Many muscle systems in our bodies coordinate together in order for us to go about our daily lives. For example, our core muscles brace when lifting heavy objects or our eyes close when we sneeze or we grip and hold objects with the right amount of force while performing tasks like brushing our teeth or writing.
One of the closest relationships between two muscle systems is between our pelvic floor and our breathing muscles. For most people, the relationship between these two systems is often taken for granted, as they never have to think about bracing with their pelvic floor during a cough in order to avoid urine leakage. But for many individuals repeated coughing is a frequent cause of distress and discomfort due to urinary incontinence.
During a cough the pressure in the abdomen increases and part of this force is transmitted down onto the bladder. If the pelvic floor muscles do not support this increased abdominal pressure on the bladder this can lead to the leaking of urine. This becomes even more accentuated in individuals who cough a lot (causing pelvic floor fatigue). This may be seen in individuals such as those with COPD, cystic fibrosis, bronchiectasis or other respiratory illnesses.
So what are some strategies to try and prevent urinary leakage during coughing?
Firstly, you can brace or activate your pelvic floor prior to a cough to help support your urethra and prevent urinary leakage. This technique is often referred to as the ‘knack’. It can take some practice to get the hang of, but involves squeezing and lifting the pelvic floor and holding the contraction during a cough, then releasing. It can be difficult to correctly contract your pelvic floor muscles with spoken instructions alone – with research showing with verbal instruction alone around 50% of people will contract their pelvic floor muscles incorrectly. An incorrect pelvic floor contraction can actually cause a worsening in urinary leakage over time. There are a variety of techniques and strategies a consult with a pelvic floor physiotherapist can provide to assist you with attaining a correct pelvic floor contraction to reduce urinary leakage.
Secondly, by making your cough more effective it can reduce the number of times you need to cough therefore reducing pressure placed on the pelvic floor. Supporting the body during repetitive episodes of coughing with appropriate postures can allow for better muscle contractions allowing for a more effective cough. If you feel the need to cough a lot or need to clear phlegm off your chest, try sitting at a dining table chair, place both feet flat on the floor and your elbows onto the table. By leaning forward onto your elbows with your arms supported you are allowing respiratory muscles to work at their best to make your cough more efficient.
If maintaining continence during coughing is something you struggle with or you cough frequently due to respiratory illness and wish to prevent incontinence, try implementing some of the above strategies or get in touch with one of our women’s or men’s health physiotherapists for a consultation and review.
