Do you ever find yourself wondering “why do I pee when I sneeze or cough?” Picture this: it’s a beautiful spring day, you are walking around the park, the flowers are blooming, the birds are singing, pollen is everywhere, you sneeze and out comes some pee. What a way to ruin your lovely stroll! Or maybe it's flu season, you caught the bug and you are laying in bed miserable. Not only are you coughing and sneezing, but now you are leaking too?! Ugh!! Don’t worry - if either of these scenarios sound like you, rest assured you are not the only one having this issue. And we are here to explain why you pee when you sneeze or cough. When someone leaks pee during a cough or a sneeze, we call that stress urinary incontinence. This happens due to a sudden increase in intra-abdominal pressure (the pressure that exists in the space created by the diaphragm, abdominal muscles, and pelvic floor). Physical activities that increase this pressure include coughing sneezing laughing straining exercising While many people believe this is only an issue that pregnant folx experience, leaking pee with a cough or sneeze can impact anyone . However, it is a common symptom during pregnancy and postpartum due to the anatomical, hormonal, and postural changes that occur. Despite being common, it does NOT have to be your ‘normal’ as pelvic floor therapy can be a great place to start treating this pesky symptom! Let’s dive deeper. Looking at the image below, we see the anatomy of the respiratory canister. The diaphragm (or breathing muscle) is at the top, the transverse abdominis core muscle wraps like a corset from the front to the back, and the pelvic floor muscles form a supportive sling at the bottom. When we take a breath in (left), the diaphragm lowers, the abdominal wall expands outward and the pelvic floor moves downward. When we breathe out (right), the diaphragm relaxes to lift up, the abdominal wall and pelvic floor muscles shorten to return to their resting positions.

Diastasis recti is a common occurrence in pregnancy. Keep reading to learn the top seven factors that impact the likelihood of developing an abdominal separation.

When you are diagnosed with a neurological condition, physical and occupational therapy become an important part of your rehabilitative journey. While you’ve likely worked on your strength, mobility, and fine motor skills to aid in improving how you walk, your posture, and other activities of daily living, chances are no one has discussed another important aspect of your care - your pelvic health. As a Doctor of Physical Therapy and neuro-pelvic health specialist, I am here to provide you with the ultimate guide to pelvic floor physical therapy for those with neurological conditions. In this blog, we’re going to break down everything you need to know about pelvic floor PT and how it can help you in your recovery whether your goals are to maximize your quality of life or regain function during your rehab process. Below you will find the answers to the following questions: What is the pelvic floor? Why does the pelvic floor need therapy if I have a neurological condition or diagnosis? What neurological-based pelvic health diagnoses can be treated in pelvic PT? What does neurogenic bladder and bowel mean? How can sexual health and function be impacted by a neurological diagnosis? What other implications does a neurological diagnosis have on my pelvic floor health? What neurologic diagnoses are treated in pelvic floor therapy? What goes into becoming a neuro-pelvic health specialist? How do I find a pelvic floor therapist who specializes in neurological conditions? What should I expect at the pelvic floor evaluation? What about at the follow-up visits? What are the results that someone can expect from pelvic PT? Can I use my insurance? I noticed a lot of pelvic therapists are out of network, why is that? How do I know if I need pelvic PT?

You may be wondering 'How much should I be peeing?' after you take what feels like your millionth bathroom trip of the day. When we ask our patients how much they are peeing, our patients provide a range of answers from every 30 minutes to once every 12 hours. Yikes! I can imagine if you polled your friends you’d get a similar response. This is because some people are peeing way too much, and others are holding it way too long. So how do you know what is normal… or the ‘right’ answer? First, let’s figure out why we are hearing such a wide range of answers and then we will get to the actual answer to the question. To get us started, let's chat about what it looks like when we pee. Our bladder has the capacity to hold between 400-600 mL of fluid (or about 1.5 to 2.5 cups) and when we pee typically 300-500 mL (or 1.25 to 2 cups) comes out. As the bladder starts to fill the detrusor muscle (pictured below) will stretch and send a signal to the brain resulting in an urge to pee. Typically, the first sensation to pee occurs when the bladder is about one-third to halfway full, however that feeling can be quieted for a little longer to allow the bladder to continue filling. During this time, the pelvic floor muscles, which provide bottom-up support to the bladder, are subconsciously active to help keep the urethra closed so the bladder can keep storing urine. When the bladder is truly full, there is a second, likely stronger feeling like you need to urinate that signals it’s time to head to the bathroom. In a perfect world, we wait for that strong need to pee rather than going too soon when we get that first small signal.

