Is This Normal? - Breakaway Physical Therapy
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Is This Normal?

Urinary Stress

The other day I was working with a patient who was coming to see me for pelvic floor issues, and I asked if she experienced any urinary leakage. She confidently responded “No”, then a few seconds later quickly followed up with, “well, except when I cough or sneeze, but that’s normal right?”

My response? It is common, but it is not normal to leak.

With Mother’s Day this month, I want to bring attention to some COMMON issues which I feel are commonly brushed off as being normal by patients or even other medical providers. Here are some COMMON scenarios I hear on a weekly (sometimes daily) basis:

  • “I can’t jump with my kids at the trampoline park without peeing my pants, but they were big babies!”
  • “When I run, I leak, but I’ve also had 3 kids.”
  • “My babies were huge, they stretched me out so much I have no more abs. I can’t work out like I used to, and I think it’s making my back hurt.”
  • “I sometimes don’t make it to the bathroom in time but I’m getting older so that’s normal, right?”
  • “Sex hurts sometimes so we just don’t do it as often. They said I tore with my last baby, so I guess that’s just what I have to live with.”
  • “I had to stop some of the classes I did at the gym because it was pulling on my c-section scar and felt weird. My c-section was 5 years ago so I guess I’ve just gotten used to modifying, I miss burpees though!”
  • “It really hurts rolling in bed and getting dressed in the morning, but my doctor just said that I’m 32 weeks pregnant, and at least I only have another 1-2 months to go.”
  • “I hate going to the GYN- PAP smears are the worst! They hurt so bad!”
  • “I never use tampons- they hurt too much trying to get them in. I really hope I’m not on my period for my friend’s birthday beach trip or I’ll have to cancel again this year.”

No, no, no, no and NO to all of this!

Yes, pregnancy, childbirth, and surgery DO change your body, but if these changes are limiting your FUNCTION and not allowing you to do what you WANT or NEED to do, then we need to do something about it! Let us get rid of this stigma that “because life happens, that this is just par for the course.”

Do you know what that phrase, “par for the course” means? It means that we are not pleased with the outcome, but we expected it to happen. Let us think about that.

  • You take your child to a museum, only to be forced to exit through the gift shop (why do they do this to parents?) and your child throws a fit because they want all the things, and they are late for their nap.
  • As soon as you saw where you were headed, you had a feeling this would happen. You could see your child starting to lose it at the end of the trip and you knew as soon as you said “no”, the whining and tears would start. You expected it. So, did you just accept it and were completely cool with it? Heck no! You addressed it.
  • You told your boss that you had to leave at a certain time for an important family function. You reminded them constantly, because the last few times something showed up on your desk at the last minute that of course, only you could handle and you were late, AGAIN.
  • You expect that the same thing might happen. If it does, do you accept it and just miss the event that was so important to you? You would probably be keeping you eyes and ears open for another job!

In all other areas of our lives, if we are not satisfied, we make the changes necessary to improve our situation. Why do we settle when it comes to our bodies? Your children will give you plenty of opportunities to guide and mold them into kind and successful human beings, jobs come and go, if you mess up you can try harder tomorrow, but you only get ONE body!

This one body is what makes all the other things happen, so why wouldn’t we want to take care of it? Let us stop being okay with something that is unpleasant just because we expected it or because it happens to other people.

Now, let us look as some of these “common but not normal” situations that I find people, and especially mother’s, “just live with”.

Probably the most common one I hear about is stress urinary incontinence.

What is Stress Urinary Incontinence?

  • This is when you leak urine when there is stress, or an increase in intra-abdominal pressure, on the bladder
  • Leakage can occur with laughing, jumping, coughing, sneezing, running, lifting, or even blowing your nose
  • I remember being in one of those boardwalk gift shops and seeing a decorative sign that read “I laughed so hard tears ran down my legs!” A group of older women were laughing about it and trying to decide which friend to give it to.
  • I’ll admit, my initial reaction was to laugh too…but then I became bothered that this issue, which can be hugely embarrassing and self-limiting, has become a joke.
  • Did you know that incontinence is one of the leading reasons why older adults are placed in nursing homes? It is never normal to leak.
  • If you are experiencing this, you should see a physical therapist who specializes in pelvic floor rehabilitation. Your therapist will be able to assess your strength, coordination, and how you are managing pressure and develop a program to improve (and hopefully get rid of) the leakage!

