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Yikes! Why do I pee my pants when I walk and what can I do about it?

Our lives have changed in so many ways recently, and even the way we stay physically active has transformed. With social distancing, it’s no longer possible to pop over the gym for your favorite lifting or spinning class, or to the yoga studio for some stretching. So where do you turn to get your daily activity and break free from cabin fever? For so many of us the answer is simple - running and walking!

But what if you pee your pants while walking or running? And with the current situation, one of the only things to do out of the house right now is..walking or running, eek! Leakage might not be something new for you, but you might have noticed your underwear is less dry these days with all those trips around the block. That leaves you to either buy more pads and panty liners, or keep doing extra laundry.

But isn’t leaking just a normal part of aging?

Often women are told that some leakage is normal after having babies, or just a normal part of getting older and we might as well accept it. But maybe in the back of your head you’re questioning how much worse it will get, and start wondering if you’re truly losing control of your body...

Here’s the good news - peeing your pants doesn’t have to be the way it is! You’re not losing control, and there is hope.

So what is the deal then?

Many women I work with on these issues are surprised to learn that they have muscles that help keep your panties dry. Yes, you read that right, you have muscles down there! Collectively, this group of muscles is known as your pelvic floor, and they sit at the bottom of your pelvis and have important jobs in support, stability, breathing, sexual function, and allowing you to pee/poop when you need or hold it in when you need to. In fact, some of the muscle fibers wrap around your urethra (where the pee comes out) and play an extra special role maintaining closure when there is increased pressure from activities like walking, running, jumping, and lifting. These muscles also work closely with your hips, back, and abdomen to maintain control of the system.

Sure, staying leak-free is impacted by changes in our bodies. For example, having babies, hormonal changes with menopause, or difficulty maintaining a regular exercise routine due to other aches and pain (if that’s the case, let’s chat!) can all have an impact on your pelvis. To deny that would do you a disservice. However, there is so much you CAN do to navigate those hurdles successfully and with grace. And just because you’ve leaked before doesn’t mean you’re doomed to continue leaking from here on out.

Here’s the thing - just like other muscles like your biceps or quads, your pelvic floor muscles can be trained to support you better, and that means less leakage! Yes, you can decrease your leakage, and you’re not relegated to a life of peeing your pants.

Now there is no doubt that leakage can stem from more than just weak muscles, and there might be other factors that influence your leakage (more to come on those, too). With that said, I see so many women stop or significantly reduce peeing while walking and running by training their pelvic floor muscles and coming up with new movement strategies around their hips, back and core.

So isn’t that just a matter of doing Kegels?

I am often asked if Kegels are the answer. Kegels, or the idea of squeezing “down there”, are a voluntary pelvic floor muscle contraction, and you’ll often hear the terms used interchangeably. So logic goes that doing Kegels would strengthen the muscles and help better control leakage, right?

Well, sort of. First of all, in my practice I see that women often struggle with performing a true isolated pelvic floor contraction, or they have to rely on other muscles in their hips and core to elicit any activation down there. Furthermore, when attempting a Kegel or pelvic floor contraction, many women hold their breath and bear down, which is the exact opposite of the desired effect, eek!

But let’s say that you can do a beautiful pelvic floor contraction all on your own. That is fantastic! Working on those squeezes may help with your leakage, but they might not get you all the way there. Think of it like this, if you tightened up the muscles in your arm and held that one position, would doing that alone make you better at a complex movement like lifting a box on a shelf? Sure, it might help some. But especially if you’re going to try to lift heavier boxes, chances are you might need some extra training, like working on coordinating the movement with the rest of your body and working under different loads (or shapes and weights of boxes) first. It’s the same with your pelvic floor! It needs to be trained in a coordinated way, and be able to adapt to different challenges or movement patterns like walking. That’s where physical therapy and movement training can help. Physical therapists are movement experts, and just like they can help you with lifting boxes, specialized pelvic floor physical therapists can guide you to better movement strategies for staying dry.

Putting the pee-ces (pieces, get it?) together

It is also important to note that some women experience leakage not just because their pelvic floor muscles need to get stronger, they may also have extra tension in their muscles too, and that makes it harder for the pelvic floor to do its job well. For these women, sometimes it takes some extra coordination training to get the muscles to fully lengthen first. You know how sometimes when the drawer is stuck it doesn’t help to continue to try to push, and you have to pull the drawer out first? Your body is way more complicated of course, but you get the idea.

Also keep in mind that your pelvic floor might not be the only player here, and there may be other factors from your hips, abdomen or back. Maybe your tummy never quite felt right after an old Cesaren section, or that nagging back pain makes you shift to one side. Yep, you guessed it, that could affect the pressure on your pelvic floor too. There could also be other structural, hormonal, neurological, pharmacological, or underlying conditions that affect your leakage. Furthermore, even our habits and beliefs around going pee can impact your ability to stay dry. It truly takes an individualized approach to put all the right pieces together and get you back to life without leaks. Each evaluation with a pelvic floor physical therapist like myself should be geared towards trying to understand all the factors that influence your symptoms, and that way we can work together to come up with a plan

tailored just for you.

The bottom line is that if you’re struggling with peeing your pants, and especially if it has gotten worse with social distancing, there really is help. Pelvic floor physical therapists undergo specialized training to help women (and men, too) with these very conditions. If you have questions or think you might benefit from some speciality training to help you stay dry, reach out and let’s chat!

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