Why Do I Leak When I Exercise?

By, Gail O’Neill, PFPT

Stress Urinary Incontinence (SUI) is a loss of urine associated with stress to the body which causes increased intra-abdominal pressure.  This occurs with running, lifting and jumping.  If you can imagine squeezing a tube of glue with the top off- the glue would squeeze out which is what happens when we have an event that increases our intra-abdominal pressure.  If that cap on the tube is on, when squeezed, the glue stays in the tube because all of the systems are in place to prevent anything from leaking out. With this example, the cap represents our Pelvic Floor Muscles. It is necessary for these muscles to work correctly by contracting with enough force in order to close our urethra and prevent leakage of urine.


Many people of all ages and backgrounds can have SUI and pelvic floor disorders.  Being an athlete may not exclude you from this disorder and some forms of exercise can actually put you at greater risk.  Most people have muscle imbalances and impairments that can lead to SUI. The most common cause is tight muscles and the inability to adequately control their pelvic floor muscles.


People who engage in high impact sports such as, Cross Fit and Gymnastics will put someone at higher risk versus someone who does Yoga or Golf.  The failure of the system occurs when the load placed on the pelvic floor muscle group is greater than the ability to properly function by closing off the urethra in order to reduce the chance of leaking.


At Pelvic Health Solutions, we have a team of well trained and experienced Pelvic Floor Physical Therapists that can evaluate your entire system and devise a custom treatment plan to help you overcome this dysfunction.

For more information about leaking or pain relief from pelvic floor disorders, contact Pelvic Health Solutions at (561) 899-7747.

If You Dribble When You Giggle You May Need to See A Pelvic Floor Physical Therapist

By, Gail O’Neill, PFPT


The Pelvic Floor is a hammock shaped group of 14 thin muscles located in the bottom of our bony pelvis intertwined with nerves and surrounded by connective tissue that support the abdominal and reproductive organs while playing a key role in urinary, bowel and sexual function as well as postural support.  When you consider the many ordinary-and EXTRAORDINARY tasks the pelvic floor is responsible for such as, childbirth, sexual appreciation, defecation, urination, continence, lifting, sitting, walking and exercise, it is surprising that this part of our body is not given more attention.


When problems arise with the Pelvic Floor, this can lead to many issues. These deficits can occur when the muscles become weakened as well as tight and in spasm.


The following is a review of how our urinary system functions:


Our bladder stores urine- approximately 10-20 ounces.  The wall of the bladder is a muscle called the Detrusor.  There are stretch receptors within this muscle.  When the bladder fills, these stretch receptors are stimulated. They tell the brain that you are going to need to urinate.  This usually happens when there is 4-5 ounces of urine in the bladder. Normally, you will not need to void with this small amount.  When it fills to 7-15 ounces, the urethral sphincters – both internal and external, begin to contract harder to prevent urine from leaking out.


The pelvic floor’s middle layer of muscle is the external urethral sphincter. The pelvic floor and the bladder muscles work together but opposite of one another. As one contracts, the other is relaxed.  Reflexes are sent between the two muscle groups which are controlled by our brain and nervous system.


As the bladder fills, our pelvic floor muscles are contracted to prevent urine from escaping.  When we sit on the toilet, we consciously relax our pelvic floor.  This sends a reflex to the bladder to let it know that it is time to contract to urinate. Urine fills the urethra, telling the bladder to contract harder.  We do not have to push the urine out – the reflex does this for us. When urine is no longer released, the urethra sends a message to the bladder to relax.  The final message is sent from the bladder to the pelvic floor to contract again.  The entire process starts over. With normal function, this process repeats every 3-4 hours during the day.


Many events can interrupt this reflex and contribute to incontinence both urinary and fecal.  Some include; various disease processes, bearing down with labor, chronic constipation, chronic cough, continuous heavy lifting, and obesity, to name a few.


Stress Incontinence:  This is the involuntary loss of urine when the abdominal pressure is more than the pressure in the bladder.  This may happen when we sneeze, laugh, cough, run and with some forms of exercise such as Cross Fit.  Pelvic Floor muscle weakness and laxity may contribute to this.  This can be caused by pregnancy, delivery, surgery, injury, hormonal changes and some forms of exercise.


Urge Incontinence:  This is the involuntary loss of urine usually accompanied by a strong desire to void. The bladder begins to involuntarily contract before you can get to the bathroom.  We call this “key- in -the -door -syndrome”. This may result from bladder instability, hormonal changes, bladder irritants and medications.  For men, this may be a sign of an enlarged prostate.



Mixed Incontinence:  This is a combination of both Stress and Urge Incontinence.  It usually starts with Stress Incontinence and develops into Urge Incontinence if not treated.



Organ Prolapse:  When the pelvic floor is weak, it does not support the pelvic organs. These organs: the bladder, rectum, uterus, and urethra can fall down or prolapse into the vagina. There are varying measured degrees of organ prolapse.  Depending on the severity, pelvic floor strengthening is often helpful. Education for these patients is key in order to avoid activities that may worsen the prolapse.


