Urinary Incontinence: Why You May Need More Than Just Kegels

Urinary Incontinence

“Lift and squeeze. Now, hold it for as long and as many times as you can throughout the day. Do it in the car while waiting at the red light, or while standing in line at the grocery store.


Is this the advice you got after the first time you leaked urine after a sneeze or laughing out loud?


After researching conservative treatment options for urinary incontinence, you may feel like you have a good grasp of how to strengthen your pelvic floor. Maybe you’ve tried Kegels, and it obviously didn’t work because you still pee your pants. Maybe you convinced yourself to seek surgical or pharmacological options. Or, perhaps, you’ve already given up and accepted urinary leakage as part of the aging process. You should consider seeking the expert opinion of a pelvic floor physical therapist before walking away from conservative treatment for good.


What is urinary incontinence?

First, let’s review our understanding of urinary incontinence (UI). It is defined as the involuntary loss of urine. In other words, your pee escapes you without your permission.


According to the International Continence Society, up to 60% of women worldwide experience UI, and the prevalence increases with age. Women are twice as likely to report UI as compared with men. Urinary incontinence is often embarrassing and stigmatizing but accepted as “normal” during certain seasons in our life.


Understand that UI is not normal, and in most cases, it is treatable.


Beware of potty myths.

What are some common misconceptions regarding UI? We were all taught many myths regarding our urogenital (urinary and reproductive) system. At a young age, you might have been encouraged to empty your bladder or pee “just in case” before a long road trip. Or, that if you drink less, you wouldn’t have to go to the bathroom as often. Someone might have told you that bladder leakage after coughing or sneezing is normal.


If this is what you think, please reconsider what you know about UI.


There are several types of urinary incontinence.

Stress urinary incontinence (SUI) and urgency urinary incontinence (UUI) are the two main types of UI. Stress incontinence is involuntary urinary leakage during physical exertion, such as coughing, sneezing, laughing, or lifting. An internal force pushes your bladder outward onto your pelvic floor muscles. If your muscles are not strong enough to resist the pressure, bladder leakage will result.


The second type of incontinence, UUI, is involuntary leakage from a sudden desire to void. Running water or turning the key in your door may result in a strong urge to urinate. Those people with UUI may receive the diagnosis of Overactive Bladder (OAB) syndrome.


“Why Do I Leak?” Get to know your body.

Smart Body Physical Therapy | Stress Incontinence | LeakageYour bladder, pelvic floor muscles, and nervous system work as a team to keep you dry. Urine is stored and collected in your bladder, which your body makes by filtering waste and extra water from your blood through your kidneys. Your bladder muscles include:

  • Detrusor muscle
  • Internal sphincter muscle
  • External sphincter formed by your pelvic floor muscles

Your sympathetic (SNS) and parasympathetic nervous system (PNS) control your bladder and pelvic floor muscles. Poor signaling or coordination between all these systems can lead to loss of bladder control.


In summary, there is a multitude of factors that could be causing your UI.

  • Improper contraction of your pelvic floor muscles could result in excessive downward pressure due to a lack of awareness or poor breathing strategy. Are you sure you are lifting and squeezing your pelvic floor?


  • Lack of coordination between your diaphragm, back, and abdominal muscles can add additional strain to the pelvic floor. Impairments such as back pain, abdominal weakness, and joint stiffness can contribute to poor pelvic floor muscle recruitment.


Many impairments leading to UI can be treated conservatively by a physical therapist. You can learn more from our knowledgeable and trained pelvic floor rehabilitation therapists. Contact the Smart Body Physical Therapy team for an appointment at 904-296-4140.



  1. Milsom, D. Altman, M.C. Lapitan, R. Nelson, U. Sillen, D. Thom. Epidemiology of Urinary (UI) and Faecal (FI) Incontinence and Pelvic Organ Prolapse (POP). https://www.ics.org/Publications/ICI_4/files-book/comite-1.pdf. 7/27/2021.–

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