Probably the second most common complaint I hear about from my pregnant patients and new moms is low back pain. You may think, no wonder! My abs are weak, I am holding and nursing this baby all day, and the car seat weighs a ton! Who would not have back pain? Again, it is common, and maybe even a little expected, but things can be done!

Your physical therapist can prescribe exercises (and more!) to improve your strength and posture, so you do not need to be in pain and exhausted at the end of each day! They can also screen you for what is called a diastasis rectus, where the connective tissue connecting your left and right abdominals are stretched thin and your abdominals appear to be separated.

Sometimes this can contribute to back pain, and it can also change the appearance of the abdomen, for example, making you appear still pregnant, or you might see a bulge or gap in the middle. Your therapist can assess for this and teach you exercises and techniques to manage a diastasis so that you can safely return to the activities you enjoy and improve your confidence in your body!

What about not making it to the restroom in time? This is called urge urinary incontinence. You get the urge to go, but you may leak on the way or just plain do not make it!

This can be extremely self-limiting- I have had patients not want to leave their house out of fear of an embarrassing episode in pubic! I think we all have felt how isolating COVID can feel not being able to see loved ones when we want, imagine if you were feeling held hostage by your own body! Your pelvic floor physical therapist can teach you strategies to manage these symptoms and get you out socializing again!

To all my pregnant women, yes, your body is changing, and yes things will feel different. However, if you are having pain that is stopping you from doing activities that you LOVE, NEED or WANT to do, this is not something you have to live with for the rest of your pregnancy!

  • Is low back pain making it hard to get through a workday or play with your kids?
  • Do you have pain down your arm and hand that makes it hard to be productive with computer work?
  • Do you have pelvic pain with walking, rolling in bed, getting dressed in the morning or getting in and out of the car?
  • Do you have pain down your leg that makes sitting or walking uncomfortable?

Low back pain, carpal tunnel syndrome, thoracic outlet syndrome, symphysis pubis dysfunction, and sciatica are all conditions which are more common during pregnancy but can be addressed with physical therapy! If surgical scars are causing discomfort, physical therapy can help as well, even if your surgery was years ago!

Pain with sex, tampon use, and pelvic exams are also not normal! Sex should be enjoyable, and tampons should be comfortable to wear, insert and remove.

Although pelvic exams and PAP smears are not typically a super pleasant experience, they should not hurt!

There are various reasons why one might experience pelvic pain, but your pelvic floor physical therapist can be part of the team to find out the cause and get rid of the pain! Even if you have suffered for years, it is not too late!

You do not have to “just live with it”. Just because something is more common, does not make it normal. Just because you expect things to be a certain way, it does not mean that this has to be end result.

Mothers especially tend to put others needs and wants before their own, but it still holds true- you cannot care for others if you do not take care of yourself.

Reach out to our TEAM at Breakaway Physical Therapy today to start taking care of yourself! Call our office today at 410-721-6333 to set up a FREE consultation to speak with a pelvic floor physical therapist and learn how we can help you feel more like YOU!

Stephanie McKay

Stephanie McKay

Stephanie graduated from the University of Maryland Baltimore in 2011 with her Doctorate of Physical Therapy. During PT school, I completed a clinical internship in Women’s Health/Pelvic Floor Physical Therapy which gave me valuable clinical experience and opened my eyes to this much needed and often overlooked area of physical therapy. There are so many conditions/symptoms such as pelvic pain and incontinence which are mistaken for being normal just because they may be common in society, chronic, or attributed to pregnancy/childbirth, however this is not the case at all! I love that I can help my patients return to activities that they enjoy without symptoms. In my free time I enjoy spending time with my family and friends, as well as exercising and being outside. I am excited to join Breakaway and to be a part of a team where there is focus on patient-centered care. I love to spend one-on-one time with my patients to ensure I am meeting their personal goals and to be able to give my patients the tools that they need so that they can maintain their progress even after discharge from PT.
Stephanie McKay

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