Pelvic Pain:   If the muscles of the pelvic floor become too tight, the nerves become inflamed, and/or the connective tissue is restricted, these can all lead to pelvic pain and dysfunction.


This can occur from straining during childbirth, straining when voiding with constipation, prolonged sitting, stress, repetitive stress, activities such as horseback riding, and cycling.


Disease of the urinary, bowel and reproductive system can result in pelvic pain.  These include frequent urinary tract infections (UTI’s), yeast infections, prostatitis and endometriosis.


When the muscles of the pelvic floor are stressed, the fibers may become tight creating trigger points or spasm. Pain may be referred from the organs surrounding the pelvic floor muscles and their response is to tighten.  Blood flow decreases which lessens the amount of oxygen to the tissue, causing pain. A tight muscle then becomes a weak muscle.  So many of the problems associated with weak muscles, such as incontinence, can in fact be caused by tightness and pain in the pelvic floor muscle group.


This is the most common reason why a woman experiences pain with intercourse which is referred to as Dyspareunia.  The pain can also mimic the signs and symptoms that one has with a Urinary Tract infection.  In this case, urinary cultures are negative for the presence of bacteria.


With pelvic pain, we do not want to strengthen these muscles by performing Kegels. Instead, the first priority is to have these muscles relax and return to their previous resting length.


We want to encourage you to get evaluated by one of our outstanding physical therapists, and regain control of your life. Pelvic pain, pelvic floor dysfunction, back pain, tailbone pain—you name it—these conditions do not have to control your life. There is hope. Call us today to book an appointment at (561) 899-7747 for Pelvic Health Solutions.

Your First Pelvic Floor Physical Therapy Visit

What to Expect with My First Pelvic Floor Appointment?

By, Gail O’Neill, PFPT

To some, Pelvic Floor Physical Therapy is familiar. Many other people have no idea that this exists. Pelvic Floor Dysfunction may affect Men, Women and Adolescents.


The first appointment is an hour-long Evaluation.  Our goal, as Pelvic Floor Therapists, is to decipher all of the contributing factors that may be involved with causing and/or contributing to our patient’s symptoms.  Some of these symptoms may include urinary and fecal incontinence (urgency, frequency and leaking), pelvic pain and spasm, pain with intercourse, chronic constipation- to name a few.


The first thing we do at the evaluation is to take a detailed history from our patient.  We encourage our patients to describe their symptoms in their own words.  We are interested in how long they have been experiencing these symptoms.  When did they begin? Did anything precipitate them?  Does anything alleviate or make them worse? How do they affect their ability to Urinate, have a Bowel Movement or have Intercourse?  How has this impacted their life?  Have they needed to modify their activities or work duties?


The answers to these questions give us clues as to what area we may want to delve in to more with our evaluation.  Once the interview phase is complete, we leave the room so that our patient can change into a gown.


The examination generally begins with a musculoskeletal exam where we observe the patient’s posture, alignment, and how the patient moves.  This is followed by a general assessment of gross muscle strength.  We then begin to palpate the abdomen, inner thighs, bony pelvis, spine and buttocks.  We are assessing to see if there are any areas of tightness and restriction, joint range of motion deficits and imbalances from one side of the body to the other.


Pelvic Floor

Our focus is then concentrated on the pelvic floor.  As Pelvic Floor Therapists, we receive extensive training to assess these muscles.  We are trained to conduct a Pelvic Floor Internal and External Exam.  Our Pelvic Floor Muscles are located in our bony pelvis behind the vaginal and rectal wall for a female and rectal wall for a male.  The only way to properly evaluate these muscles is to palpate them.  We are ascertaining their quality: muscle tone, presence of trigger points, motor control, and if appropriate their strength.

We are also able to determine the presence of an organ prolapse, diastasis recti, dermatologic issues, nerve entrapment and tissue integrity.


As part of our patient’s first visit, we begin the education phase of their treatment.  We have 3-dimentional models that have the bones, pelvic floor muscles and organs represented.  We systematically educate our patients regarding the proper function of all of these structures and how they relate to one another.  Deficits in one area may create a dysfunction in another.  We highlight the areas we have identified that are not working correctly or are dysfunctional.


The treatment plan is discussed with our patients as well as setting mutual goals for recovery.  These Goals are both Short Term- involving 1-2 visits and Long Term which may be 4-6 weeks depending on the severity of the impairments.


Our evaluations at Pelvic Health Solutions and subsequent treatment sessions are 1 hour in duration with the same therapist.  We pride ourselves in offering comprehensive treatment plans customized to each of our patient’s needs.


We have observed that greater than 50% of our patient population who have been compliant with our treatment strategies have demonstrated some improvement with symptoms and function in the first 2-4 weeks.



If you still have questions, please contact us.

We want to encourage you to get evaluated by one of our outstanding physical therapists, and regain control of your life. Pelvic pain, pelvic floor dysfunction, back pain, tailbone pain—you name it—these conditions do not have to control your life. There is hope. Call us today to book an appointment at (561) 899-7747 for Pelvic Health Solutions.