How Pelvic Floor Physical Therapy Can Help Stop Stress Urinary Incontinence

Do you leak urine when you sneeze, cough, laugh, exercise, run, or lift something heavy? You are not alone—and you do not have to simply accept it as a normal part of aging, pregnancy, or having children.

Stress urinary incontinence (SUI) is one of the most common types of urinary incontinence in women. The good news is that pelvic floor physical therapy can significantly reduce urinary leakage and, for many women, eliminate or greatly improve stress incontinence.

In fact, supervised pelvic floor muscle training is recommended as a first-line treatment for stress urinary incontinenceby major clinical guidelines. NICE recommends a supervised program for at least three months. [1,2]

What Is Stress Urinary Incontinence?

Stress urinary incontinence occurs when urine leaks from the bladder during an activity that increases pressure inside the abdomen.

Common triggers include:

• Coughing

• Sneezing

• Laughing

• Running or jumping

• Exercising

• Lifting weights

• Getting up from a chair

• Changing positions

• During or after pregnancy

• Sexual activity

Despite its name, stress urinary incontinence is not necessarily caused by emotional stress. The "stress" refers to physical pressure or stress placed on the bladder and pelvic floor.

Why Does Stress Incontinence Happen?

Your pelvic floor is a group of muscles and connective tissues that sits at the bottom of your pelvis. These muscles help support the bladder, urethra, bowel, and reproductive organs.

When you cough, sneeze, jump, or lift, pressure inside your abdomen increases. Your pelvic floor muscles should respond quickly by contracting and helping support the urethra so urine remains in the bladder.

If the pelvic floor muscles are weak, poorly coordinated, injured, overly lengthened, or unable to contract at the right time, the urethra may not be adequately supported.

The result can be urine leakage.

However, pelvic floor weakness is not the only possible cause. Some women have difficulty coordinating their pelvic floor muscles, while others may have changes in connective tissue, pelvic organ support, urethral mobility, or other contributing factors.

That is why simply being told to "do Kegels" does not always solve the problem.

How Pelvic Floor Physical Therapy Helps Stress Urinary Incontinence

A pelvic floor physical therapist performs an individualized evaluation to determine what may be contributing to your leakage.

Treatment may include several components.

1. Pelvic Floor Muscle Training

Pelvic floor muscle training (PFMT) is one of the best-studied conservative treatments for stress urinary incontinence.

The goal isn't simply to make the pelvic floor "stronger." A comprehensive program may address:

• Muscle strength

• Muscle endurance

• The ability to contract quickly

• Coordination

• Timing

• Relaxation

• Functional control during movement

Research supports pelvic floor muscle training as an effective treatment for women with stress urinary incontinence.

A 2018 Cochrane systematic review included 31 randomized or quasi-randomized trials involving 1,817 women. Among women with stress urinary incontinence, those participating in pelvic floor muscle training were substantially more likely to report being cured or improved than women receiving no treatment or inactive treatment. [3]

The review found that women with SUI who performed pelvic floor muscle training were approximately eight times more likely to report being cured and approximately six times more likely to report cure or improvement compared with control groups in the analyzed studies. [3]

2. Learning How to Contract the Pelvic Floor Correctly

One of the biggest misconceptions about pelvic floor exercises is that everyone automatically knows how to perform them correctly.

Many women inadvertently:

• Hold their breath

• Tighten their abdominal muscles excessively

• Squeeze their buttocks

• Bear down instead of lifting

• Contract the pelvic floor without fully relaxing afterward

• Use the wrong muscles

• Perform too many contractions without adequate rest

A pelvic floor physical therapist can assess your ability to contract and relax the pelvic floor and teach you the appropriate technique.

Current NICE guidance specifically recommends assessing a woman's ability to perform a pelvic floor contraction before beginning supervised pelvic floor muscle training. [1,2]

3. Training the Pelvic Floor to React During Coughing, Sneezing, and Exercise

Your pelvic floor needs to work during real-life activities—not just while you are lying down doing exercises.

Physical therapy can help you learn how to coordinate your pelvic floor with activities such as:

• Coughing

• Sneezing

• Getting out of a chair

• Squatting

• Lifting

• Running

• Jumping

• Exercising

A physical therapist may teach strategies sometimes referred to as a "the knack," which involves appropriately contracting the pelvic floor before or during activities that increase abdominal pressure.

The goal is to help your pelvic floor respond automatically when you need it most.

