You’ll never convince me it’s normal to pee in your pants!
I like to masquerade as a super chill person. I wish I were. I’d like the calm and happy facade I present to the world to be 100% true. Honestly, these days I am fulfilled, passionate, and joyful about life, but like T Swift says, “Would it be enough if I could never be your peace?” My ability to remain placid is frequently disrupted by bullshit I hear from society.
So welcome to another of my “hot takes.” If you’re here, I’m assuming you’ve enjoyed some of the past ones, or you’re rubbernecking the shit show waiting to see when I’m canceled by the internet. For those of you who don’t know, I’m a doctor of physical therapy who specializes in pelvic health and pediatrics. I have extensive clinical and personal experience in both of these areas…childhood burn “victim,” tiny vagina survivor, and mom to a tweenager who has some connective tissue dysfunction.
I talk about pee, poop, and sex for a LOT of my working and non-working time. I spend my nights and weekends writing and teaching this content. I make sure to practice what I preach. If you want to see my head spin, say the words, “I leak the normal amount, you know, like when I cough, sneeze, laugh, or jump.”
Let’s start with some delineation between common and normal. Something can be super common. Let’s look at a list of some things that could be considered common but not normal: abuse (sexual/physical/emotional), break ups, obesity, eating disorders, heart disease, diabetes, cancer, car accidents, and poverty. Statistically, these things happen a lot. They’re frequent. They’re no fun. I doubt most people would want them labeled as NORMAL.
So why do people, in this case cisgender females, accept leaking urine at any point in their life, with any activity, as normal? Well, let’s blame the patriarchy. I always joke I’m a closet feminist and I’m going to come out for a minute. The social injustice on what is acceptable in pelvic health based on gender is heartbreaking and infuriating at the same time.
When penis owners who identify as men have problems, society takes them seriously. (Sadly this is not true of my trans friends who have penises). With general medical care, the stats favor men over women getting better care. They’re the squeaky wheel and they get the oil. The women are over here thinking their heart disease is chronic reflux and not getting proper screening and treatment.
Back to the “dudes”…when a man can’t get an erection, resources are thrown into finding multiple solutions for this problem. We take prostates so seriously that at 45 – 50 men start to be assessed routinely for this kind of cancer. When do women get assessed for cancer? Well, we’re subjected to annual pap smears to make sure we don’t have cervical issues, which are mostly caused by the sexually transmitted HPV…so because of penises we have to have THAT exam. As far as other gender specific breast cancer, the age is 50 – 74, and you should “talk to your doctor from age 40 – 49 about if you need a mammogram.” 70% of ovarian cancer cases are diagnosed late stage, whereas 80 – 85% of prostate cancers are diagnosed locally or regionally, meaning they have a earlier catch and cure rate.… are you seeing a discrepancy yet?
Recently, the amount of male to female gynecologists is getting closer (43% males to 57% females), but this was not always the case and the amount of female doctors only recently began to rise in the 1970s (only 7% of gynecologists were women back then). There was a steady trend of health issues being dismissed in women as hysteria, mental illness, psychosomatic, etc. prior to women entering the healthcare field. So it’s no surprise then when women did start telling their male doctors they leak after childbirth that they were told, “Oh that is normal.” The doctor didn’t have answers or thought the only answer was Kegels. They didn’t know the cause, and therefore didn’t want to deal with it. The logic to getting out of addressing the inconvenience of these frequent incontinence complaints was to label them as normal.
Incontinence is an evolution. It’s not necessarily new, but as birthing practices and lifestyles have changed, the abdominal canister, and therefore pelvic function, has also been affected and changed. We used to birth babies squatting in fields, wear them on our back while we carried water from the river, and women died in childbirth if things didn’t go just right. I would have been one of those moms that died with a baby stuck in me. Things are different now. Modern medicine got involved in the process, sometimes for good, and sometimes not so much. My daughter was delivered safely and I’m here to write this blog, so it’s not all bad!
