Header image: AI-generated landscape inspired by the Pacific Northwest.
You plan a run around bathroom stops. You cross your legs before a sneeze. Or you avoid the jumping part of a workout because you know what might happen.
Leaking with coughing, sneezing, or exercise can be stress urinary incontinence. Here, “stress” refers to physical pressure on the bladder—not a diagnosis of emotional stress.[1]
It is a reason to seek support, not something you need to be embarrassed about. At At Ease Physiotherapy, we want to understand what happens when you move, what else you are experiencing, and what you want to return to.
First, What Kind of Leakage Are You Experiencing?
With stress incontinence, urine leaks during activities such as coughing, laughing, lifting, or running. With urgency incontinence, leakage accompanies a sudden need to urinate, before you can reach the toilet. A combination is called mixed incontinence.[1,2]
That distinction matters because the treatment plan can differ. NICE recommends at least three months of supervised pelvic floor muscle training for women with stress or mixed incontinence. For urgency or mixed incontinence, bladder training is also a first-line option.[2]
Bladder symptoms are not exclusive to women, but these particular recommendations come from guidelines for women. Assessment and treatment should reflect your anatomy, health history, and symptoms rather than transferring one programme to everyone.[1,2]
More Than “Just Do Your Kegels”
Pelvic floor muscle training is not simply a reminder to squeeze harder. NICE recommends assessing contraction and relaxation, then tailoring training to the person’s ability, discomfort, and goals.[3]
Useful questions include:
- Can you identify a pelvic floor contraction and let it go afterwards?
- Are you experiencing pelvic pain, pressure, or difficulty emptying your bladder as well as leakage?
- Does leakage happen immediately, or only towards the end of a workout?
- Which activities have you started avoiding?
These questions help us choose what to assess. They are not an invitation to diagnose yourself as having a “weak” or “tight” pelvic floor from symptoms alone.
How Susannah’s Training Shapes the Assessment
Susannah Reid has completed Pelvic Health Solutions Levels 1, 2 & 3, postpartum rehabilitation training, trauma-informed care, and Clinical Pilates mat and equipment training. Her qualifications also include Integrated Systems Model mentorship and certification.
The Integrated Systems Model starts with what matters to the person and the task they want to do.[4] For leakage, that task might be lifting a child, completing a set of squats, or running without planning around pads and toilets.
An assessment may therefore look at pelvic floor function alongside breathing, abdominal effort, and how you perform that task. For example, we might explore a different way of coordinating a lift, rather than asking you to hold your abdomen tight all day.
These are ways to individualize care—not proof that a particular rib position or breathing habit caused your leakage.
You Remain in Control
Our pelvic health service offers an optional internal examination, with explanation and consent. It can provide information about pelvic floor function, but you may decline, pause, or stop. We can discuss external assessment options and any limits to the information they provide.
You do not need to agree to an examination before you understand why it is being offered.
Where Breathing, Hands-On Care, and Pilates Fit
Susannah’s approach brings together gentle hands-on care and movement practice. In pelvic health, the important question is what each part of the plan is intended to address.
Breathing practice might be used to explore comfort or coordination during a movement. However, a systematic review found scant or no evidence that breathing exercises replace pelvic floor muscle training or add further benefit for incontinence and prolapse.[5]
Similarly, adapted Pilates can be a setting for returning to exercise, but it should not replace the pelvic floor training prescribed for your symptoms. Where pain or discomfort accompanies leakage, we would assess that concern separately rather than assume that more strengthening—or more manual treatment—is the answer.[2,3]
What About Visceral Manipulation?
Susannah’s advanced visceral-manipulation training is part of her broader skill set. It does not establish that this treatment improves bladder leakage.
In a five-week trial involving 52 women, adding visceral manipulation to pelvic floor muscle training did not improve the measured outcomes more than training with sham manual treatment.[6] It should not be presented as a proven way to stop leakage or as a substitute for established pelvic health care.
Individualized care means choosing relevant tools, not using every tool.
A Practical Starting Point
Before your appointment, note when leakage occurs, whether you feel urgency, and whether you have pain or difficulty emptying your bladder. A bladder diary can help an assessment; NICE recommends recording at least three days covering different usual activities.[2]
Bring the question you most want answered. It might be “Can I keep running?” or “Why hasn’t the exercise programme I found online helped?”
We would build a plan around the findings, with enough guidance to practise between visits and a review of how symptoms change. Three months of training is a treatment trial to reassess—not a guaranteed cure date.[2,3]
When to Seek Medical Care
Arrange medical assessment for blood in your urine, painful urination, bladder pain, or difficulty emptying. If you suddenly cannot pass urine, seek urgent medical care. These symptoms should not be assumed to be a pelvic floor exercise problem.[7]
New bladder or bowel changes with back or leg pain, numbness around the genitals or bottom, or significant leg weakness need emergency assessment. That is different from an established pattern of leakage when sneezing.[8]
You deserve a plan that makes sense for your symptoms and the activities you enjoy. Contact our South Surrey clinic to discuss pelvic health physiotherapy, or explore what pelvic health care involves.
References
- National Institute of Diabetes and Digestive and Kidney Diseases. Definition & Facts for Bladder Control Problems (Urinary Incontinence).
- National Institute for Health and Care Excellence. Urinary incontinence and pelvic organ prolapse in women: management. NICE guideline NG123. 2019. Assessment, bladder diaries, pelvic floor muscle training, and bladder training recommendations.
- National Institute for Health and Care Excellence. Pelvic floor dysfunction: prevention and non-surgical management. NICE guideline NG210. 2021. Recommendations on supervised, individualized contraction and relaxation training.
- Diane Lee & Associates. The Integrated Systems Model. Description of meaningful-task assessment; not independent evidence of treatment efficacy.
- Bø K, Driusso P, Jorge CH. Can you breathe yourself to a better pelvic floor? A systematic review. Neurourology and Urodynamics. 2023;42(6):1261–1279. doi:10.1002/nau.25218.
- De Marco M, et al. Effects of visceral manipulation associated with pelvic floor muscles training in women with urinary incontinence: A randomized controlled trial. Neurourology and Urodynamics. 2022;41(1):399–408. doi:10.1002/nau.24836.
- National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & Causes of Bladder Control Problems (Urinary Incontinence).
- NHS. Sciatica. Emergency neurological warning signs.
