Don't Fear The Sneeze

There are a lot of people in my "biz" who get really annoyed about jokes made online about  moms "peezing". I 100% do not blame them one bit. 

We, as pelvic floor PT's see the negative long term social, emotional, financial, economic and general well being impacts that stress incontinence has on people. We know it's no joke. See my last blog post "what if it's not JUST a little leak" to see for yourself. 

However, what these funny articles, blogs and social media posts do allow us to do. Is take something previously too taboo, too heavy to talk about, and bring it to light. 

They allow for a conversation to start, and then, before we know it. ALL. WOMEN. KNOW that there is help for leaking urine, if it happens to them, it is not something to leave un-treated. Also, it helps them know that they are 100% not alone. So, in reality, I'm glad for these types of posts and jokes. 

This all being said. What I want to share are some of my favorite tips for decreasing leaking with sneezing, or "peezing"  as well as for things like coughing or laughing. 

Lets first talk about what many people do to try to prevent leaks and why it may or may not be as helpful as we hope! 

1. Crossing Legs 

Squeezing inner thighs together, is not a horrible idea... in theory. Our inner thigh muscles actually have connections to our anterior pelvic floor muscles and they often work together functionally with things like walking. HOWEVER. If we have pelvic floor weakness, this super hard squeeze from inner thighs with the downward pressure from the sneeze will overpower  the pelvic floors ability to lift and contract to actually stop the leak. - And may actually make the leak worse.

2. The "Knack" 

This may be a very unpopular opinion. So if you disagree, let me know! I'd love to talk about it.. but hear me out. 

The "knack" is a little trick many pelvic floor PT's teach in order to help people stop leaking with sneezes and coughs. 

The "knack" is when you contract pelvic floor right before the cough or sneeze to help keep bladder lifted , sphincters closed and pee inside. 

This is great! and it WILL work... IF and that is a big IF... you know how to properly contract your pelvic floor. Some research has suggested that after only verbal instructions on how to contract your pelvic floor only about 60% of women did it correctly. Clinically, in my experience, I would say that fairly accurate. SO... for upwards of 40% of women, telling them to contract pelvic floor before a sneeze  (without PT guidance and assessment if they are contracting properly) then this technique may not work. 

For the 60% who do, or for those in pelvic floor PT getting direct guidance, this still is not my favorite technique. 

Our pelvic floor should reflexively lift and engage with powerful exhalations - like a cough, sneeze or hard laugh. Having to consciously tell your pelvic floor.. "ok pelvic floor" ready... "NOW!" is not always a great long term strategy. 

We don't have to say that to our quad muscles " OK quad... contract " with every step we take- they just do it! -

So what are some better strategies to use in order to teach the pelvic floor to do its job better, reflexively, and keep us dry? 

 1. This sometimes is a scary one.. but "LET IT GO!" 

Yes, just let that sneeze rip! No gripping, clenching, trying to stifle or make it "smaller" - like I said above tightening everything (including the pelvic floor) prevents the pelvic floor from doing it's "thing" 

When we breathe in ( like the big breath we take before a sneeze) our pelvic floor "should" lengthen and it is this lengthening phase that allows the pelvic floor muscles to preform a more powerful contraction through its "full range of motion" . 

Let's talk physics a minute: 

Power= Force x Velocity 

Velocity= Distance/Time

SO what does this mean for a pelvic floor. Well... A sneeze or a cough is a high "power" event. We need our pelvic floor to match the downward forces with the contract and lift forces to prevent leaking. 

If we are "tensing" every muscles in our body or even "pre-contracting" our pelvic floor muscles with a "knack" we are decreasing the "Distance" the muscle has to contract through.. thus making it more difficult to create the power needed to prevent a leak. You could have the "strongest" pelvic floor out there but still not have the adequate "power" to prevent a leak. 

Following? 

So... I may not be able to make my pelvic floor "stronger" in one day ( increase the force of contraction) but I CAN increase the distance travelled by my pelvic floor by letting is relax prior to the needed contraction- you may be able to generate the needed Power to over come that sneeze. 

If I lost you at the equations.. I don't blame you one bit! 

Just remember to RELAX and LET IT GO! 

 Sticking with the above concept...

2. Getting a stronger and "quicker" pelvic floor will help 

I am a big advocate for strong and mobile pelvic floors. I am also a huge fan of making a pelvic floor stronger without laying still and doing kegels all day and night and at every stop light and with a timer ect ect. 

However, learning to contract your pelvic floor in isolation may be an important place to start. 

Ideally, a pelvic floor PT can help guide you thorough this but I will give an example here to get you started. 

Sit on a rolled up towel or place your hand under your pelvis in sitting with your middle finger lined up with the middle. Take a breath in and try to feel movement down into the towel, or your hand. Exhale and try to feel the muscles lifting away from the towel. 

Many people have this pattern backwards. Lifting on the inhale and relaxing with the exhale, trying to hold the lift as long as you are exhaling, then let it fully release with the next inhale. 

You can then add some "speed" contractions. I like to teach these to still be happening during an exhale. What you do is begin with your "inhale expand" and exhale lift. Then in that exhale release fully and lift again, and again and again- as many times as you can in one exhale. Training the "fast twitch" pelvic floor muscles can really help with that "fast sneeze" that sneaks up on you! 

Once you have this mastered, If you are struggling with this and awaiting help from a PT directly, you can join my newsletter  HERE  (if you haven't already) for my favorite ways to strengthen a pelvic floor without kegels 

3. Single leg standing

This is the topic I covered in my reel on Monday 1/25/21 - It's a favorite hack of mine for a few reasons. 

- you don't have to "think" about a kegel

-it's using the built in systems your body already has 

Ok, let me explain. Using the biomechanics of gait. 

When we walk and we have one foot on the ground. We call that "down" leg, the "stance leg" or say that its in "stance phase" 

When we are in "mid stance" our pelvis orients to the stance leg side- it causes our inner thigh ( adductors) outer hip (glut med) posterior thigh (hamstring) and abs (Internal Obliques and Transversus Abdominus)  to all work together. Guess who ALSO comes along for the ride when all this is happening! Yup! our pelvic floor, on the stance leg side will reflexively lift, and engage without having to do any sort of conscious "lift" . 

You may find you feel stronger control when you stand on one leg vs the other for sneezes, but it is a great little hack either way! 

I hope you found this useful, and as always if you have any questions, concerns or you would like to book a session with me please feel free to reach out! 

Wednesday is Q& A day on my instagram page so be sure to check that out for more! @hayleykavapt