A common question I have received before is “Why do I pee my pants? I’ve never had children.” Pelvic floor dysfunction is complex and multi-factorial, and having had a child is not a prerequisite for dysfunction to occur.
Pelvic floor dysfunction (heaviness, incontinence, pain with intercourse, etc.) can be present regardless of past medical history. Many factors play a role including bladder/bowel habits, level of fitness, activities of interest, and life cycle (ex. menopause).
Let’s dive first into bowel and bladder habits.
Holding in urine or trying to hold a bowel movement, instead of going when the urge arises, creates a few issues if performed repeatedly over time. First off, the pelvic floor and glute musculature must stay more engaged to prevent going sooner than wanted, which can create abnormal tone and pelvic floor restrictions. Secondly, when performed consistently, this creates a circuity with the brain that then links back down with the bladder. As this continue in the future, it will relay incorrect signals and perhaps cause some urge sensation or urge incontinence (there is a wonderfully complex picture below that shows the link between the muscles of the bladder and the brain itself). Ultimately, the lesson here is to follow your body’s urges but also don’t JIC (just in case pee) as that also will, with time, train the bladder in a negative way.
Another sensitive area to dive into is BMI and overall weight. Weight does play a role in pelvic floor function and dysfunction. A Brazilian study found that out of 1050 women between the ages of 20-45, women with a BMI of >30 noted more cases of nocturia (waking at night to urinate) as well as more cases of urgency (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4907402/). This is always something to keep in mind when setting personal health goals for one’s self. Also something to consider is the foods/liquids we are consuming. Artificial sweeteners, coffee, tea, chocolate, alcohol, citrus foods, and acidic drinks are all bladder irritants; each person reacts differently to these, and that reaction may also change throughout their lifespan. Food for thought…literally 😊
When considering lifestyle and setting personal goals, it is also important to consider the activities in which one is participating. For example, a friend once told me that when she finished a track race in high school, she always peed her pants, which at the time she didn’t think much of. Now many factors could be involved here. Was it the sympathetic fight or flight response going? Was it heightened tone in her pelvic floor? Was it pelvic floor weakness that, by the end of the race, led to the inability to control her pelvic floor musculature? Many factors can contribute, but if you are having incontinence with a specific activity it is important to:
1) check out the pelvic floor and surrounding musculature and
2) check out your form during that activity
With double-unders for example - are you starting to curl forward and lose postural stability which is contributing to a pressure management issue and consequently incontinence? Or with running - are you landing ahead of the body which is leading to increased pressure on the pelvic floor? All are factors that can contribute to pelvic floor dysfunction and should be addressed with a trained medical professional.
Finally let’s talk about menopause.
As menopause approaches, the ovaries make less of a hormone called estrogen (and also progesterone). Estrogen plays a role in pelvic floor stability and consequently, women may start to notice some incontinence with sneezing or jumping, or a sudden urgency when they walk in the door at home to use the bathroom immediately. Many of these individuals show up in the office reporting they never had any dysfunction until peri/menopause hit. Those hormones play a powerful role in how the body operates, so it may be a good opportunity to get checked out to make sure that everything functions well moving forward as well.
Overall, the pelvic floor is a powerhouse! Many times underlying deficits can be asymptomatic so if you do start to notice some negative changes I suggest reaching out to your closest pelvic floor physical therapist to check things out to prevent further limitations in the future.