Why Do I Pee When I Cough, Laugh or Sneeze?

pelvic health pee when i cough laugh sneeze physical therapy

One common question we hear from our Women’s Health Physical Therapy patients is: why do I pee when I cough, laugh or sneeze? Is this normal? While this occurrence may be common, it’s not something you should have to accept and learn to live with. Urinary incontinence, or the loss of control of your bladder, is a condition that may be a sign of weakened muscles in the core and pelvic floor.

urinary incontinence physical therapy pelvic floor dysfunction

When we cough, laugh or sneeze, there is an increase in intra-abdominal pressure which causes our diaphragm to contract down into the area of our bladder. If the bladder can’t withstand that pressure, it causes you to urinate unintentionally, aka “leakage”. We tend to over-utilize our abdominal muscles to compensate for weakened pelvic floor muscles. The good news in all of this is that physical therapy can actually help to strengthen the core and pelvic floor muscles that are responsible for holding up the bladder, thus, preventing leaks.

For patients suffering from urinary incontinence or other symptoms related to weakened core and pelvic floor muscles, physical therapy provides minimally invasive, one-on-one treatments to help strengthen those muscles and address any functional limitations. Just like any other condition treated by physical therapy, we can address the unique musculoskeletal problems of this region and also provide preventative services to keep this issue from ever coming back.

If you’re experiencing symptoms of urinary incontinence or any other issues associated with the pelvic floor, contact one of our physical therapists today.

Why Every New Mom Should See a Physical Therapist

mother physical therapy baby postpartum

After a new mother has her child, issues with stretching, back stiffness and weakened muscles in the core and pelvic floor require attention to ensure that the body returns to a state in which it can function normally and without pain. Our physical therapists work with postpartum women to strengthen pelvic floor muscles and develop custom therapeutic exercise programs to repair and restore these areas that have undergone so much change.

When pregnant, stiffness in the thoracic spine, or upper back area, may occur as a result of the anterior movement of the baby essentially pulling you forward. Stretching in the abdomen and pelvic floor can also result in weakened muscles in the pelvic floor though luckily these issues can be resolved with physical therapy. Your PT will work with you to improve the strength and stability of these muscles to repair stretching and ensure that you’re not at risk for back pain.

Common pelvic floor conditions for new moms can include incontinence and prolapse (which occurs when an organ in the body slips forward or down). Your PT can help to build your pelvic floor back up and restore the foundation of your body so you can resume life healthy as ever. Visit our Women’s Health Physical Therapy page to learn more about our pre- and post-partum services and to understand how we can help you address your unique pelvic musculoskeletal issues to improve your quality of life.

Urge Incontinence & Bladder Irritants

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Urge Incontinence is a problem with the bladder that causes you to feel like you have to go to the bathroom suddenly, when really you don’t need to. But why does this occur?

While it could be based on a number of factors, one of the big things that we consider are bladder irritants—certain foods and beverages that can actually contribute to the irritation of the bladder lining, which normally protects the bladder from toxic contents in urine. “The Four Cs” is a helpful rule to remember when considering bladder irritants.

The Four Cs
• Citrus: Fruits like oranges and limes contain high amounts of citric acid which can worsen bladder control.
• Caffeine: Beverages like coffee and tea can increase bladder activity and contribute to higher urgency and frequency of urination.
• Cocktails: Any type of alcoholic beverage will irritate the bladder and also act as a diuretic, increasing urinary frequency.
• Carbonation: Beverages like soda (which often also contains caffeine) has been shown to worsen incontinence symptoms.

Pay attention when you have these things and if you notice an increased urge following, take note of that and consider making changes to your diet.

Visit our Women’s Health Physical Therapy page for more information.

Female Bladder Urgency: What’s Normal?

female-bladder-overactive-urinary-urgency

At Therapydia NOLA, our physical therapists address the unique musculoskeletal problems of the pelvic region to help and treat any functional limitations and also offer preventative services. As part of our Women’s Health Physical Therapy services, we field a lot of questions surrounding bathroom norms, urinary urgency and overactive bladders. Below are just a few things to remember when it comes to daily bathroom use:

When it comes to voiding, how many times should I be using the bathroom in a day?
Normally, you should use the restroom around 5-8 times per day.

