I overheard two women discussing urinary incontinence in the ladies room. One complained that coughing caused her to pee her pants. The other was upset because she leaks a little urine when she exercises. Unable to keep myself from responding to what I consider a woman’s health emergency, I said, “I’m a gynecologist. And in order to prevent this kind of urinary problem, you have to develop strong buttocks muscles and get in touch with your pelvic floor. I recommend peeing in the shower.” They were a little offended by my brash advice.
About one in four women suffers from urinary incontinence, the involuntary loss of urine when sneezing, coughing, or laughing. And even more have what’s called “urgency incontinence” when the urge to urinate is so strong that you fear you won’t get to the bathroom in time. Urinary problems in women are epidemic. In fact, the number one reason why older women have to go to nursing homes is…drum roll…urinary incontinence!
Did you know that the average woman suffers in silence for an average of seven years before she finally brings it up with her healthcare practitioner? When she does, usually she is told one of two things: take a drug or do Kegel exercises.
The drugs stop “urge incontinence” by blocking some of the nerve endings on the bladder’s main emptying muscle (the detrusor). When the muscle is less irritated, it’s less likely to contract involuntarily—and cause you to lose urine at an inconvenient time. These drugs have bothersome side effects, though, like dry mouth. And besides, like so much of modern medicine, they don’t really cure anything. They just mask the symptoms.
The Kegels strengthen the PC (pubococcygeous) muscle, which closes the sphincters of the pelvic floor and stops the flow of urine. Kegels are a step in the right direction. But they don’t address the function of the entire pelvic floor—they strengthen only one muscle. A strong, rigid muscle isn’t necessarily a functional, strong, flexible muscle. That’s where the squats in the shower come in.
When you squat to urinate as opposed to sitting up straight on the toilet, you automatically engage your butt muscles. And your pelvic floor naturally stretches and tones. Moreover, because your urethra is now pointed straight down all you have to do is relax for urine to flow out easily—as opposed to sitting up straight and having to strain to empty your bladder. The same thing is true with moving your bowels.
Before going on, I want to bust a popular myth that childbirth results in urinary incontinence. This is not true. Many teenage girls have incontinence. And so do nuns who have never had children. Yes, childbirth—especially when conducted without knowing how to push correctly—may weaken the pelvic floor for a time. But that is reversible.
So what do I recommend if you have urinary incontinence or are worried about it?
- See a women’s health physical therapist who specializes in the pelvic floor. This relatively new specialty uses Pilates and other exercises to assist you in reclaiming a healthy and functional pelvic floor. The pelvic floor is all the muscles and tissue between your pubic bone and tailbone, and it holds in your bowels, bladder, and genital organs. When this part of your body isn’t strong or toned, your organs tend to fall out! That’s known as a prolapse. Prolapses can often be treated well with physical therapy alone. You don’t always need surgery.
- When you sit on the toilet, put your elbows on your knees so that you are in a squatting position. Notice how much easier it is to empty your bladder or bowels. Better yet, get a stool and put it under your feet so that your body is comfortably seated in a squatting position. (Check out the squatty potty video to see what the proper position is.)
- Strengthen your core. I have done Pilates for 15 years and can attest to its ability to strengthen one’s pelvic floor.
- Read The Bathroom Key: Put an End to Incontinenceby Kathryn Kassai and Kim Perelli or go to www.thebathroomkey.com for more resources and to locate a physical therapist in your area.
I’m a 59 yr old woman. I do have an occasional incidence of the incontinence mentioned in this article, but my bigger problems is when I’m sleeping. My brain cannot discern whether I am really in the bathroom or not. Even in my dreams I am checking myself to make sure I’m not asleep and am REALLY in the bathroom and once I’ve satisfied the reality I go ahead and pee… only to wake up wetting the bed. It seemed when I was drinking hot lemon water in the morning, I didn’t have the problem. The lemons though hurt my teeth. I started with MCT oil and that seemed to be doing the trick for a while but now, I’m on a lectin free diet and the problem is much worse having 2 incidents in one night recently. I’m so frustrated. A response would be really appreciated! Thank you for this article!
I speak with women of all ages and sizes who have incontinence. There are literally 100s of products out there to keep you dry but unfortunately most stores do not carry a good assortment or have anyone who can assist you in selection of the right product. Please call one of the many online stores available and ask questions to help you find the right product. These are the questions they will ask you, so have the answers ready before calling: 1. Amount of absorbency you need. Drips, moderate, maximum, heavy, overnight? 2. Pads, Pullons, Briefs (tabs on side), Belted Undergarment, Booster Pads? 3. Waist/hip size in inches, which ever is larger. Using the right product in the RIGHT way will keep you dry.
I would think those are just bandaids. I would want to get to the root of the problem like local estrogen used in the vagina. Also strengthening the pelvic floor.
Amazing article! I think the majority of women think childbirth causes urinary incontinence. Most women are embarrassed to bring it up or just assume it’s a normal thing that happens. This is great advice, thank you for posting!