Thanks to social media , pelvic health therapy has gained a lot of attention. But how many times have you said “I saw it on TikTok so I’m not sure how true it is?" Well I am here to provide you the ultimate guide to pelvic floor physical therapy, written by a Doctor of Physical Therapy and pelvic health specialist with 10 years of experience, so you can rest assured that this information is coming from an expert! Throughout this guide we will answer the top questions we get asked about pelvic floor therapy on the regular and provide links to extra resources in case you want to learn more! Below you will find the answers to the following questions: What is the pelvic floor? Why does the pelvic floor need therapy? Why have I never heard about pelvic floor therapy? What kind of symptoms or diagnoses do you treat in pelvic floor therapy? Who can benefit from pelvic floor PT? When should I see a pelvic therapist? Do I need a referral to see a pelvic floor PT? What training is involved in becoming a pelvic floor therapist? How do I find a pelvic floor therapist? What should I expect at the pelvic floor evaluation? What about at the follow-up visits? Is pelvic floor therapy awkward? Can’t I just do kegels? What about those shorts or that chair that does kegels for you? What kind of results can I expect at pelvic floor therapy? Can you dry needle the pelvic floor? What if my physician doesn’t think PT will help? Can I use my insurance? I noticed a lot of pelvic therapists are out of network, why is that? How do I know if I need pelvic PT?

At Pelvic Pride we talk a lot about taking a whole body approach to our treatment. This doesn’t just mean assessing a patient from head to toe, it also means considering other factors that impact someone as a whole person as we aim to discover the underlying ‘why’ to their symptoms. We ask about daily habits, work activities or the things that fill their day, and the impact of the environment on their symptoms. These questions can be fit into what we call the four pillars of pelvic health: stress, sleep, movement, and nutrition. Each area has an impact on how we feel in our body and impacts our body’s ability to heal. Let’s take a look at each pillar and its impact on the pelvic floor. (You can also check out our podcast episode on the four pillars of pelvic health!) The Four Pillars of Pelvic Health: 1. Stress We are all too familiar with stress. Maybe it's a tough day at work, or an upcoming personal event. Other times it is physical stress on the body like a long weekend of house chores or training for a marathon. While some stress is necessary for survival, too much bad stress can negatively impact the pelvic floor. As we hold onto the bad stress our nervous system starts to become upregulated (read: ON FIRE! ). This is felt when you start to notice that you are becoming irritable very quickly. Maybe you seek out quiet, want to escape the clutter, or even start to feel hypersensitive to the way things feel on your skin. Yep! Those are the signs that your nervous system is moving towards fight-flight-freeze-fawn . As a result the pelvic floor muscles start to guard (or tighten up) as to protect your body from harm (we are looking at all your who joke that you are tight asses). While there may be no actual harm occurring, the body will hold onto that stress anyways - just in case. The pelvic floor isn't the only place we see this happening. Many people hold stress in their neck and shoulders while others may hold it in their jaw by clenching their teeth. Well, guess what? The jaw and the pelvic floor are very related, so if you clench your teeth, chances are your pelvic floor is clenched too. So what?! When we clench our muscles we are not allowing blood flow into the area which is key for healing, bringing oxygen to the tissue, and keeping the pelvic floor muscles functioning optimally by fully relaxing and engaging through their full range of motion. How do I fix it? Try doing body scans throughout the day. Take a deep breath and slowly scan down your body and let go of what feels tight: relax your jaw, shoulders, belly, butt, and pelvic floor muscles . If things feel engaged or tense, channel your inner Elsa from Frozen and let it go. 2. Sleep Ah, sleep! For some this is the best part of the day. For others it is a dreaded time of laying in bed, struggling to fall asleep and counting down the hours until morning. This is because sleep is a vital part of survival. In fact, we can survive longer without food than we can without sleep . While we sleep our body is in a restorative state aimed at five key areas: Increased blood flow throughout the body which carries oxygen and nutrients to the muscles for recovery Hormones released during deep sleep help to aid in healing, muscle repair, and new tissue growth Prolactin is released to reduce inflammation throughout the body Cortisol levels are reduced therefore the stresses in our body are reduced (cortisol is the stress hormone that can result in a decreased immune system and increased blood pressure) Proteins are produced by the body to help build new cells for healing and tissue repair So whether you are recovering from a pelvic floor surgery, have recently delivered a baby, have a chronic pain or inflammatory disorder, or have been under an increased amount of stress lately, sleep is clearly an important factor when considering your road to recovery. This is why we will discuss your sleep habits and address various areas including your fluid intake and bathroom trips around your bedtime routine, the positions and supports (like pillows) you utilize when laying down to sleep, and how to cultivate a restful environment for improved quality of sleep such as avoiding screen time 30 minutes before bed, using a weighted blanket, or listening to a meditation prior to falling asleep . 