How much water should I drink in a day?
To figure out how much fluid you should intake each day, take your body weight and divide that number by two. This amount of water in ounces that you should aim to intake each day.

For example: If you weigh 150 pounds: 150/2=75. You should be drinking at least 75 ounces of water per day.

For women, remember to always sit and to never push when voiding.
The pelvic floor is a group of muscles. Everything exits through here. We want these muscles to be relaxed in order to promote healthy habits.

Never “just in case” pee.
Everyone has a different tolerance within their bladders as far as how much it stretches. If you use the bathroom all the time throughout the day, this “just in case peeing” is teaching your bladder to tell you that you need to urinate when really you don’t need to.

For more about our Women’s Health Physical Therapy services, visit: Women’s Health Pelvic Floor Therapy

Why Ab Separation Happens During Pregnancy

Pregnancy Ab Separation Treatment Therapydia

What is a Diastasis Recti?

Most of the physical changes that come along with pregnancy are strictly temporary. Unfortunately, some physical issues don’t resolve immediately after you give birth. Abdominal separation, or diastasis recti formation, is commonly seen within the pregnant/postpartum patient population with 2/3 of women experiencing some degree of separation pre or postpartum. Abdominal separation happens when your rectus abdominis or abdominal muscles become lax and disconnects midline at the linea alba. If you recently had a baby, it’s key to know how to identify if you have abdominal separation before returning to any workout routine in order to prevent injury and further separation.

Unbalanced Abs, Unbalanced Body

Abdominal separation is usually something a new mom might not even know she has. However it is important to check seeing how it interferes with the way your core muscles work together, leading to postural deficiencies and increased risk of injury centered around your body having an inability to stabilize your core. These deficiencies can result in or contribute to a variety of symptoms such as:
• Low back pain
• Sacroiliac pain
• Hip pain
• Stress incontinence (urine loss when laughing coughing or sneezing)
• Prolapse (when internal organs fall or slip out of place)

How To Check If You Have Ab Separation?

You can identify if you have a diastasis recti by doing a simple self-test.

• Lie down on your back with knees bent at 90 degrees and feet flat
• Place fingers of one hand horizontally across midline of abdomen at the belly button
• Slowly raise your head and shoulders a few inches off the floor
• If a separation exists your fingers will sink into a gap/ditch with your right and left muscles to the side
• Note the number of finger-widths that can be placed between the muscle bellies
• Check at your belly button, above, and below

If you feel a separation of 2 to 3 finger-widths or greater you are considered to have a mild Diastasis Recti, and 4 to 5 fingers width is a moderate to severe separation.

Healing Your Deep Core

First of all don’t panic or stress if you feel you have an abdominal separation. This is a very common problem where there are specific exercises that can help with the healing process and facilitate for full abdominal closure. To enable healing it is important to limit abdominal stressors involving lumbar flexion. This is characterized as the forward movement of your body such as crunches or when moving from your back to sitting upright when getting out of bed. Movements like this potentially lead to greater abdominal separation rather than closure. Correct movements are targeted towards having strong deep core activation with targeted transverse abdominis activation.

Transverse Abdominis Activation

Therapydia Pregnancy Physical Therapy

• Maintain a flat back with a chin tuck and shoulders over wrists
• Keep your hips and toes tucked under
• Inhale while causing for outward and upward movement in your back body/ribs
• Then exhale and pull your ribs up and in from your stomach
• Perform 6 to 7 breaths of 3 sets while being careful to not over breathe to limit any lightheadedness or dizziness

Closing The Gap

Your abdominal separation is something that should be reassessed every 2 to 3 weeks checking for closure with a proper exercise program established.

Experiencing ab separation postpartum is unique to everyone’s body and pregnancy journey. If you feel limited or uncomfortable because of the weakness in your core, don’t hesitate to contact us if you have any questions. Although some cases may be mild enough to solve on your own, some cases may need to be seen by a physical therapist who specializes in women’s health and pelvic floor therapy.

