The Condition Nobody Talks About at the Playground
You sneeze and cross your legs. You avoid trampolines, jump ropes, and high-impact exercise. You have a mental map of every bathroom in every store, restaurant, and gas station between your home and your office. You have started wearing dark pants "just in case."
You are not alone. Pelvic floor disorders affect an estimated 1 in 4 women over their lifetime, rising to nearly half of women over 80. The number climbs significantly after pregnancy and childbirth. Yet this remains one of the most under-discussed, under-treated areas of women's health because the core symptom (leaking urine or a sensation of "things falling out") carries a deep, undeserved stigma.
At MomDoc, we refuse to let embarrassment prevent treatment. Pelvic floor problems are medical conditions with excellent treatment options, and you deserve to cough, laugh, lift your kids, and run without anxiety.
Understanding Your Pelvic Floor
The pelvic floor is a hammock of muscles, ligaments, and connective tissue spanning the base of your pelvis. This muscular sling supports your bladder, uterus, vagina, and rectum, and plays a crucial role in urinary control, bowel control, sexual function, and core stability.
When the pelvic floor weakens, stretches, or is injured, the structures it supports can lose their position and function.
Common Causes of Pelvic Floor Dysfunction
- Vaginal childbirth: The single most significant risk factor. Pushing during delivery stretches and can tear pelvic floor muscles and nerves.
- Pregnancy itself: The weight of the growing uterus stresses the pelvic floor for months before delivery.
- Aging and menopause: Declining estrogen levels reduce the strength and elasticity of pelvic tissues.
- Chronic straining: From constipation, chronic cough, or heavy lifting.
- Obesity: Increased abdominal pressure weakens pelvic support over time.
- Genetics: Some women have inherently weaker connective tissue.
The Three Core Pelvic Floor Conditions
1. Stress Urinary Incontinence (SUI)
Leaking urine during physical activities that increase abdominal pressure: coughing, sneezing, laughing, jumping, running, or lifting heavy objects. This occurs when the urethral sphincter and pelvic floor muscles cannot maintain closure under pressure.
2. Overactive Bladder (OAB) / Urge Incontinence
A sudden, intense urge to urinate that is difficult to control, often resulting in leaking before reaching the bathroom. Patients describe "key-in-the-door" urgency or waking multiple times at night.
3. Pelvic Organ Prolapse (POP)
When weakened muscles allow one or more pelvic organs to descend into the vaginal canal [2]:
- Cystocele: Bladder drops into the front vaginal wall
- Uterine prolapse: Uterus descends toward or through the vaginal opening
- Rectocele: Rectum bulges into the back vaginal wall
Symptoms include vaginal pressure or heaviness, a visible or palpable bulge, difficulty emptying the bladder or bowel completely, and discomfort during intercourse.
Diagnosis at MomDoc
We perform a comprehensive pelvic floor assessment:
- Detailed symptom history: Using validated questionnaires to quantify your symptoms and their impact on daily life.
- Pelvic examination: Assessing muscle tone, prolapse staging (using the POP-Q system), and demonstrating stress incontinence.
- Post-void residual measurement: Checking whether your bladder empties completely.
- Urinalysis: Ruling out urinary tract infection as a contributing factor.
- Additional testing: Urodynamic studies or cystoscopy may be ordered for complex cases.
Treatment: A Progressive Approach
First Line: Pelvic Floor Physical Therapy
ACOG recommends supervised pelvic floor muscle training as the first-line treatment for both incontinence and mild prolapse [1]. This is not generic "do your Kegels" advice. A specialized pelvic floor PT uses:
- Biofeedback: Sensors that help you visualize your muscle contractions, ensuring you are engaging the correct muscles
- Manual therapy: Internal and external techniques to release tension, improve coordination, and strengthen weak areas
- Progressive strengthening: A structured program that builds endurance and power over 8 to 12 weeks
- Behavioral strategies: Bladder retraining, timed voiding, and fluid management
Pessary Support
A pessary is a silicone device inserted into the vagina to physically support prolapsed organs. It is non-surgical, removable, and highly effective. Pessaries come in many shapes and sizes, and your MomDoc provider will fit you and teach you proper care.
Medication
- Anticholinergics or beta-3 agonists: For overactive bladder, these medications relax the bladder muscle and reduce urgency.
- Topical estrogen cream: For postmenopausal patients, restoring local estrogen improves tissue health and urinary symptoms.
Surgical Options
When conservative treatments are insufficient:
- Midurethral sling: A minimally invasive outpatient procedure for stress urinary incontinence with a success rate exceeding 80%.
- Prolapse repair: Vaginal or abdominal surgical correction to restore pelvic organ position. MomDoc offers robotic-assisted repair for complex cases.
- Urethral bulking agents: Injectable materials that bulk up the tissue around the urethra for mild SUI.
Myth Busting: "Leaking Is Just Part of Being a Mom"
This is false, and it is harmful. Urinary incontinence is a treatable medical condition. Normalizing it as an inevitable consequence of motherhood prevents millions of women from seeking care that could profoundly improve their quality of life.
You delivered a human being. You are a warrior. You also deserve to sneeze without anxiety.
The MomDoc Approach
- No embarrassment, no judgment. We discuss pelvic floor health openly and proactively at postpartum visits, annual well-woman exams, and menopause consultations.
- Referral network: We maintain relationships with pelvic floor physical therapists across the Phoenix metro area who specialize in prenatal and postpartum rehabilitation.
- When to come in: If you are using more than 2 pads per day for urine, if urgency is affecting your activities, or if you feel pressure or a bulge in your vagina, schedule an evaluation.
Take Control
Stop Googling "is it normal to pee when I sneeze." Call MomDoc at 480-821-3601 or book a gynecology appointment online. This is fixable.
This content is for informational purposes only and does not replace professional medical advice. Always consult your MomDoc provider regarding your specific symptoms and treatment plan.