Does the thought of running after you've had a baby sound daunting? Don't worry you are not alone! Many people don't know where or how to start, others aren't sure if their body is ready to move like that. Keep reading to learn the latest on returning to running in your postpartum stage! Traditionally, there has not been much research regarding return to exercise as a postpartum individual. In turn, there has been limited guidance for the best way to return to an activity postpartum, especially something as high-impact as running. Due to this increase in demand from our bodies, postpartum individuals need adequate time to heal and recover. Fortunately, a recently published research review led by UK-based physiotherapists discusses exercise guidelines aimed to assist healthcare providers and postpartum individuals return to running. Great news! This review emphasizes the importance of the kinetic chain (aka that our joints and muscles connect together to move our bodies), in regards to our spine, core, hip, and pelvic floor’s mobility, coordination, and strength, when creating an individualized return-to-run program. They additionally highlight the importance of considering pelvic floor symptoms when returning to exercise to create the best possible outcome for each person. These guidelines are free for public access- check them out here ! (Or keep reading for a quick summary of the guidelines. You can also listen to our podcast episode about return to running postpartum here !)

You may recognize that urine leakage sensation following a bad winter cold, possibly when out on a run, or even when trying to get to the bathroom on time. At Pelvic Pride, we educate our patients that urinary leakage is common, but does not have to be your ‘normal’! Let’s dive in further. What is urinary incontinence? Urinary incontinence (UI) is any undesired urine leakage during the day or night that can range from a few drops to enough to wet your clothing. Urinary leakage can impact any person with a bladder, and can be associated with a history of: Pregnancy and childbirth (including delivery via Cesarean section) Chronic urinary tract infection (UTI) symptoms Surgical or medical procedures in the abdomen, hip, pelvic, or genital tissues/structures Post prostatectomy surgery An underlying medical condition, such as diabetes or neurological condition To prevent urinary leakage, we rely on the pelvic floor muscles. These muscles run from the pubic bone (front) to the tailbone (back) in your pelvis and form a bowl- or hammock-shape at the base of the pelvis to help provide ‘bottom-up’ support to the urethra, bladder, and colon.

As physical therapists we collect a lot of “tools” for our therapy tool box. Some of them are physical tools like cups, massage balls, or Theraband. Others are treatment techniques like dry needling, visceral mobilization, or myofascial work. Each tool we collect has a purpose to help the pelvic floor in one of the three types of pelvic floor treatment ( read more about that here ). When developing your plan of care for therapy we are working to find just the right combination of these techniques to help address the issues that brought you to pelvic floor therapy. One of our most commonly used tools at Pelvic Pride is yoga . Yoga can help improve flexibility, increase blood flow, cultivate a better mind-body connection, reduce stress, and downregulate the nervous system - aka put out that fire ! We utilize yoga poses with our patients to hit on all of these benefits and to empower our patients with actionable tasks to do when they are not in the clinic with us. As we have incorporated yoga poses into our practice, we have narrowed it down to these top nine favorite yoga poses for the pelvic floor. Each of these poses were chosen to help provide direct and/or indirect relaxation to the pelvic floor muscles. Keep in mind the goal for these poses are relaxation, stretching, and letting go in and around the pelvic floor. You will not be tightening or actively engaging muscles during these postures and you should not experience pain during these poses. If you struggle to get into or maintain a pose try the modified version we’ve described. Once you've settled into each pose, hold this posture for 5 deep breath cycles.