Why Urinary Leaks Can Worsen During Your Menstrual Cycle
Cramps. Headaches. Fatigue. Acne. Brain fog.
These are common complaints that many women report in the days leading up to and during their periods.
But there’s another symptom that some women deal with which isn’t often spoken about.
Stress urinary incontinence is the official term for urinary leakage that occurs during exercise, coughing, sneezing, laughing, or any other activity that increases the pressure in your abdomen (and therefore puts a stress on the bladder).
Some people experience leaks any time they do one of the above-listed activities (If that’s you, please seek out a pelvic floor physical therapist asap to help!). Many others find that they only have this leakage during their periods. If you fall into that camp, read on to understand why this sometimes happens and what you can do about it.
Let’s start with the why. There are quite a few factors that can exacerbate urinary incontinence during our monthly cycles.
Let me give you the bad news first. Foods such as chocolate, coffee, and alcohol can sometimes irritate the bladder, which can cause an increased need (or urge) to urinate. If you are already prone to urinary leakage, this increased urgency can sometimes put too much stress on the bladder, leading to leaks.
If you tend to eat more chocolate, and drink more coffee & wine during your cycle, this could be affecting your urinary issues. The solution here would be to attempt to notice whether your incontinence is associated with any food (which you can do by keeping a bladder diary for a few days) and if so, to reduce or eliminate that trigger. Of course, eliminating our favorite foods is much easier said than done! But often just knowing that there is an association of a certain food or drink to urinary symptoms can help to reduce them if you use that information to plan your days better. For example, if you’ve noticed that coffee is your trigger, you can plan to drink your morning cup after your CrossFit class rather than before. A little bit of planning can make a big difference for those with sensitive bladders!
Of course, there can sometimes be more to the picture than just what we’re eating. There are also a variety of physiological changes that happen within the body during a menstrual cycle that can increase your likelihood of leakage.
As you near your cycle, the uterine wall thickens and blood flow to the area increases. (Obviously, right?) Because tissue and blood have weight, this process results in the uterus becoming a little heavier. The uterus is positioned above and behind the bladder (see below picture) so any additional uterine weight can put added pressure on the bladder. This can increase the urge to use the restroom and lead to leaking if the pelvic floor muscles lack control or strength.
Image origin here.
The cervix (the part of the uterus closest to the vaginal canal) also lowers to allow the extraneous blood and tissue a quicker exit. This can again put added pressure on the urethra, which is where urine exits from. This urethral compression can lead to involuntary leaks – just think of a hose being squeezed! This is another factor in our anatomy that simply doesn’t work in our favor.
Finally, changing hormones can also affect our urinary control. Fluctuating estrogen levels during a menstrual cycle can also contribute to what’s called ligamentous laxity, which simply means that the ligaments holding the uterus and bladder in place will stretch and therefore not give as much support to those organs. Less support can lead to increased urinary symptoms.
Are you sensing a theme? As I’ve mentioned a few times now, a big cause of stress urinary incontinence is increased pressure in the pelvis. While you may not be able to always control everything that influences pelvic pressure, the good news is that you can control how you manage increased pressure.
Understanding how to use your breath is going to be key here. As a PT, I’ve noticed that a lot of the times, when my patients are exercising, they are holding their breath to help them create more core stability and generate more power. While this might be a good short-term strategy, this also can lead to increased pressure on the bladder and the pelvic floor. Luckily, you can learn to change your breathing patterns so that you can use your breath efficiently without putting additional pressure on the pelvic floor. The easiest way to do this is through an exercise called 360 breathing.
Settle into a comfortable position, either seated or lying down.
Place one hand on your chest and the other on your abdomen.
Take a few deep breaths here and notice if one of your hands is moving more than the other. Ideally, both hands should be moving evenly, but many people are chest breathers and will find that their top hand is moving most. If you notice that you are breathing mostly into your chest, try to focus on bringing air into both hands so that your chest and belly rise and fall together.
Once you have mastered that, you can then move your hands to the sides of your ribcage and take a few breaths here. (This is where the 360 part comes in - 360 refers to 360 degrees and ideally, our torso will expand in 360° when we are breathing deeply.)
So far, we have focused on the inhale portion of our breath. But that’s only half the equation. Once you feel like you’re able to fully expand into your chest, belly, sides (and back!) as you breathe in, then I want you to purse your lips and exhale forcefully, keeping your hands on your sides. If done correctly, you should feel some oblique engagement on your exhale. Continue for a few breaths, adding this gentle abdominal contraction to your exhales.
Though a simple exercise, many of my patients are surprised to find how much coordination this takes! I usually advise practicing for a few minutes 2x per day (morning and night) to begin to teach your body how to naturally coordinate your abdominals with your breath. When your abdominals are engaging, your pelvic floor muscles naturally do as well, which will help them to counteract downward pressure from the pelvic organs (which are the bladder, the uterus, and the rectum!). Incorporating this breathwork into your daily routine should then help your abdominals and pelvic floor instinctively coordinate better during exercise as well (or even when you sneeze!).
If you continue to experience leakage, try to consciously remind yourself to exhale during activities when you usually leak. For instance, if you notice yourself leaking when you stand up from a squat (or even from a chair), consciously remind yourself to exhale as you stand and see if that helps. You can even try actively contracting your pelvic floor (aka performing a kegel) on your exhale as well, as long as you remember to let it go on your inhale. (Don’t even get me started on over-kegeling - yes there is such a thing, but that’s a different blog for a different day!).
Some may advise you to reduce high impact activities (such as running, jumping, or any other HIIT) before and during your menstrual cycle in order to avoid the physical stresses to the bladder altogether. And while that certainly can be a way to manage symptoms, it will ultimately not solve pelvic floor dysfunction. So if you have tried the above exercises but your symptoms are not resolving, I would highly recommend you being evaluated by a pelvic floor physical therapist (Pelvic floor PTs are the best! And I’m only a little biased…).
Additional restorative poses for the pelvis such as child’s pose or supported bridge can also be beneficial during this time, provided that they feel good in the rest of your body.
To perform a child’s pose,
Come onto your hands and knees (on a soft surface to protect your knees).
Push your hips back onto your feet.
Sit here for a few deep breaths, focusing on letting your back and pelvis relax.
Variations:
You can keep your knees together or keep them wide, whichever feels better to your body.
You can keep your arms long in front of your body or put them down by your sides.
Some people prefer to put a pillow underneath their body to take pressure off the hips. Remember this should feel like a nice stretch so it shouldn’t be painful in any part of your body.
To perform a supported bridge,
Lay on your back on a firm surface.
Bridge up by lifting your hips into the air.
Slide a yoga block, bolster, or firm pillow underneath your hips, and then drop your hips to let your sacrum rest on the object.
As with the child’s pose, stay here for a few deep breaths, focusing on letting your back and pelvis relax.
Hope this helps you understand a little bit more about your body! If you have any questions or are having symptoms regularly, feel free to reach out so that we can help!
Sources:
Chidi-Ogbolu N, Baar K. Effect of Estrogen on Musculoskeletal Performance and Injury Risk. Front Physiol. 2019;9:1834. Published 2019 Jan 15. doi:10.3389/fphys.2018.01834