There have been so many trends in childbirth, and if you talk to people over generations you’ll see just how much. My child is 11, and the birth practices have changed significantly even from when I had her. Hearing about the births my grandmothers and mother experienced has opened my eyes even more to this change. We’ve tried things like hypnobirthing, “twilighting,” mandatory episiotomies, required cesareans, super “natural” and over medicated approaches, to name a few.
As birthing has changed and medical intervention has increased, so has the incidence and prevalence of incontinence. It is expected that birthing a baby would alter a person’s pelvic floor. However, because it is so common, providers have just started to accept it as normal, and encourage their patients to also do so. If they don’t have anything to offer to solve the problem, like medication or a surgery, it becomes even easier to say, “This is normal, there is nothing to be done, and this is now life.” That’s much less embarrassing than saying, “I have the same problem and haven’t solved it yet,” or “I don’t know the answer and haven’t taken the time to find the resources.”
Many providers only get a very short introduction into pelvic health, a snapshot aspect of their learning with little depth reviewed on the topic. They may know pelvic floor therapy exists, but not what it is. They think things like, “It’s just Kegels,” or “it only helps THIS diagnosis.” They may not know what a pelvic floor evaluation entails. If you’re curious and don’t know, check out this blog. I literally wrote a book called Pelvic Health 101: A Visual Tour of the Pelvic Floor because this topic is so mystifying to people. Who treats pelvises? Obviously weirdos, voodoo doctors, witches and gremlins! (Joking, pelvic floor friends!!)
Urinary incontinence can be simple or complex. It can be linear or evolving. It needs a thorough evaluation and an assessor who understands ALL of the related systems: the muscles, skeleton, kidneys, bladder, brain, spinal cord and more! It can happen to anyone at any point in their life. Incontinence does not limit itself to postpartum moms or menopausal grannies. It’s not necessarily something that will “go away on its own,” nor will it be the “new normal.”
The good news is pelvic floor therapy is an excellent treatment option with great literature and anecdotal support for it helping to decrease and usually eliminate urinary incontinence. The reason I get so mad about so many people accepting incontinence as normal is that in doing so, we limit a person’s ability to get help with a skilled pelvic floor provider. When we say, “Oh, you’re just peeing when you sneeze because you’re pregnant,” that means that person may not get help working on skills to stop that from happening. They may further think that the leak AFTER delivery is normal too, and then not even speak up. They have a few more babies, and they leak even more.
Suddenly they’re spending weekly money on pads or absorbent underwear, avoiding fun things like trampoline parks or games of tag with their kids, and praying whenever they have a cold that they don’t empty their bladder in a way that is embarrassing. A person with incontinence gets worried they smell, they frequently tell me they’re dirty, and that a partner won’t want them if they knew. They stop engaging in intimacy or things that could lead to intimacy due to fears of leaks during any part. They limit sexual activities like oral sex because they feel so self conscious of their parts. It’s a vicious descent into a sad pelvic floor life. Wet pee pants, less (or no) sex, and limits on playtime activities. This timeline can be true of vulvovaginal and penilescrotal people!
You’ll never convince me to say leaking is “normal” or “no big deal.” Something that is common: orphaned, homeless kittens. Yeah, there are a ton, and it’s a damn shame, but it should not be normal. In my world and from my perspective, leaking pee (or poop…or gas) in any amount is a HUGE life altering and quality of life degrading condition.
If you’ve been here for a bit, you know I’m not a big fan of “new year, new me,” BUT, for January, Practically Perfect PT is launching our first ever seven day challenge called “The Happy Bladder Challenge.” This will include 7 days of mini-lessons and self check-ins to help you have a happier bladder without having to do more than 10 minutes of work a day. You can sign up for our email list here to find out more information to start taking steps to not leak or avoid future leaks! This challenge will be launching in early January, 2024!
Perfectly yours,
Dr. Mora and the staff at PPPT
