If you have ever leaked urine when you sneeze, felt a sudden urgent need to get to the bathroom, or noticed low back pain that doesn’t seem connected to anything obvious, you are not alone. These are common experiences, and they are often more connected than people realize.
Incontinence and core instability tend to go hand in hand, and the reason comes down to anatomy. Understanding what is happening inside your body is the first step toward doing something about it.
What is incontinence?
Incontinence is the involuntary loss of bladder or bowel control. It can range from small leaks during everyday activity to a complete inability to hold urine or stool. It affects millions of people of all ages and genders, and it is a medical condition, not an inevitable part of aging.
What types of incontinence are there?
Incontinence is not one-size-fits-all. The type you experience matters because each has a different underlying cause and responds to different treatment approaches.
Stress urinary incontinence
This is the involuntary loss of urine during activities that increase abdominal pressure, such as laughing, coughing, sneezing, or lifting. It typically occurs because the pelvic floor muscles or the supporting structures around the bladder outlet are not doing their job.
Urge urinary incontinence
Urge incontinence is what most people mean when they say they “didn’t make it in time.” The sensation to urinate comes on suddenly and intensely, and the bladder muscle contracts before you can get to the bathroom.
Overflow urinary incontinence
This occurs when the bladder does not empty properly and overfills, leading to continuous or frequent leaking. You may not feel a strong urge to go because the bladder is simply too full to signal correctly.
Functional urinary incontinence
Here the urinary system itself is functioning normally, but something else, whether a mobility issue, cognitive change, or environmental barrier, prevents you from getting to the toilet in time.
Fecal incontinence
The inability to control bowel movements, allowing stool to leak unexpectedly. This can range from small amounts during gas to complete loss of bowel control.
What causes incontinence?
Many factors can contribute to incontinence. Some of the most common include:
- Weakness or poor coordination of the pelvic floor muscles
- Pregnancy and childbirth, including C-sections
- Previous abdominal or pelvic surgeries
- Hormonal changes
- Obesity
- Bladder infection or irritation
- Constipation
- Neuromuscular conditions
- Medications
- Chronic cough or smoking
- Stress
Some of these are systemic, but many come back to the same thing: how well your pelvic floor and core are functioning together.
How is the pelvic floor involved in leakage?
What is the pelvic floor?
The pelvic floor is a group of muscles that runs from the tip of your pubic bone to your tailbone. These muscles form the base of your core and are responsible for supporting your bladder and internal organs, contributing to spinal stability, controlling the sphincter openings, and supporting sexual function.
The pelvic girdle is a complex ring of joints, ligaments, and muscles. The three main bones of this region, two ilium and the sacrum, meet together to form three joints: the pubic symphysis and two sacroiliac joints. These joints have very broad-based surfaces that allow them to have some movement and to transfer the large loads placed on them during activity.
In order for these bones to move as we walk, bend, and run, they need an outside force to stabilize them. That stabilizing force comes from the ligaments and four central muscle groups: the pelvic floor muscles, multifidi, transverse abdominis, and psoas major.
💡 The Bigger Picture
Did you know that your jaw, your feet, and your breathing are all deeply connected to your core and pelvic floor?
Discover how these systems work together — and find the missing pieces to your health puzzle — in our comprehensive resource hub: Your Guide to Core and Pelvic Health.
How the core and pelvic floor work together
Think of the pelvic area as a cylinder. Equal pressure on the contents of that cylinder protects everything inside: your spine, your nerves, and your bladder. You maintain that pressure by coordinating the contraction and movement of the four central muscle groups.
When any one of them is weak or poorly coordinated, pressure shifts, and the structures inside, including the bladder, bear more load than they should.
The pelvic floor muscles are comprised of several layers of musculature that serve the following functions:
- Supporting the bladder and internal organs
- Supporting the spine
- Sphincter closure (closing the vaginal and anal openings)
- Sexual function
Research has shown that the pelvic floor muscles contract in coordination with the transverse abdominis. When we cannot coordinate that contraction, or when we lack sufficient strength, we lose stability in the pelvic ring and spine, and we put more force on the bladder.
Trauma to this region, including C-sections, pregnancy, lumbar injury, or previous lumbar and abdominal surgeries, can impact how these muscles function and how well they support your spine and bladder.
Can physical therapy help with incontinence?
Yes, and often more effectively than people expect. Physical therapy for incontinence focuses on improving pelvic floor muscle strength and coordination so you have better support for your bladder and better control over bowel and bladder function. A pelvic health PT can help you develop a program that may include:
- Exercise, including strengthening and neuromuscular training of the pelvic floor and supportive musculature
- Education on the bladder and normal bladder emptying techniques
- Dietary modifications to reduce bladder or bowel irritants
- Instruction in posture, body mechanics, and how to brace the pelvic floor during daily activities
- Biofeedback and electromyography (EMG), which uses electrodes to record muscle activity and help you learn to contract and relax the pelvic floor correctly
- Manual therapy, including soft tissue and joint mobilization
- Modalities for pain management
Furthermore, if you do activities that involve bending, walking, or running, you need adequate spinal stabilization to use your hips, knees, and ankles without putting excess strain on the joints below. The pelvic floor is not just a bladder issue. It is a whole-body issue.
When should you see a pelvic health PT?
If any of the following apply to you, a pelvic health physical therapy evaluation may be worth considering:
- You experience any type of urinary or fecal leakage
- You feel urgency or frequency with urination that disrupts your daily life
- You have pain in the pelvis, hips, or lumbar spine
- You have a history of pelvic or abdominal surgery, including C-sections
- You have had a previous low back injury
If you have any sudden loss of bowel or bladder control, please consult your physician immediately.
Pelvic floor concerns? Our PTs can help.
Leakage, urgency, and core instability are common — and treatable. Therapeutic Associates has pelvic health physical therapists across the Pacific Northwest ready to help you get back to feeling like yourself.
