If you’ve ever crossed your legs before a sneeze, sat out the trampoline at a kid’s birthday party, or mapped every bathroom before a run, you’re in very good company.
Leaking when you laugh, cough, or jump is incredibly common, especially after kids and around menopause. Common isn’t the same as something you have to live with. Here’s what causes it and how we treat it.
Stress incontinence is leaking urine when pressure hits your bladder: coughing, sneezing, laughing, lifting, running, or jumping. The “stress” is physical pressure, not the emotional kind, although it certainly doesn’t help.
It’s different from urge incontinence, that sudden “I have to go right now” feeling, and many women have a mix of both. Sorting out which you have matters, because the treatments are different. Stress incontinence affects up to one in three women at some point.
Your urethra stays closed thanks to a team effort: the pelvic floor muscles underneath it and healthy, supportive tissue around it. When either one weakens, pressure wins. Common reasons include:
And a twist: not every leaky pelvic floor is weak. Some are too tight and can’t contract well. That’s why an evaluation beats guessing.
When you leak, how much, and what triggers it. We may ask you to keep a simple bladder diary for a few days. It sounds tedious, but it’s one of the most useful tools we have.
A pelvic exam lets us check your pelvic floor strength and tone, the health of the tissue, and whether there’s any prolapse. We’ll also rule out things like a urinary tract infection. It’s gentle, and we explain everything as we go.
Then we lay out the options, what the evidence says about each, and what we’d recommend, and we decide together.
Each HIFEM session takes about half an hour. You sit, fully clothed, and feel strong tingling and rhythmic muscle contractions. It’s weird, not painful, and you can go right back to your day. The initial series is two to three sessions a week for a few weeks.
Usually weekly visits for a few months, plus exercises at home. The homework is where the progress happens.
Muscles respond to repetition, so sticking with the plan matters more than any single treatment.
Pelvic floor strength fades if you stop using it. Ongoing home exercises, plus a maintenance session in the chair once a month, help hold onto your gains.
Many women notice improvement partway through a HIFEM series, with continued gains in the weeks after it ends. Pelvic floor therapy typically shows results over six to twelve weeks of consistent work. Vaginal estrogen takes a few weeks to a few months to strengthen tissue.
If you’re not improving, we adjust the plan or refer you on.
Results vary. Your plan and expectations will be based on your own evaluation.
Leaking is often treated as a punchline. It shouldn’t be. Many women quietly stop exercising because of it, and giving up running, lifting, and jumping in midlife costs muscle, bone, and heart health that’s hard to get back.
Your pelvic floor also plays a role in sex, including sensation and orgasm. Strengthening it can pay off well beyond the bladder, which is exactly why we treat it as part of your whole health.
We’re a cash-pay clinic, so there are no surprise insurance bills.
You’ll get a clear quote after your first visit, before anything starts.
Your care is led by Dr. Jake Shank, a board-certified physician and Menopause Society Certified Practitioner. We bring the pelvic floor, hormones, and tissue health together in one plan, and we know when to send you to a surgeon instead.
It’s common after kids, but that doesn’t make it something you have to accept. It’s very treatable, even years later.
Sometimes. But many women do them wrong, or have a pelvic floor that’s too tight rather than too weak, in which case Kegels can make things worse. An evaluation tells us which you are.
Strong tingling and rhythmic contractions while you sit fully clothed. Most women call it strange, not painful. Some find it oddly satisfying.
Usually not. Concentrated urine can irritate the bladder and make things worse. Timing your fluids helps more than cutting them.
Most women don’t. But if non-surgical treatment doesn’t do enough, surgery can work very well, and we’ll refer you to a urogynecologist we trust.
Book a consultation and bring your questions, even the awkward ones. Especially the awkward ones.
