Sometimes I pee myself a little.

Just a little.

Life as a pelvic floor therapist is a good time. You never know when your mom will call to report that so-and-so is absolutely desperate for your help (this has happened more times than I can count). Neighbors, other family members, randos at the gym, old grad school classmates — everyone reaches out at one time or another.

(And if this is you — keep asking! I really do love it.)

If I had a dollar for every time someone asked about stress incontinence, I’d be an exceptionally well-resourced woman.

But what about the type of stress incontinence that most people like to ignore? The “just a little” club that doesn’t mind… until they do.

Let’s get into it.

Here’s the tl;dr:

• If you’re a person with a vulva (and therefore a relatively short urethra), urinary incontinence is a really common concern. This is particularly true if you’ve been pregnant or birthed a baby — no matter how that went down.

• Many clinicians will tell you that no amount of stress urinary incontinence (SUI) is normal. I think there’s a gray space. I also think the concept of normal sucks.

• If there is a persistent and consistent pattern to the SUI you experience, that is something to pay attention to, and may be worth seeking support for.

• Great news: the “just a little” club of SUI often resolves easily, with exercises you can do at home, and of course, I’ve included a bundle at the end of the post!

literally my favorite image on the internet regarding this matter

The deep dive:

Newer epidemiological research suggests that 61.8% of adult AFAB (assigned female at birth) people experience urinary incontinence of some stripe at some time in their lives. Read that again. SIXTY ONE PERCENT, people!

Within the folks who experience incontinence, 37.5% of the study sample had SUI, while 22% had urge urinary incontinence (UUI — see this post for more) and 31.3% had mixed incontinence with both stress and urge features.

My point is, you’re in really fucking good company.

Many, many pelvic floor therapists will tell you that no amount of leaking is okay, ever. I disagree. Leaking is a sign that your pelvic floor is overloaded, and yeah, it’s worth listening to your body communicating this message. But if you are very occasionally leaking a small amount, and it doesn’t bother you, then that’s okay in my book. This is def true in late pregnancy (when I peed myself once!). Your body, your choice.

When things start to take on a consistent pattern, that is, IMO, when you should consider asking for support. Even a “I only leak when I get a bad cold, and then I leak every cough” is worth checking out, because I hate to break it to you, you’re gonna get another cold. Similarly, peeing yourself once or twice in late pregnancy is different than every sneeze whilst preggo.

If you’re in your late 30s or 40s and noticing any kind of pattern, I strongly recommend getting support before perimenopause comes to hang out. To be clear: You’re never screwed. But it is helpful to start earlier. Don’t let it slide if you notice a distinct pattern.

SUI happens for a lot of reasons that go beyond “my pelvic floor is weak”. Let’s take a look at the most common ones:

• tension: Think of your pelvic floor like a trampoline. You don’t want a trampoline made of cotton, but you also don’t want a trampoline made of wood. A too-firm pelvic floor will be less resilient to impact, making it more likely that you’ll leak when a big old cough comes around.