Stress Incontinence... more than just "do your kegels"

Updated: Jan 26, 2021

Stress incontinence is leaking with a cough, sneeze, laugh, bend or running. One of the most common times I see patients with this is in the postpartum period. Often, leaking appears during pregnancy and remains through the postpartum period. Risk factors are leaking in pregnancy, having more than 1 baby, having a baby 37+ weeks gestation and constipation. So, if you are pregnant and leaking, it is a great idea to book an appointment with me during your pregnancy to “rehab” your pelvic floor prior to having your baby. Another tip-off that you should see me when you are pregnant is leaking after your 1st (or 2nd) baby, as multiparity (more than 1 pregnancy) is another risk factor.

You might be thinking a cesarean will prevent stress incontinence… but studies show that rates of incontinence are similar for vaginal deliveries and for cesarean for obstructed labor. Cesareans performed without labor do have lower rates of stress incontinence (Groutz).

Even in those who have never been pregnant, incontinence ranges from 5.56% in low-impact exercise to 80% in trampolining athletes. The amount of training influences leaking symptoms (Leitner). Women who are active and leak may not be leaking if they were sedentary, and we know that exercise, running and jumping also strengthens the pelvic floor. I suggest my patients exercise just shy of the point of leaking and slowly build over time.

With stress incontinence, it is important to figure out why pressure is going out the pelvic floor causing leaking. Is her pelvic floor weak? This is sometimes the case, but often it is more complicated. Did she have a muscle tear in delivery contributing to weakness? Is her pelvic floor tight and weak?-- I see this in enough postpartum mamas to never assume she should “just do kegels”. Another pattern I see is that the left and right sides are not symmetrical and one side contracts more than the other.

To solve incontinence, it is essential to look beyond the pelvic floor. How does she get her core stability? Common postpartum core strategies are overusing the back, overusing the abdominal wall and overusing the buttucks to "grip." All of these patterns can contribute to leaking (and prolapse and diastasis!). Other common issues are rib flare and the diaphragm being stuck. Are her ribs flared after pregnancy and diaphragm stuck and unable to move? Are her hips weak and not stabilizing her pelvis when she runs? -- the hips intimately connect to the pelvic floor and play an important role in pelvic organ support. Contraction of the hips elevates the pelvic floor by tensing the fascia (connections) (Leitner). Is her posture contributing?-- the pelvic floor contracts optimally in a neutral position-- not tilted forward as we see in some postpartum mamas, nor tilted backward.

There is a lot to consider and that is why you want a detailed assessment. I have been a pelvic floor health physical therapist since 2007, have completed all 3 “levels” of pelvic floor trainings (plus more!) and have mentored other pelvic health PTs for years. Reach out with any questions at

We offer house calls, clinic visits in the Fan district and virtual visits throughout the state of Virginia.

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