By Whitney Braswell Fedor, PT, DPT, Specialized Woman’s Health Physical Therapist via Herman and Wallace Institute, Kineticore Dry Needling Level 1 and 2 certified practicing at Therapydia NOLA in Metairie. She can be reached at (504) 324-8345.

Preparing Your Body For Pregnancy

Pregnancy Physical Therapy Therapydia

Pregnancy is a time of wellness accompanied with tremendous musculoskeletal, physiological and emotional change. Many women experience these changes with pain and discomfort, which can actually be prevented. There are specific muscle groups that can be trained to help you adapt and better prepare your body for pregnancy. The idea is to combat the strain that is put on the areas of the body that are carrying the weight of the growing baby by improving muscular support and strength. These areas include the lower back and sacroiliac joints.

How Does Your Body Change During Pregnancy?

During pregnancy there are many different changes that occur within you body, but for the sake of this blog, let’s focus on the changes related to the musculoskeletal system.

Most important of all the connective tissue changes occur primarily with the release of hormones, relaxin and progesterone. These hormones cause tendons and ligaments throughout your body to become more elastic, allowing for a greater stretch to occur across joints, and in turn causing for overall joint hypermobility. This “stretch” is a good thing because it allows your body to accommodate the growing baby, and also helps facilitate the baby coming out during delivery. However, with this increased elasticity comes your body’s need to rely more on muscular support and stability within the pelvis to combat joint hypermobility.

Also, core muscular changes occur primarily due to the stretching of muscles, specifically within your abdomen and pelvic floor. This stretching increases as the baby grows, which in turn, decreases your ability to elicit a strong muscle contraction due to the muscle tension relationship. However, if these areas are trained and/or strengthened prior to or during pregnancy, they can help combat this stretch for decreased episodes of lower back pain and stress incontinence.

In this article, we are specifically looking to help decrease the occurrence and severity of the common issues of pregnancy:

• Lower back pain
• Sacroiliac/pelvic pain
• Hip pain
• Urinary stress incontinence

Building Body Core Strength

Avoiding strain on your body during pregnancy involves strengthening the muscles around your core and pelvis area. If you go into pregnancy with strong core and hip stability, you’re going to be able to help combat these issues allowing for an easier time carrying the baby and for a faster recovery post-baby.

Clams:

Therapydia Pregnancy Physical Therapy

Therapydia Pregnancy Physical Therapy

• Lay on side with hips in a stacked position towards the ceiling
• Knees at a 90-degree angle and hips in line with knees
• Keeping ankles together, raise top knee towards the ceiling
• At the same time, lift at the hip and keep hips forward
• You can place your hand behind your hip to keep your hips from rolling backwards
• Return to start
• To increase resistance you can add a cuff weight around the lateral thigh or apply an elastic band slightly above both knees
• Perform 30 repetitions once a day

This is important with pregnancy to help strengthen the muscle surrounding the sacroiliac joint by helping to prevent sacroiliac issues with enhanced glute and hip external rotator stability.

Kegal/Abdominal Bracing:

Therapydia Pregnancy Physical Therapy

• Lay on back with knees bent
• Pull up and in with the vaginal opening as if you are trying to stop the flow of urine
• Make sure to not squeeze your bottom and to not tighten your muscles in a way that will change the neutral position of the spine
• Perform 30 repetitions with a 2 second hold 2 times a day

This is what I call a secret exercise because when performed correctly the outside observer will see no movement. This exercise is important to help counterbalance the stretching of the pelvic floor that occurs with pregnancy which can help to decrease incontinence issues during and post-baby.

Quadruped Multifidi Activation:

Therapydia Pregnancy Physical Therapy

Quadruped Multifidi Activation

• Start on your hands and knees (shoulders and hips at 90 degrees)
• Tighten your back and your stomach by pulling your belly button to your spine internally and holding
• Without shifting your pelvis and keeping the neutral position of the spine, pick one knee up slowly while also making sure to hold the opposite hip in the same position
• Then perform with the other knee as well
• Perform 20 repetitions on each side (pain free exercise)

When performed correctly, this exercise helps to strengthen your core in the back and abdomen region. It also helps to strengthen your hip external rotators causing for greater sacroiliac and hip stability.

