It’s estimated that 40 per cent of women in the UK live with some form of urinary incontinence.
Defined by the NHS as the unintentional or involuntary leakage of urine, it can be broadly be categorised into four sub-types.
The most common type – affecting an estimated fifth of women aged 40 and over, but believed to be hugely underreported due to embarrassment – is stress incontinence.
Stress incontinence is caused by weakened pelvic floor muscles after going through pregnancy, childbirth and menopause, and is also linked to obesity and ageing.
Dr Zena Wehbe, Chief Scientist from female health brand Jude, told the Daily Mail that it’s a common misconception that the pelvic floor is a single muscle.
She said: ‘The pelvic floor is a group of muscles that form a supportive sling across the base of the pelvis.
‘This muscle group endures the pressure of around 80 kilograms of fluid throughout the day, and it’s a core part of the body that supports posture, movement, and the rest of the muscles.
‘It works together with your diaphragm, core, hips, and nervous system to support bladder, bowel, and sexual function.
The pelvic floor is a group of muscles that form a supportive sling across the base of the pelvis
‘It’s also critical for core stability, posture, and movement efficiency, so it’s involved in much more than just bladder control.’
The other three types of incontinence aren’t directly related to pelvic floor health.
Urge incontinence, also known as having an overactive bladder, is caused by overactivity of the muscle in the bladder lining. It is often linked to neurological conditions such as MS and Parkinson’s, bladder irritation from caffeine, alcohol and UTIs, or nerve damage.
There’s also overflow incontinence, known as chronic retention, which is caused by a bladder obstruction, for instance from a tumour, which prevents full emptying and causes frequent leaks as pressure builds.
And lastly, functional incontinence which is where people struggle to reach the toilet in time due to physical or mental impairments like dementia and severe arthritis.
Traditionally, the ‘solution’ for urinary incontinence has been to build on strengthening the pelvic floor with kegel exercises, movements designed to strengthen the muscles supporting the bladder, bowel, and uterus.
They are simple and discreet, and involve contracting and relaxing the muscles that you would use to stop the flow of urine.
Dr Wehbe said: ‘Generally, there are leaks that occur either due to a weak pelvic floor that cannot counteract the rise in intra-abdominal pressure that occurs with sneezing, coughing and other physical activity, but there are also leaks that occur following a sudden urge to go to the loo, and this is highly related to the bladder muscle and the bladder-brain signalling.
Strengthening the pelvic floor needs to take an overarching approach, say Jude team
‘The “remedy” isn’t always the same for both. Urge-related leaks largely require bladder regulation, whereas physical or stress-related leaks need pelvic floor muscle strength and retraining.
‘In some cases an overly contracted pelvic floor also leads to dysregulation of these muscles, also leading to leaks. For these people kegels may make their symptoms worse.’
Kegel exercises were named after American gynecologist Arnold Henry Kegel, who formally described pelvic floor muscle exercises as a non‑surgical treatment for stress urinary incontinence back in the 1940s – a solution which has never been questioned, or improved upon.
But Dr Wehbe says that there is no ‘one size fits all’ approach for tackling leakage – especially as it’s not always weakness in the pelvic floor which is causing the issues.
‘Some women who experience leaks or urgency actually have a pelvic floor that’s too tight or overactive rather than weak,’ she said.
‘If the muscles become overactive or tense, it makes them less able to contract and relax appropriately.
‘Signs of a tight pelvic floor can include pain, a sense of urgency, difficulty emptying your bladder completely, or discomfort during intercourse.
‘Weakness, on the other hand, might show up as leaks during activity or an inability to control your bladder when you laugh, cough, or lift something heavy.
‘It’s really important to get assessed by a women’s health physiotherapist, because guessing can sometimes make things worse.’
The pelvic floor – which is located at the base of the pelvis, forming a muscular hammock from ‘front to back’ between your tail bone and the pubic bone and between the two ‘sit bones’ from left to right – is largely made up of a combination of slow- and fast-twitch skeletal muscle fibres.
Around 70 per cent are slow-twitch fibres, which respond best to endurance work, breathing exercises, and longer periods of activation.
The remaining 30 per cent are fast-twitch fibres, which are responsible for quick, reactive movements, for example, when you cough, sneeze, or lift something suddenly.
‘Both fibre types are important for proper pelvic floor function but require different types of exercise to ensure their optimal activity,’ says Dr Wehbe.
‘The key is not just squeezing more – like a lot of women have been told for decades – but retraining the pelvic floor to work in coordination with your core, glutes, and breath.
‘Fast squeezes could help with the minority of fast twitch fibres but they are certainly not enough for the majority of the pelvic floor muscles which require endurance and functional loading based exercises.’
So if kegels aren’t going to be the best solution for everyone, what is?
The new school of thought is that the focus should be on functional exercises that mimic real-life movements, such as lifting, coughing, or running, which help the muscles learn to respond appropriately under load.
‘Strength without relaxation isn’t true strength. Timing, coordination, and control are just as important as the ability to contract,’ added Dr Wehbe.
According to a new poll of 2,000 UK women 40+ commissioned by Jude, a considerable 94 per cent experience accidental leaks, with 42 per cent saying leaks occur at least once a week, with 12 per cent struggling with urinary incontinence almost every day.
And while the solution seem to be either doing kegels or paying for a pricey in-clinic treatment using lasers or soundwaves to strengthen the pelvic floor, there is a new alternative.
The Strength Method Program, which has its roots in sports science, is a free, six-minute protocol that trains the pelvic floor in coordination with the core, glutes, and breath, preparing the muscles for real-life stress – whether that’s coughing, laughing, lifting, or running.
The programme, created by science-led health and wellbeing consultancy The Well HQ and Jude, focuses on relearning connection, coordination and timing, the skills that allow the pelvic floor to respond when it is needed and relax when it is not.
‘With 1 in 3 women still experiencing pelvic floor weakness, we know that what’s been done to support the pelvic floor so far isn’t enough,’ said Dr Wehbe.
‘We recognise that the pelvic floor isn’t a stand alone group of muscles, but rather part of a network of interconnected tissues that need to work together for optimal stability and strength.’
