To Pee Or Not To Pee? Dr. Lauren Croal WOD & Wine Women’s Workshop Series Badger CrossFit

To Pee Or Not To Pee? What is stress urinary incontinence? Review the “Core” Pain Why do people pee with activity? How breathing affects the pelvic floor Not all about the “kegel” Treatment

Stress Urinary Incontinence “Unintentional loss of urine…when physical movement or activity — such as coughing, sneezing, running or heavy lifting — puts pressure (stress) on your bladder.” -Mayo Clinic “Occurs when your bladder leaks urine during physical activity or exertion. It may happen when you cough, lift something heavy, change positions, or exercise.” -National Library of Medicine

Core Layers of the Abdominal Core Superficial: Rectus Abdominis External and Internal Obliques Deepest Layer: Transverse Abdominis Stabilizes spine and pelvis

Pain You may have NO pain at all OR you may have or have had Abdominal Buttock Low back Pelvic You may not present with pelvic pain Be aware that abdominal pain, pelvic pain, buttock pain and low back pain can all be symptoms of incompetent pelvic floor If you were previously treated for abdominal, buttock, or low back pain and the pelvis was not addressed – seek treatment!

Why? Incompetent pelvic floor muscles Nerve related Overactive pelvic floor muscles Deficient lower extremity function Non-skillful movement patterns Incompetent pelvic floor muscles – fascial injury, tear, avulsion Nerve related – nerve entrapment, tight musculature Overactive pelvic floor muscles - hypertone Deficient lower extremity function – poor load dissipation Non-skillful movement patterns – motor control imbalance

Optimal Breathing Diaphragm and pelvic floor muscles are synchronized Increased abdominal pressure (lifting/exercise) leads to greater force on pelvic floor Incompetent pelvic floor leads to urinary incontinence with inhale (descend) and exhale (ascend) When you increase intraabdominal pressure – hold core muscles tight while performing lifts and exercising the pelvic floor has to withstand the pressure in the abdominal cavity and prevent descending. If the pelvic floor is incompetent to do so or the intraabdominal pressure is too great – urine will leak out

A word about “kegels” >50% of women perform them incorrectly Can worsen pelvic pain conditions

Treatment Figure out what is the cause of your stress urinary incontinence Assess posture, breathing, mobility and strength Treat the WHOLE YOU for optimal function and performance Not black and white like last talk

Questions? Dr. Lauren Croal 11702 W North Ave Wauwatosa WI 53226 Free Consults Direct Access (no referrals needed) In network with most major insurance companies Dr. Lauren Croal 11702 W North Ave Wauwatosa WI 53226 414-763-2941 www.wiscopt.com