding with each stride. To manage the bladder, the run turns into a walk with intermittent jogging. This pounding may signal to the brain that the bladder is actually full.

Like scenario one, leaking while running is a form of stress urinary incontinence (UI). Similar to scenario two, the body-brain connection is distorted and causes a feeling of urgency and fullness when the bladder is only half full!  When urge UI and stress UI are combined, it is called ‘mixed urinary incontinence’. Reducing urge will require techniques, mentioned above, however, reducing the stress for running will likely require endurance and strength training for the pelvic floor. Just like other muscles need to be conditioned to work harder or for extended amounts of time, the muscles in the pelvic floor need to be trained the same way!  A pelvic health physical therapist will prescribe pelvic floor muscle training according to how your body moves, length and intensity of exercise, and other case-by-case factors.





Published by Dr. Cora T Huitt

Cora T. Huitt, PT, DPT, BCB-PMD ~Thirty seven years of clinical practice, specializing in women's health for fifteen years. ~BS Degree in Allied Health Professions, Ohio State University, '72. ~Master of Arts in College Teaching (MACT) focus in Physical Therapy & Therapeutic Exercise, University of North Carolina, '76. ~ Doctorate of Physical Therapy, Alabama State University, 2010 ~Attended multiple courses offered in Women's Health Physical Therapy, including Pelvic 1, 2, 3 Course in Women's Health Section APTA. ~Member of VPTA and APTA, Women's Health Section. ~BCIA-PMDB Biofeedback- Pelvic Muscle Dysfunction Biofeedback. ~Certified Pilates instructor, ProHealth. ~Affiliate member of the American College of Obstetrics and Gynecology. ~Member of International Continence Society. ~Member of National Vulvodynia Association. ~Adjunct Clinical Faculty for student affiliation at multiple universities. ~Director of APTA Women's Health Residency since 2007, credentialed in 2008. (only other residency at Duke Unviersity)

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