Physiotherapist: Squeezing Can Make Urinary Incontinence Worse

If you leak urine when running, jumping, or coughing, you have probably been given one piece of advice: squeeze your pelvic floor more. That classic exercise where you tighten your lower body as if stopping a flow of urine. But very often, that is precisely the wrong solution, and at worst, it makes the situation worse. Here is what few people know: there are two opposite causes for incontinence, and they require completely different treatment. If you guess wrong, you can worsen the problem. That is why I sat down with a specialized pelvic floor physical therapist and asked her the exact questions that thousands of women type into internet search bars but rarely get a proper clinical answer to. After reading this, you will know which case applies to you, so let's dive in.

When a woman says urine leaks when running, jumping, or coughing, what is happening in the body, and is it normal? Well, it is common, but I wouldn't say it is normal. It always indicates something. Something incorrect is occurring in abdominal pressure regulation. Today we talk a lot about intra-abdominal pressure regulation — how pressure distributes across the core and pelvic floor when jumping, coughing, or sneezing. If pressure regulation fails, it predisposes you to symptoms even if your core and pelvic floor muscles are strong, because they fail to coordinate together. On the other hand, incontinence can stem from weak pelvic floor muscles or weakened tissue structure, or from hypertonic, over-tight muscles that impair function.

If the pelvic floor can also be too tight, how do you distinguish between weak and over-tight pelvic floor muscles, and why is tightness so often missed? Pure weakness may not produce symptoms other than incontinence during high exertion. But an over-tight or hypertonic pelvic floor can cause additional symptoms: pelvic pain, pain during intercourse, pain with urination or bowel movements, or urinary frequency — feeling the urge to urinate constantly throughout the day. If we simply prescribe kegels every time someone has pelvic floor symptoms, we can go completely off track.

What is considered normal urinary frequency? Generally, urinating 7 to 10 times per 24 hours is considered normal. If it consistently exceeds 10 times a day, we may be dealing with an overactive bladder or urinary frequency issues. Think of any muscle — if you clench your bicep hard all day long, eventually the muscle gets exhausted and stops functioning. The exact same thing happens in the pelvic floor. If it is under constant tension and control, then when a sudden pressure spike occurs — like jumping on a trampoline — the exhausted muscle fails right when it needs to contract.

When do kegel contractions help, and when can they worsen the situation? Kegels have their place — after childbirth when nerve signaling needs recovery, after spinal surgery, or with disc herniation symptoms affecting nerve supply. But if hypertonicity or tightness is present, continuous squeezing exercises drive the problem deeper rather than solving it. Nowadays in clinical practice, we see far more clients with stress, high athletic tension, and muscle tightness in the pelvic floor, where learning to relax the muscle and relieve pain is far more crucial than pure strength training.

What about postpartum pressure sensations and prolapse? During the first 3 to 6 weeks after vaginal delivery, pressure sensations can be normal as tissues recover. But if pressure and bulging persist months after childbirth, a gynecological prolapse may be present. Pelvic floor physical therapy is an excellent path to evaluate muscle function and strengthen surrounding structures so prolapse symptoms do not progress.

Can pelvic floor issues occur in women who have never given birth? Yes! Pelvic floor symptoms can occur from childhood onward. Young women and athletes involved in sports demanding intense core bracing often suffer from hypertonicity-related pelvic pain and urinary urgency. As women approach perimenopause and menopause, declining estrogen levels affect mucosal hydration and muscle elasticity, making early pelvic floor care essential.

Self-test for home assessment: Pay attention to your abdominal posture. If you constantly suck your belly in or hold your breath, it restricts diaphragmatic breathing and keeps the pelvic floor in a state of chronic elevation and tension. Relaxing your abdominal wall allows deep breathing and relaxes the pelvic floor. Furthermore, when trying 10 gentle pelvic contractions, if muscle activation quickly feels fatigue-scrambled or unresponsive, hypertonicity is likely present. If weakness is the main issue, the contraction-relaxation cycle remains clear even if muscle force is low.

If there is one key message from this interview: Pelvic floor symptoms are highly treatable. You do not have to live with restrictions in your active life, running, or confidence. Seeking assessment from a specialized pelvic floor physical therapist can transform your quality of life.