4. Biofeedback When Appropriate

Some women have difficulty knowing whether they are contracting their pelvic floor correctly.

Biofeedback can provide visual or auditory information about muscle activity and may help a patient better understand how to contract and relax the pelvic floor.

Research has examined biofeedback-assisted pelvic floor muscle training for women with stress urinary incontinence, including randomized controlled trials and systematic reviews. [4,5]

Importantly, biofeedback is not necessarily required for everyone. Current NICE guidance recommends considering biofeedback when a woman is unable to perform an effective pelvic floor muscle contraction. [2]

This is one reason an individualized physical therapy evaluation can be more useful than simply following a generic online exercise program.

5. Improving Pelvic Floor Coordination

Strength is only one part of the equation.

Your pelvic floor must also coordinate with your:

• Diaphragm

• Abdominal muscles

• Hip muscles

• Spine

• Breathing

• Movement patterns

For example, holding your breath while lifting a heavy object can dramatically change pressure within your abdomen.

Your physical therapist can help you learn how to breathe and coordinate your pelvic floor with movement so that your body can better manage pressure.

6. Addressing Contributing Factors

Pelvic floor physical therapy may also address factors that contribute to urinary leakage.

Depending on your individual evaluation, treatment may include education and exercises related to:

• Abdominal and core function

• Hip strength

• Breathing mechanics

• Posture

• Movement patterns

• Constipation and straining

• Exercise technique

• Pregnancy and postpartum recovery

• Pelvic organ prolapse

Treatment is individualized because stress urinary incontinence does not look exactly the same in every woman.

"I've Been Doing Kegels, But I'm Still Leaking. Why?"

This is a very common concern.

Doing pelvic floor exercises doesn't necessarily mean you are doing the right exercises—or performing them correctly for your particular problem.

For example, someone with significant pelvic floor weakness may need a progressive strengthening program. Another person may have adequate strength but poor coordination and timing.

Someone else may be holding excessive tension in the pelvic floor and have difficulty relaxing.

That's why pelvic floor physical therapy involves much more than simply prescribing Kegels.

The goal is to determine what your pelvic floor needs and why you're experiencing leakage.

How Long Does Pelvic Floor Physical Therapy Take to Work?

There is no single timeline that applies to everyone.

The research and clinical guidelines generally support giving pelvic floor muscle training several months to produce meaningful improvement.

NICE recommends a supervised pelvic floor muscle training program lasting at least three months for women with stress urinary incontinence. [1,2]

The exact timeline depends on factors such as:

• Severity of symptoms

• Muscle strength

• Ability to correctly perform the exercises

• Consistency with the home program

• Pregnancy or postpartum status

• Presence of pelvic organ prolapse

• Previous pelvic surgery

• Other health conditions

• The type and amount of physical activity you perform

Progress should be monitored and the exercise program adjusted as your strength and control improve.

Can Pelvic Floor Physical Therapy Actually Stop the Leaking?

For some women, yes.

Research shows that pelvic floor muscle training can result in cure or significant improvement in stress urinary incontinence. [3]

However, it is important to be realistic: pelvic floor physical therapy cannot guarantee that every woman will become completely continent.

The severity and underlying cause of SUI vary considerably from person to person.

The good news is that pelvic floor physical therapy is a non-invasive, evidence-based first-line treatment that can substantially reduce symptoms for many women and may help some women avoid or delay more invasive treatments.

NICE's evidence review notes that pelvic floor muscle training was considered an appropriate first-line treatment because of its effectiveness and lack of the surgical risks associated with invasive procedures. [6]

What Happens During a Pelvic Floor Physical Therapy Evaluation?

Your first visit may include:

A detailed health history

Your physical therapist may ask about:

• When leakage occurs

• How often you leak

• How much urine you lose

• Pregnancy and childbirth history

• Exercise habits

• Bowel habits

• Bladder habits

• Previous pelvic or abdominal surgeries

• Sexual health concerns

• Pelvic pain

• Other pelvic floor symptoms

Movement and physical assessment

Your therapist may evaluate your:

• Breathing

• Abdominal muscles

• Hip strength

• Posture

• Movement patterns

• Pelvic floor function

Pelvic floor muscle assessment

When appropriate and with your consent, your therapist may perform an internal pelvic floor assessment to evaluate muscle strength, endurance, coordination, tone, and the ability to contract and relax.

