I call leaking urine “the post-baby golden shower.”

Just kidding. I absolutely Do Not call leaking urine that. I just thought that that was funny and could not help myself. After all, a baby shower is a thing. A golden shower is a euphemism. And here we are… explaining the joke.

… and the rim shot

Leaking urine, also known as incontinence, can happen to anyone. It can happen even when a woman hasn’t had a baby. The causes are vast, but in the setting of post-baby, it is often due to weakness in the muscles of the pelvic floor. Those muscles can easily get weaker during pregnancy and after both vaginal or c-section deliveries.

In this post I will explain:

1. The types of urine leakage, or incontinence.
2. Some of the causes.
3. Some ways to treat it naturally and with your doctor.

Yes, no one is safe from the possibility of incontinence.

Not even a c-section can spare you from this possible fate. But why does it happen? You have to think of the urine mechanism as a faucet connected to a hose. There is a sphincter or muscular valve that keeps urine in. There is also a hose-like structure called the urethra that works with that sphincter to keep urine in. If the muscles of the pelvic floor aren’t strong, that sphincter can open and turn on the faucet.

The “hose” can also unkink and let out urine during sneezing, coughing, laughing, running and any abrupt physical movement that allows an unstable pelvic floor to shift abruptly.

Wait, pause for Popcorn.

Many of you already know that I wrote a whole book about all things female. Consider the remainder this post, a preview/snippit of the treasures held within It Smells Just Like Popcorn.

Types of incontinence

Urinary incontinence is divided into types- two of the most common being Stress and Urge. If you remember the “Gotta go, gotta go, gotta go right now” commercials, those were for a medication that treats the urgent sensation to urinate that would make you push a grandmother and her toddler grandchild out of line in bathroom. Stress incontinence is the type that catches women off guard with a sneeze, cough, run or laugh. You think that your co-worker doesn’t think any of your jokes are funny, but really she just doesn’t want to wet herself laughing at your terrible jokes.

There are various levels of evaluation and treatment for urinary incontinence. Fecal and flatus (gas) incontinence are also symptoms that should be evaluated by a physician. A woman can start to treat minor symptoms of urinary incontinence with Kegel, exercises. If symptoms persist, don’t just deal with it, get evaluated. I mentioned that I like treating this because it IS often something that I can help improve.

Kegels: Who, What, When, Where, Why, How?

You know that you are both old AND wise when a sneeze comes with an automatic Kegel. It shows forethought and prevention of an accident that you used to think only happened to potty-training toddlers. Alas, if you have been through my section on incontinence, you know that the bladder does not have eyes or ears. It does not always know when you are on the toilet versus when you are sitting at your desk, standing in line at the grocery store, or watching a movie that is just getting to the good part. If your pelvic muscles tend to relax at the most inopportune time, you may need to call in reinforcements in that pelvic floor.

A Kegel exercise is a voluntary contraction of the muscles of the pelvic floor. These are the same muscles used to hold urine, hold in gas, and push out bowel movements or babies (or both at the same time in some cases). A person, in theory, should be able to stop their urine midstream by contracting these muscles. I say “in theory” because that is not a very comfortable action to perform and is often an unnecessary test of the strength of the pelvic floor. A Kegel is not an abdominal muscle work out. Your face does not have to move to perform a Kegel exercise. If I coach a woman to isolate these muscles, I make sure her abs are relaxed and she is not using her thighs either.

I once saw a woman holding a surf board with her vagina. She was posting on some news or social media platform, and had a series of pictures of her holding various heavy items from a string emerging from beneath the leg hole in her shorts. This woman had an ovule of some sort attached to a string, attached to items weighing more than many items I would want to hold with an outstretched arm, let alone with my vagina. Why would she do such a thing? She claimed that having rock-hard Kegels (that doesn’t even look right on paper) helped her have stronger orgasms and not leak urine.

I can support her desire to stay dry, but an orgasm from a vagina strong enough to hold a surf board sounds like it would do more damage than good to the partner. The anticipation alone seems like it would make a man nervously limp. If you haven’t already guessed, I don’t recommend a woman hold anything in her vagina for any purpose. Having strong Kegel muscles can, however save a woman the embarrassment of wet clothing.

This guys Kegels, though

So what is the best way to perform Kegel exercises? I recommend that my patients perform ten 2-3 second contractions of the pelvic floor at least twice daily. I also think it helps to have triggers to remember to do them. A reminder in your phone, a radio morning show, or a meeting at work can all be times and places triggering your recollection of the need for this much needed regular exercise. My best trigger is while I am coaching one of my patients to push out a baby. While I am counting to 10 during each of her intense pushes, I am counting out my own Kegel session so that nothing falls out of my own vagina without my consent.

If all else fails…

If Kegels don’t work, the first thing that you should know is what type of incontinence you are dealing with. Your doctor will often first want to rule out infection. Then he or she will likely ask you a bunch of questions, perform an exam, and possibly even refer you for or perform bladder testing called Urodynamics. This will reveal whether pelvic floor physical therapy, temporary medication, or surgery are your best option. A Pessary may also be an option for certain populations.

My take home points are as follows:

1. 1. Urine leakage is not uncommon. You are not alone.
   2. You don’t have to live with untreated incontinence. It can often be improved
   3. Don’t be ashamed. Speak up
   4. After you’ve done all you can, sing about it….

Check out my record-breaking birth plan post by clicking on this image