Pelvic Floor

Q: I’m surprised to see that at age 35, I’m having trouble with leaking urine when I cough or sneeze, is this normal?


Leaking urine when you sneeze or cough is called stress incontinence. It is very common in women and can appear as young as the teenage years. Among younger women, the causes for stress incontinence are often related to high impact sports, childbirth or just a family history. Any sport where you are hitting the ground hard can do damage to the muscles of the pelvis and the tissues surrounding the bladder. Regardless of the cause, many women who suffer from stress incontinence find that practicing regular pelvic muscle exercises called Kegels can improve the condition. Stress incontinence can also be treated using biofeedback, a method which uses relaxation techniques to help women gain more control over their pelvic muscles. More severe cases may be improved through the use of treatments such as electrical stimulation, the insertion of a support device called a pessary or minimally invasive surgical procedures that are now available.

Harry W. Johnson, MD

Q: I have tried Kegel exercises for my urinary incontinence, but they didn’t help. What can pelvic floor physical therapy do?


A Kegel exercise is the formal name for a contraction of the pelvic floor muscles. The pelvic floor muscles make up a hammock-like sling in the bottom of the pelvis that supports the organs and keeps the urethra and rectum closed. Strengthening the pelvic floor muscles can reduce urinary incontinence by improving the closure of the urethra during activity.

Although many people try Kegels at some point, they often do them incorrectly. At pelvic floor physical therapy, a specially trained physical therapist personally instructs you in the proper technique. You may also undergo biofeedback, which shows you a graphic representation of how your muscles are working. Once proper technique is established, you will learn a more complex series of pelvic floor exercises in various positions to challenge and further strengthen those muscles. Physical therapy also uses lower abdominal and core exercises to strengthen the pelvic floor for more vigorous activity.

Kelley Huestis, PT, MPT