I have suffered with incontinence for at least 10 years. I am 64 now and my knees are shot. I need help getting up or down with my bad knees so cannot squat. I have had inter-stem implant but it does not seem to help but they want to go in and fix a lead that is loose for some reason. I never did feel like it helped very much even when first put in! How can I do the squats with bad knees.
Wondering if you can comment and reply to help me? Thanks!
For over 10 years I took part in trampolining, 8 of which competitively, training 2-3 times per week. I struggled along with stress incontinence for about the final 3-4 years (having initially been problem-free) but eventually quit the sport for this very reason. I was so upset because I loved trampolining – by the end I was having to go to the toilet to change pads after every time it was my turn to bounce. At the time I quit I was 19 and extremely embarassed. I had never heard of this problem in young women and rather jealous that others did not seem to be affected the same as me. I did not like to discuss the condition with my (male) trampoline coach. I finally spoke to my mum and my doctor about it and was eventually referred to a physio specialist, but perhaps was not mature enough to adhere to her advice as I found the whole matter traumatic.
6 years on and I am now 25. The problem doesn’t bother me generally as I simply avoid trampolines or any rebound sports, though feeling sad about my reasons for doing so. I have found I have developed urge incontinence and have had a few terribly embarassing situations to deal with! I have put this to the back of my mind for so long and would like advice on long term, sustainable stategies for tackling it. It would be amazing to no longer be concerned about this problem!
Thank you 🙂
Check out Katy Bowman – she has simple exercises you can do to improve your pelvic floor…and your overall body alignment 🙂
The exercises alone weren’t working for me…I tried a stimulation unit called Dr. Norm’s Fem-Tone, and it worked for me!
Does rebounding in exercise rebounders or small exercise trampoline worsen prolapse or does it strenthen the muscles improving it. What is the best exercise to strengthen muscles ? what muscles should i be strengthening please.
I am so glad I found your site!! I am 22 years old and have suffered from incontinence all my life…It’s an extremely embarrassing thing although this issue unlike so many other women only happens to me when I laugh it is much more than just a few dribbles of urine. I am about to deliver my first child tomorrow. I was given the opportunity to go C section but felt very strongly about a vaginal birth and did not want to put my child at any unnecessary risk. I realize my problem will probably get much worse but I am hoping that through your program and with determination and diligence i can get my body back to where it needs to be…I have been suffering with this problem my entire life and have been so incredibly ashamed of it…I am at the point in my life where I had to choose between risking the quality of my sons life or the quality of my life and I chose mine. I am praying that after my delivery i can go to a physical therapist and become dry for good. I am very much hoping that at the young age of 22 there are people out there that can help me with this problem and help me become leak free. I very much believe that my problem is fixable.
Just had to comment that squatting is a miracle! I have had eight deliveries and not been able to jump, run, sneeze, or do heavy lifting with out dribbling in years. I starting squatting and in one month I’m pee free!! I feel like a new women and yes it has made a difference in all my functions in that area! Thank you for promoting this!
How do you squat? Is it a workout or do you do a series of squats? Please share in more detail. Thank you.
I have had your book “The Wisdom of Menopause” for years and just this morning read in it that the use of a Chinese techniique using cone weights was something you recommended for strengthening the pelvic floor.
There’s a new treatment for stress incontinence to cause stem cells to generate new healthy tissue. The procedure is called o-shot which has been very effective with my patients.
More can be seen at OShot.info
Hope this helps.
Charles Runels, MD
Thank you! I’ve noticed just since the birth of my 4th baby (2 1/2 years ago) that I suddenly have issues when I sneeze or cough (or even pass gas!). Furthermore, my 9 year old daughter told me she is slightly wetting her pants occasionally just doing normal daily activities, too. I also wondered how incontinence relates to diastasis recti abdominis. I’ll look into the reading you recommended as well as the other recommendations. Thanks, again!
I became incontinent when I was 21, and waited 7 miserable months to tell anyone and get real help because I was so ashamed of myself, I wanted to curl into a ball and die. I saw a woman’s health physical therapist, who taught me a lot of helpful exercises & stretches to improve my overall bladder function. I continue to educate myself on how to better improve it, and I found this really helpful. Thank you so much!!
I started pilates about two years ago for back issues. Not too long after, I noticed that I loved to come forward with elbows on knees and just relax a moment while on the toilet. I played with this and now bypass the knees and round and stretch my back all the way with arms forward and hanging freely. I truly feel releaved and wonderful afterwards. No more back problems, and come to think of it, I have not had incontinence issues since…..
I am 56 years old. I had my last period two years ago and began to have more frequent UI with coughing, sneezing, etc. I stumbled onto blogger Katy Bowman’s “Katy Says”. Katy is a biomechanist and has written many posts on the pelvic floor. I have been using her suggestion to pee in the shower and have started doing my squats correctly (harder than I thought). I am beginning to see improvement.
