Bladder leakage, urgency and your pelvic floor
Leaking when you cough, sneeze, laugh, run or lift. A sudden need to go that does not wait. Going before you leave the house whether you need to or not. These are among the most common things women live with, and they are usually treated as one problem with one answer. They are not. Leakage has several distinct causes, and they are treated differently. This page is about telling them apart, and about why that has to happen before anyone tells you what to do.
Most women do not call it incontinence. They call it nothing, and they plan around it.
None of these is a failure of willpower or a sign you should have done something sooner. They are the accommodations a sensible person makes when nobody has explained what is going on. They are also useful: what you leak with, when you feel urgency, and what you have already tried are exactly what tells a clinician which kind of problem this is.
Your pelvic floor is a group of muscles, fascia and connective tissue at the base of the pelvis. It supports the bladder, bowel and reproductive organs, it controls continence, it works with the rest of your core to stabilise posture and movement, and it plays a part in sexual function and sensation.
When those muscles are too weak, too tight, or not coordinating properly, the body compensates, and symptoms appear. That last part matters more than most women are told. Weakness, tightness and poor coordination can all produce pelvic-floor symptoms. That is one reason symptoms alone do not always tell you what the pelvic floor is doing.
Leaking with effort, a sudden urgent need to go, going far more often than you used to, and a feeling of pressure or something dropping are different symptoms. Weakness, overactivity, urgency and early prolapse can look the same from the outside, and many women have more than one at the same time. They are not treated the same way.
That is the whole reason to assess before treating. The approach that helps one pattern can be the wrong approach for another. A woman whose problem is a tight, overworking pelvic floor does not need more strengthening; she needs the opposite. A woman with urgency needs something different again. Strengthening, retraining, tissue care and procedures are each right for some women and wrong for others, and the only way to know which is which is to work out what is actually happening first.
Many women arrive having done Kegels for years, faithfully, and still leaking. Kegels are not the answer for everyone. If you are not engaging the right muscles, at the right time, with proper breath and support, they may not help, and in some cases they can make things worse. Most people need help to learn whether Kegels are right for them at all, and if so, how to do them properly.
Real pelvic floor rehabilitation goes beyond isolated contractions. It starts with assessment and includes feedback, breathing, posture and how the pelvic floor works with the rest of the body. Which is another way of saying: the exercise is not the treatment. Knowing what your pelvic floor is doing is the treatment. The exercise comes after.
Pregnancy and birth change the pelvic floor, the core and sometimes the tissue itself. Some of that resolves on its own. Some of it quietly does not, and at some point you stop calling it postpartum and start calling it normal. Leaking with exercise, heaviness by evening and a core that never quite reconnected can still be assessed, and can still change, months or years after the baby. If your youngest is eight, this page is still about you.
Bladder symptoms that begin or worsen in your forties and fifties can have a hormonal component. Through the menopause transition and after it, the tissue of the bladder, urethra and vagina responds to falling estrogen, and that change has a name, GSM, and effective treatment. New urgency, going more often, discomfort when you pee, and infections that keep coming back can be part of that picture. Waking at night to pee can be too, though it has other causes. That is why a bladder problem in these years is assessed alongside where you are hormonally rather than on its own.
The pelvic floor does not only show itself through the bladder. A sense of pelvic heaviness or drag by the end of the day, discomfort with sex or tampon use, constipation or straining, and a wobbly or disconnected feeling in the core are all signs the same system is under strain. Pressure, heaviness or a dragging feeling, and especially the feeling of a bulge, can be symptoms of prolapse, where the bladder, uterus or bowel has shifted downward. Pressure and heaviness have other causes too, and how strong the feeling is does not tell you how much has shifted. This is one of the things the assessment looks for, and one of the reasons a bladder problem is never assessed in isolation.
Because the symptom does not tell you the cause, and the cause decides the treatment.
At FORM Women's Health by Élevé, every new patient starts with the Women's Health Assessment. Your Élevé clinician, a nurse practitioner on the Élevé clinical team, reviews a detailed questionnaire before you arrive, then works through what you leak with, when you feel urgency, what you have already tried, how your pelvic floor is behaving and where you are hormonally. An examination happens only if it is clinically useful, with your agreement, and explained first. You leave with a written summary and a recommended plan. We recommend, you decide.
The Élevé Method behind that assessment was created by Dr. Alaina Garbens, a fellowship-trained urologist, and is directed by her. Bladder and urinary health sit directly within the clinical expertise the model was built on.
Depending on what the assessment shows, a plan for bladder leakage, urgency or pelvic floor symptoms can draw on pelvic floor physiotherapy, bladder retraining, medication where appropriate, in-clinic treatments that strengthen or restore tissue, including Emsella (a chair-based electromagnetic treatment) and V-Tone (intravaginal muscle stimulation) for appropriate patients, and procedural options where clinically appropriate. Which of these, in what order, is determined clinically, from your assessment. Nothing on this list is chosen before it, and none of it is a promise.
It is common. That does not make it inevitable. Leaking with effort is one of several patterns, and which pattern you have decides what would help.
Age changes tissue and hormones, and those changes can be assessed and addressed. "Just aging" describes when it started, not what it is.
It may not be, and if physiotherapy is the right answer for you the plan will say so. The difference is that the assessment works out what your pelvic floor is actually doing, and whether the bladder, the tissue or your hormones are part of the picture, before anyone recommends physiotherapy, or anything else.
Maybe. Maybe the opposite. That depends on whether your pelvic floor is weak, tight or poorly coordinated, which is one of the first things the assessment works out.
No. Pelvic floor changes from pregnancy and birth can be assessed and can change years later.
No referral is required to book the Women's Health Assessment. The Élevé Method was created by a fellowship-trained urologist, and the appropriate pathway for you is determined from what the assessment shows.
$219 CAD. Not covered by OHIP. No referral required. About an hour.
Ready to Schedule? One of our friendly expert Patient Coordinators will be in touch by phone to personally confirm your appointment and answer any questions you may have. To secure your dedicated consultation time, a consultation fee will be requested at that point. Contact us today to begin your journey.
