By Dr. Mercola
Urinary incontinence, often the result of weak pelvic floor muscles,1 affects 25 million people, approximately 75 percent of whom are women.2
Urinary incontinence is the term used to describe an unintentional loss of urine. The types of incontinence range from stress incontinence to overactive bladder and nighttime urination.
Unfortunately, symptoms may be debilitating and cause embarrassment and anxiety. Finnish researchers surveyed over 3,700 people and found that although urinary urgency was common, stress incontinence was rated as most bothersome.3
The combination of millions of sufferers and a high rating of embarrassment by sufferers has created a significant market for pharmaceutical companies. Television, digital and print advertising advocate the use of medication and urinary incontinence pads to reduce symptoms and prevent embarrassment.
However, recent research has determined there is another way of addressing incontinence that results from weak pelvic floor muscles, without the added risks associated with medications. Interestingly, the solution may help support your posture and reduce lower back pain as well.
Stress Incontinence Linked to Higher Muscle Mass
Stress incontinence is a physical challenge more prevalent in post-menopausal women than in young women. In a study published in the Journal of the American Geriatric Society, researchers determined women who maintained lean muscle mass or strong grip strength were less likely to experience stress incontinence.4
Researchers theorized this population of women also maintained strong pelvic floor muscles, which support the pelvic floor organs.5 These muscles are responsible for urinary and fecal continence, stabilize connecting joints in the pelvis, perform as a lymphatic and venous pump in the pelvis and aid in sexual performance.
If these muscles become too weak, they allow urine to leak when you cough, sneeze, lift a heavy object or during exercise. This study examined data from over 1,400 women between age 70 and 79 at the start of the study.
They found those who didn't experience a decline in muscle strength over the three year study period were less likely to suffer from stress incontinence.6 Women also had reduced risk of incontinence if they lost weight and fat mass, as obesity contributes to the overall risk of incontinence.
Although a high body mass index (BMI) is a known risk factor for young and middle-aged adults, the relationship to incontinence becomes more complex in the elderly as there is a change in body composition as you age.
Researchers used questionnaires about incontinence and gathered data on BMI, grip strength, quadriceps power and walking speed.
Women who lost 5 percent grip strength were 60 percent more likely to suffer incontinence, while those who had a 5 percent or more drop in BMI were 54 percent less likely to experience incontinence.7 Dr. Anne Suskind, assistant professor of urology at the University of California, said:8
"Our study found that changes in body composition and grip strength are associated with changes in stress urinary incontinence frequency over time, but not with changes in urgency urinary incontinence frequency over time.
This finding may be explained by the anatomic underpinnings of stress versus urgency incontinence."
Factors That Increase Your Risk of Incontinence
Overactive or urge incontinence may result from a bladder infection, bladder cancer, bladder stones or nerve injury.9 Once an underlying medical condition has been ruled out, treatment may include strengthening pelvic floor muscles and lifestyle changes.
Your risk for both urge and stress incontinence may increase if you are overweight, as this places increased stress on the pelvic floor muscles. Inactivity, diabetes and depression may also affect the strength of your pelvic floor muscles.10 Other factors that can increase your risk for developing incontinence later in life include:
- Pregnancy and childbirth
- High-impact exercises, as chronic shock to the pelvic floor may increase your risk of incontinence
- Hysterectomy may double your risk12
The prevalence of urinary incontinence peaks during menopause and steadily rises thereafter, as women may lose more muscle tone while their hormone levels are slowly declining.13
Dr. Cindy Amundsen, urogynecologist at Duke University, North Carolina, commented on the need for weight reduction and muscle strength as women age:14
"By reducing weight and abdominal fat there is less pressure on the bladder resulting in less stress urinary incontinence. Better muscle strength may be associated with higher pelvic floor muscle strength and function, decreasing the susceptibility to urine leakage.
Women should optimize their body composition by achieving a normal BMI and improve their muscle strength, and they should continue to do so well into their 70s."
Not for Women Only
Compromised pelvic floor muscles may be seen as a sign of aging, but it is not. In this short video, Katy Bowman, a biochemist who educates people on the role movement plays in the body and the world, discusses poor pelvic alignment and pelvic floor muscle shortening as one challenge that may increase your risk of experiencing symptoms of pelvic floor muscle weakness.
Although strengthening your pelvic floor muscles will help reduce your risk for urinary incontinence, these muscles do more than hold back the flow of urine. In fact, according to Harvard Medical School, men suffer from some of the same issues when pelvic floor muscles become weak, including urinary incontinence, bowel issues and even problems with erections.15
Women tend to experience weakened pelvic floor muscles from childbirth, and both sexes may suffer tight muscles from prolonged sitting.16 Pelvic floor muscles also help stabilize your lower back and hips. When these muscles are tight they may be just as dysfunctional as when they are weak. Just as with other muscles in your body, tight muscles are not as functional or balanced, reducing the support they offer your body.
Loss of strength in the pelvic muscles may result in pelvic organ prolapse, when pelvic organs slip downward with gravity and bulge through the vaginal wall.17 It may also result in back and pelvic pain, or instability of the back and pelvis, contributing to loss of balance.18
Many women will forget to exercise these muscles and most men aren't aware the exercises will benefit them as well. Building a strong core will also sometimes weaken your pelvic floor muscles if the exercises are done improperly. Traditional sit ups and crunches increase abdominal pressure and strain pelvic floor muscles, much the same way pregnancy and added weight increases pressure on these muscles.19, 20
The key is to engage your internal core muscles, which will help prevent weakening the pelvic floor. Working core muscles vigorously doesn't necessarily provide an added benefit.