This information helps create a treatment plan specifically for you.

When Should You See a Pelvic Floor Physical Therapist?

Consider talking with a pelvic floor physical therapist if you regularly leak urine when you:

• Exercise

• Run

• Jump

• Cough

• Sneeze

• Laugh

• Lift

• Change positions

You may also benefit from an evaluation if you have tried pelvic floor exercises on your own but aren't seeing improvement.

And remember: you do not have to wait until urinary leakage becomes severe before seeking treatment.

Pelvic Floor Physical Therapy

If you're experiencing stress urinary incontinence, pelvic floor physical therapy can help you understand why you're leaking and what you can do about it.

At Naples Pelvic Health, pelvic floor physical therapy is individualized to your symptoms, goals, lifestyle, and physical findings.

Whether you're leaking during workouts, running, sneezing, coughing, lifting, or after having children, an individualized pelvic floor evaluation can help identify the factors contributing to your symptoms and develop a plan to improve bladder control.

Urinary leakage is common—but it doesn't have to be something you simply live with.

If you're searching for pelvic floor physical therapy for stress urinary incontinence in Naples, FL, consider scheduling an evaluation to learn whether pelvic floor therapy is right for you.

Frequently Asked Questions About Stress Urinary Incontinence

Is stress urinary incontinence normal after having a baby?

Urinary leakage is common during pregnancy and after childbirth, but common does not mean you have to live with it. Pelvic floor muscle training is recommended during and after pregnancy to help prevent and manage pelvic floor dysfunction, including stress urinary incontinence. [2]

Are Kegels the same thing as pelvic floor physical therapy?

No. Kegels are pelvic floor muscle contractions. Pelvic floor physical therapy is individualized healthcare that may include pelvic floor muscle training along with assessment of breathing, movement, strength, coordination, relaxation, and other contributing factors.

Can pelvic floor therapy help with exercise-related leakage?

Yes. Pelvic floor muscle training can improve stress urinary incontinence, and therapy can also help you coordinate your pelvic floor with running, jumping, lifting, and other activities that trigger leakage.

How long should I do pelvic floor exercises?

Current NICE guidance recommends a supervised pelvic floor muscle training program for at least three months for women with stress urinary incontinence. [1,2] Your therapist can determine the appropriate exercises, repetitions, intensity, and progression for you.

Do I need surgery for stress urinary incontinence?

Not necessarily. Pelvic floor muscle training is recommended as a first-line conservative treatment for stress urinary incontinence. Some women who do not achieve adequate improvement with conservative treatment may ultimately consider other treatment options with their healthcare provider. [1,6]

Evidence-Based Resources & References

1. NICE. Urinary incontinence and pelvic organ prolapse in women: management (NG123). NICE recommends supervised pelvic floor muscle training for at least three months as first-line treatment for women with stress or mixed urinary incontinence. NICE clinical guideline: Urinary incontinence and pelvic organ prolapse in women

2. NICE. Pelvic floor dysfunction: prevention and non-surgical management (NG210). The guideline recommends supervised pelvic floor muscle training for at least three months for women with stress or mixed urinary incontinence and emphasizes individualized supervision. NICE guideline: Pelvic floor dysfunction

3. Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews. 2018;10. The review included 31 trials and 1,817 women and found substantial benefit from PFMT for stress urinary incontinence. PubMed: Cochrane systematic review

4. Pereira VS, et al. Biofeedback for pelvic floor muscle training in women with stress urinary incontinence: a systematic review with meta-analysis. Physiotherapy. 2018. PubMed: Biofeedback systematic review

5. Gumussoy S, Kavlak O, Yeniel AO. Effects of biofeedback-guided pelvic floor muscle training with and without extracorporeal magnetic innervation therapy on stress incontinence: a randomized controlled trial. Journal of Wound, Ostomy and Continence Nursing. 2021. PubMed: Biofeedback randomized controlled trial

6. NICE. Rationale and impact: pelvic floor muscle training. NICE's evidence review supports supervised pelvic floor muscle training as first-line treatment for stress urinary incontinence. NICE rationale and evidence discussion

Important Note

This article is for educational purposes and does not replace an evaluation by a qualified healthcare professional. Urinary leakage can have different causes, and women with blood in the urine, recurrent unexplained urinary tract infections, difficulty emptying the bladder, significant pelvic pain, or other concerning symptoms should be appropriately evaluated by a medical professional.