Mobilizing Your Pregnancy Muscles

Knowing how your body is going to change is key to preventing physical discomfort and pain during pregnancy. Strengthening specific areas can lead to a smoother pregnancy, birth, and rehab post-baby by combatting any musculoskeletal imbalances.

Contact Whitney Braswell at Therapydia NOLA if you have any questions about prenatal care and strengthening. We can work with you to design a treatment program that’s unique to your body and your pregnancy.

By Whitney Braswell Fedor, PT, DPT, Specialized Woman’s Health Physical Therapist via Herman and Wallace Institute, Kineticore Dry Needling Level 1 and 2 certified practicing at Therapydia NOLA in Metairie. She can be reached at (504) 324-8345.

Why Kegels Aren’t Enough: Pelvic Physical Therapy

Therapydia Pelvic Pain Treatment

Many women do not normally associate pelvic pain with physical therapy. They feel pain and notice the symptoms, but can’t tie a physical reason to the discomfort they’re feeling. Unfortunately, conditions related to pelvic health can take years to diagnose and treat. This gap develops because most of the time it’s hard for providers and patients to realize that musculoskeletal problems are at the root of their pain. At least a quarter of women suffer from a pelvic floor disorder—and these are just the reported cases. Considering the statistics and how these conditions can affect a woman’s quality of life, it’s important to educate women about what can be done.

Breaking Down Pelvic Pain

Anything related to pelvic health has to do with the bladder, bowel, sacroiliac joint (joints at the bottom of the spine), and low back. The pelvic floor is a sheet of muscles suspended from the SI joint in the middle of the pelvis to the tailbone. It provides support for your core and internal organs. These muscles can dysfunction in many different ways, but in general they are either hypotonic (weak) or hypertonic (tight/painful) which causes for pelvic floor dysfunction. Someone with a weaker pelvic floor could present to physical therapist with issues of incontinence while someone with a tight pelvic floor could present with pain.

A pelvic disorder doesn’t necessarily only cause pain in your pelvis. Organs in your pelvic area (i.e. bladder) could also be experiencing discomfort. Any muscular problems you’re having could manifest as incontinence or prolapse, when your pelvic organs drop down from their normal positions. You may also feel increased urgency or pain when urinating or during bowel movements. Having unexplained pain the the lower back and pelvic area may also be a sign.

Kegels Aren’t For Everyone

There’s a general myth that only older women or women who have had children need pelvic floor treatment. The truth is these conditions are common in many different age groups. Numerous situations can cause dysfunctions that may have no connection to childbirth. Kegel exercises help to strengthen your pelvic floor, but that’s not all treatment comes down to. Are you really performing your kegel exercises correctly? Chances are that you aren’t.

Pelvic floor physical therapist can ensure you are performing your exercises with the proper techniques. Additionally, there are some women with pelvic floor disorders, where kegel exercises should be avoided. In these cases, doing kegels may actually make the pain worse. This is why you should always seek the help of a physical therapist to ensure proper guidance is in effect.

Empower Your Pelvic Floor

Physical therapy is a great way to get your life back—and feel like you again. Consider when you would ever go to a physical therapist. If you had injured your lower back or had some knee pain, you would most likely go see a physical therapist for treatment. The same applies to pelvic disorders. It all comes down to relaxing, strengthening, and healing muscle tissues. Treatment can include the use of hands-on treatment methods that can range from manual therapy and therapeutic exercise to dry needling. Devices for electrical stimulation and biofeedback electromyography (measuring muscle response) can also aid with healing.

Having incontinence, pelvic pain, and lower back pain are not a natural part of the aging process. These are certainly not conditions one should just have to deal with. If you feel you may be suffering from a pelvic floor dysfunction, follow through with physical therapy treatment.