It is amazing to me that correcting our body movement can have such a positive impact:)
Kath, do you do rebounding at home or at the gym? If it is at home, could you please recommend a video? Rebounding is not common or easy to find here in Spain. Thanks
Brava! So many women struggle in silence. Something I might also have women consider is gluten sensitivity and food allergies. In my medical practice at The UltraWellness Center, where I work with Dr. Mark Hyman, we’ve seen incontinence improve with identifying and removing foods that trigger inflammation and irritation. This doesn’t substitute for strong pelvic floor muscles, but is sometimes an underlying cause. Warm wishes and respect, Aviva Romm MD, CPM
It does my heart SO MUCH GOOD to read your comments and to know that so many of you now have the solution to the common problem of UI– even in young women!!! I have found that my squatty potty has really changed my hip flexibility– even though I don’t have incontinence problems. Kegels are just ONE form of pelvic floor strengthening– but they do NOT tone and stretch the pelvic floor muscles nearly as well as developed a good set of gluteus muscles. let’s hear if for strong booties!!!!
After three vaginal births, trampoline class was my miracle cure. If you don’t have a trampoline workout program in your area, purchase a rebounder for use in your home. Nia can also provide some benefit although not to the extent of the trampoline. Myofascial release can also work wonders if your MFR therapist has had training specific to the pelvic floor.
If you follow the step-by-step, physical therapy methods presented in THE BATHROOM KEY book, your stress and urge incontinence will become a thing of the past–like it has for thousands of my patients. Studies show that you can reduce your bladder prolapse non-surgically, too, as Dr. Northrup confirms in her recent radio show. Don’t endure it…Cure it!
–Kathryn Kassai, PT, Co-author of THE BATHROOM KEY: Put An End To Incontinence
Love this information….I have suffered with incontinence for many years, have tried pills and they didn’t work… I now use a stool and I do try squatting in the shower. I haven’t tried pilates yet, and I have tried kegels, without much results. I also have a video tape of C. kent, haven’t watched it in a long time…I do have the book”The Bathroom Key” Iam praying that something helps…Thank you again for all you do.. Katherine.
This was so helpful. I recently had bronchitis and I was constantly having to clean up myself. That is the last thing you want to suffer with at 41 yrs old. I also found there was some leakage during sex which was horrifying. I thought the only thing I could do was have surgery which I willing to do if I had to. It is not a topic you just bring up. Although when I started to talk to a few friends about it, they mentioned they had the same issues. Thanks for the information.
Timely with the new article in this issue of Journal of Women’s Health Physical Therapy that surveyed 18-30 year olds. 71% feel that they are not able to speak freely about their incontinence. Let’s continue to spread the word about available resources and diminish the shame associated with UI!
During my last visit to my doctor for an annual checkup, he mentioned that I had a slight prolapse, and suggested getting physiotherapy, specifically for the pelvic floor, to stop the leaking I experienced when sneezing, or exercising. Coincidently, my massage therapist mentioned she was seeing such a specialist, who was in the area. After several treatments, I have gotten in touch with my pelvic floor, and will continue the exercises for the rest of my life.
Thanks so much for this information. Ever since I went through menopause I have had some leaking. I have been told I need surgery for a dropped bladder and uterus. Maybe by strengthening these muscles I can move them back into place. I hope. Worth a try.
Thank very much for this excelent information. I found it useful and also with new advices .
After months ‘sucking it up’ and of not following through on a referral for pelvic floor physio from my doctor – I’ve finally called and made an appointment! Relief hopefully in sight!
So glad for this information. Thanks for your constant research. Squatty potty here I come.
I thought you endorsed the Whole Woman Posture. However, Christine Kent is against Kegels, but here in the article you recommend them. I stopped doing my Kegels when I found out that, according to C.Kent, they might actually make my condition worse. Now I read your article and wonder whether I should take them up again. I know you don’t reply to individual consultations but I’m positive I’m not the only one who follows you both and is unsure about what to do. Please help.
Rebounding made a huge difference for me after 13 years of pads, post child birth. I started this winter and in 4 weeks of light rebounding, I had about a 75% improvement. I also started Nia 5 stages exercises in the morning, some hooping to strengthen my core. But the rebounding changed my body significantly. Thank you for bringing this topic to light. I got the “kegel and lose weight” advice too. My gut told me to try my own way. So glad I listened! What a relief!
Thank you Dr. Northrup for once again shedding light on problems no one else wants to talk about. You are a great teacher for all us!
My mom suffered from incontinence for years and she was sooo upset by it.. and now I will occasionally have leakage ( if I sneeze or exercise) and I have done Kegel but it did not seem to help.
Reading this has given me such hope! Thank you for all the information you provide. I think this will relieve (pun intended) many women.
10 years ago I was at a party. I laughed and soaked my pants. I was so ashamed, deciding I would never go to a party again. The next week I worked as a guest therapist at the Myofascial Release (MFR) Center in Paoli, PA. Part of the program involved receiving MFR each day. I opted for pelvic floor work and the difference in 5 sessions was amazing. It made such an impact on me that I signed up for the Women’s Health seminar for MFR and started a private PT practice offering pelvic floor work.