If you’ve read any of my past blog contributions, you know I’m someone who has managed pelvic pain for the past decade, (if you haven’t read them, feel free to check them out here, here, and here) and while I was confident that in that time I had gamely faced and overcome all of the issues, big and small, that come with that, turns out I was wrong. Enter cold and cough season.
This year I got struck early on in the season by a nasty case of bronchitis (basically a fancy word for chest cold). A hacking cough ensued. After a couple of days of heavy coughing where I was sure any minute a lung would come flying out, something…er…interesting happened. During a fit of coughing, I completely lost my bladder. At first I thought it was just the result of a particularly wracking coughing spell, but for the next few days, every time I coughed, bam! I peed my pants.
I panicked. “So is this a new symptom that I’ll have to figure out?!” I wondered. “Are my ‘tight’ pelvic floor muscles now also ‘weak’ pelvic floor muscles?!” “And if so, wouldn’t any efforts to strengthen my tightish pelvic floor be a bad idea?!”
To put my fears to rest I did what I always do when my pelvic floor stumps me: I called Stephanie, my PT.
In this blog post, I’m going to share what I learned from Stephanie because turns out what happened to me is very common for folks with a pelvic floor that runs a little on the tight side or who have pelvic pain.
What I was experiencing is known as “stress urinary incontinence,” something that can happen when the pelvic floor muscles don’t work properly.
You see, when you urinate, urine flows from the bladder through the urethra to the outside, and the pelvic floor muscles are among the structures that support the bladder and urethra. And when the pelvic floor muscles are compromised, urine can escape when pressure is placed on the bladder.
And that’s exactly what was happening to me. When I would let out a real wallop of a cough it put a ton of pressure on my abdominal muscles, which then put pressure on my bladder.
But it wasn’t happening because my muscles were weak, which is what I assumed at the time.
“Your pelvic floor muscles are not necessarily weak, but they are tight. ” Stephanie explained. “Muscles function optimally–meaning they generate maximum force–at a certain length. When muscles are too tight they generate less force. In your case, because your muscles are too tight, the amount of force they were able to generate was not enough to keep your urethra closed against a powerful cough.”
So because my issue was tightness, not weakness, which is what I originally assumed when the leakage began, I didn’t have to strengthen, but needed to continue on the track of lengthening my too tight pelvic floor muscles. Which was a relief because I knew that efforts to strengthen pelvic floor muscles, such as doing Kegels, could have an adverse effect on too tight muscles, making them even tighter and causing pelvic pain.
“Lastly,” Stephanie said, “while leaking urine is a sign that something is not working properly, it’s important NOT to panic and to know that the problem is likely going to be transient. If anything, it’s indicative that you still have tight pelvic floor muscles.
Coughing is similar to doing repetitive Kegels. My patients with pelvic pain may feel an increase in their symptoms after being sick because their muscles could not relax after the forceful pelvic floor contractions that come with coughing. The good news is you can work on improving your pelvic floor muscle function through your continued PT and home exercises. ”
Stephanie advised that I manage the symptoms for as long as they lasted, which turned out to be about a week, which for me meant wearing pads and/or hanging out on the throne when I felt a particularly bad coughing spell coming on. And to counter the muscle tightness, she suggested that I get back into the habit of doing my pelvic floor drops.
However, there was one lingering question that my cough induced leakage brought up that I wanted to run past Stephanie: What happens in situations where someone has both a tight and a weak pelvic floor? Because if there’s one thing I’ve learned in the years I’ve dealt with pelvic floor issues, it’s that the pelvic floor is fixable; if it’s too tight, you can work to loosen it up, and if it’s weak you can strengthen it. But what if you are someone who has both a weak and a tight pelvic floor? What then?
Here’s what Stephanie had to say about this: “While tight pelvic floor muscles result in what appears to be weakness, the fact is that once they’re lengthened to a normal position, they are able to generate more force. So if a tight muscle is returned to its normal resting length, and is still unable to generate adequate force, it is in fact also a weak muscle and it’s time to strengthen it.
Generally speaking, however, women with a history of pelvic pain that are still menstruating and have not given birth likely have tight muscles. On the other hand, peri-menopausal, menopausal and/or women who have given birth may have muscles that are weak. Both groups may leak urine in situations where the abdominal pressure exceeds the capacity of their pelvic floor muscles. My suggestions are different for each group.
Women with weak muscles will benefit from an uptraining program to strengthen their pelvic floor and girdle muscles and improve their motor control. Additionally, this group may reduce episodes of stress urinary incontinence by performing a technique referred to as “the knack” prior to coughing or lifting. The knack is a learned motor skill that involves contracting your pelvic floor muscles when urine is likely to leak.
Conversely, women with tight muscles need to focus on lengthening their pelvic floor muscles, taking the steps mentioned above. The knack technique will not help them because contracting their muscles further just leads to more shortening, which generates even less force.
I hope this post has been helpful to anyone who, like me, thought they had seen it all when it comes to pelvic floor maintenance. If you have any questions about the issues covered in this post, or about incontinence in general, please leave them in the comment section below, and I’ll be sure to pass them along to Stephanie!