Build Strong Pelvic Floor Muscles With More Than Kegels
Kegel exercises are traditionally recommended to strengthen pelvic floor muscles. And, while they are powerful and effective, they are not the only exercises that will help improve your muscle strength and reduce tightness in the area. Here's a short list of exercises, including Kegels, and protective mechanisms to help both men and women enjoy continence and improved sexual satisfaction.21,22,23
✓ Protect Your Pelvic Floor
An ounce of prevention is better than struggling for a cure. The key to safety and stability of the pelvic floor muscles is to reduce stress during exercise and everyday activities. Most of the recommendations help to reduce the pressure in your abdominal cavity, and therefore the stress on these muscles.
Remember to breathe in and out during activities and don't hold your breath, this includes while having a bowel movement or doing crunches. Strive to use correct posture and form, including stabilizing your abdominal muscles and engaging the pelvic floor during instances of higher stress, such as lifting or pushing.
Use the exercises below to help engage your abdominal muscles without straining your pelvic floor muscles. While exercising and sitting, keep your knees together, which helps to support these muscles and reduce your risk of developing piriformis syndrome.
✓ Kegel Exercises
Just like with other exercises, if not performed correctly, Kegel exercises may do more harm than good to your pelvic floor muscles. It's important to learn the correct technique and practice them diligently to enjoy the greatest effect.24
Speak with your physician first to determine if there is any underlying medical condition that may preclude starting Kegel exercises, such as a urinary tract infection or prostate problems.
Kegels help to contract and relax your pelvic floor. The key is to fully relax the muscles after contraction, as keeping them slightly contracted will eventually weaken the muscle. These exercises are best learned lying down so you aren't also fighting gravity.
Your pelvic floor muscles surround your vagina and anus, so it's helpful to visualize squeezing and lifting this area toward your head, while not engaging your abdominal or gluteal muscles.
Hold the contraction for 5 to 8 seconds and do up to 10 repetitions. After learning how to do them and isolating the muscles, you can do them sitting in your chair or standing. No one ever knows you're doing them. It's easier to remember to do them daily if you associate them with another activity you do daily, such as brushing your teeth, sitting at a stoplight or checking your email.
✓ Move Through All Planes
Most people are used to moving forward through their day; whether walking, jogging, on an elliptical trainer, rowing machine or stair climber, you are moving forward. However, your body has the ability to move in other directions, and many of those movements functionally engage your pelvic floor muscles.
Doing hip and body circles or moving side to side, in a more upright position than a speed skater, engages your hips, also attached to your pelvic floor. Functional exercises improve the interaction between muscle groups and, over time, reduce problems with injury.
✓ Zip it
Keeping your abdominal muscles engaged during the day helps to reduce lower back pain and improve your overall posture. But, most people only use their external muscles, while forgetting the internal pelvic floor muscles. Imagine doing a gentle Kegel exercise and gently pulling your belly button toward your spine while pulling your shoulders back.
Engaging these muscles helps to keep your head to hips in proper alignment and reduce pressure and strain on your lower back, hips and pelvic floor.
✓ Head to Hips in Proper Alignment
Maintaining great posture burns calories as it engages your muscles and improves balance and reduces lower and upper back pain. Sitting for long hours in front of a computer or standing with shoulders down and hunched forward places your pelvis in an unnatural position. Keeping a watchful eye on your posture from head to hips reduces pain and the potential for injury.
Your lumbar curve should be relaxed but not pronounced. If your lower back muscles are tight, causing your buttocks to stick out, you may have to stretch your lower back muscles to allow you to stand appropriately.
Check your head alignment as well. Your head should be centered over your body and hips, with your chin tucked. As your chin tucks and your head aligns over your pelvis, this functionally engages the muscles without over tightening or stretching.
✓ Upper Back Alignment
Often called a dowagers hump, kyphosis is a rounded upper back that may result from sitting at an office chair for hours or leaning forward and looking down as you walk. An increase in this curvature will also increase your risk of incontinence and weak pelvic floor muscles.
Paying attention to your sitting and standing posture during the day is an important addition to both reducing back pain and problems with incontinence. Try stretching your back over a foam roller in the evening to massage tired muscles and do several squats to engage and strengthen your lower back.
What's in Your Incontinence Pads?
Last but not least, let's talk about the safety of the products you might use to prevent an embarrassing accident. In this short video Andrea Donsky comments on her frustration with the inability to get full disclosure on the ingredients in a product that comes in close contact with a highly vascularized area of the body. She also burns two feminine hygiene pads to demonstrate the differences in product ingredients.
Since incontinence pads and feminine hygiene products are classified as "medical devices," manufacturers are not required to disclose the ingredients. To give pads their pristine white appearance, the product must first be bleached, leaving behind chlorine. This interacts with carbon based organic matter (human tissue) to create disinfection by-products (DBPs). These by-products are some of the most dangerous substances to which you may come in contact.
There are safer alternatives that may reduce your exposure to toxic chemicals. Look for products manufactured from organic cotton, as some pads contain the equivalent of four plastic bags per pad. With everything that is now known about exposure to plastics, this alone is cause for concern.