"I Laughed So Hard I Peed My Pants! A Woman's Essential Guide for Improved Bladder Control." by Dr. Kelli Berzuk of Nova Physiotherapy

"I Laughed So Hard I Peed My Pants!" How many times have we heard women say this? We hear it used on TV and within casual conversation, always thrown around as an easy joke. This commonly used phrase is a way for women to make light of a problem that most women unnecessarily experience at some point in their lives. We hear the phrase and smile but we never really talk about the issue. The book, “I Laughed So Hard I Peed My Pants! A Woman’s Essential Guide for Improved Bladder Control.” was written specifically to raise attention to a highly prevalent, yet rarely discussed problem, that being 'female urinary incontinence'.

Do you really need to know about bladder control problems? Well, since many women are involved in sports or physical activity, most women experience childbirth, and all women go through the hormonal changes of menopause, ALL women are at risk of loss of bladder control! We all need to be aware of what we can do for ourselves to either prevent, reduce or correct, urinary incontinence. You may be among the millions of women experiencing episodes of lost bladder control, or perhaps you have watched others suffer and want to prevent this from happening to you. You may also be in the position where symptoms of bladder dysfunction have begun but you are not aware of these warning signs. Or maybe you have never given any thought to your bladder. This information is important regardless of your current level of bladder control since a proper pelvic floor muscle strengthening program should be a part of every woman's life.


It is vital to recognize the early warning signs of incontinence so that you may stop the progression of these symptoms and work toward resolving the problem.

Ask yourself the following questions:

  • Do you refrain from laughing whole-heartedly? (Do you worry about leaking while you laugh?)
  • Do you cross your legs when you sneeze?
  • Do you have trouble holding back gas?
  • Do you know the location of every washroom around you and in your neighborhood?
  • Do you use the washroom more than nine times in a day and one time during the night?
  • Do you leak urine when you cough, sneeze or exercise?
  • Do you often have a strong urge to void?
  • Do you race your children to the bathroom?
  • Do you need to reposition yourself on a chair until the feeling of "urge" passes, and then race to the washroom?
  • Does your bladder seem to be contracting as you pull up on your driveway or just as you get your key in the door?
  • Would you think twice before jumping on a trampoline or skipping rope with your children? Would you need to run to the washroom first, or put on a pad, or would you just tell your kids that mommy's don't jump on trampolines?
  • Do you use the washroom "just-in-case" every time you are about to leave the house, even if you just went half and hour ago?
  • Have you altered any physical or social activities because of your bladder?
  • Or do you just feel that things are not the same as they used to be, your bladder is more finicky or your pelvic floor does not feel as toned as it did before you had your babies?


If you answered yes to any of these questions, you may be experiencing urinary dysfunction or the early warning signs of a pelvic floor muscle that needs attention and strengthening.


How about these questions?

  • Do you think that incontinence is a normal consequence of childbirth?
  • Is urinary incontinence a normal part of aging?
  • Is loss of bladder control just something that women have to learn to live with?


For these three questions the answer is definitely NO! Incontinence is preventable, treatable and often curable. We see and hear reference to poor bladder control all the time, often on TV with ads for bladder control garments and pads. These commercials lead us to believe that loss of bladder control is a normal and natural part of aging, an expected experience in a woman's life.

Well, this simply is not so, or at least it does not need to be. Urinary incontinence is not a normal part of aging, it is not a normal consequence to childbirth and menopause, and it should not be viewed as an acceptable part of a woman's life! Often improved diet and proper exercise is all that is needed to regain or improve bladder control. Many women are unaware that treatment is available or do not seek help due to embarrassment. This is very disturbing since most women can be treated and dramatically improve their situation, often resolving their symptoms. If you are hiding the fact that you occasionally, or frequently, leak urine, it is important to know that there are many things that you can do to help yourself as well as many medical treatment options are available to you.


I am a pelvic floor physiotherapist in the Medical Arts Building and over 20 years I have had the pleasure of working with women, men and children wanting to improve their bladder control. In the pelvis there are muscles that when healthy and strong, silently do their job, allowing us to go about our lives and activities without interruption. The pelvic floor muscle holds the great responsibility of supporting your internal organs, increasing satisfaction in your sex life and preventing urinary and fecal leakage. A weakened or injured pelvic floor may no longer effectively close off the urethral and rectal openings and urinary and fecal

incontinence may result. Laxity or weakness in the pelvic floor muscle may lead to a decrease in sexual appreciation and sensation. And weakness or injury to the pelvic floor can allow the pelvic organs (such as the bladder, uterus, rectum and intestines) to fall downward instead of supporting them in their proper positions.

So ladies, its easy to see how important this muscle is and yet amazingly, most of us do absolutely nothing to ensure its good health, and many do not even know it exists.

The pelvic floor muscle is an extremely underrated and often neglected area of the body. But thankfully, it is also quite resilient and forgiving. It takes only a small amount of consideration and exercise for this muscle to respond positively. It is often injured with pregnancy, vaginal delivery, the strain of chronic coughing or chronic constipation, or simply from being over weight. Now is the time to recognize the significant contribution made by the pelvic floor muscle and to promote its protection through strengthening!


Often women begin leaking occasionally when laughing, coughing and sneezing. This continues to progress gradually over the next few years, while they struggle to ignore and hide the problem. Some women start to wear a mini-pad daily and women will usually adjust their activities, perhaps dropping their aerobic class, or avoiding that second cup of coffee since intuitively they feel that caffeine may aggravate their symptoms. Some women even say that they try not to laugh too much; I still find this comment very unsettling to hear. Just imagine the control the bladder has on their quality of life; it can even affect their sense of humour!


Another common scenario is the woman who does not even realizes that she has a bladder problem. This woman usually has ignored the occasional small leak over the years, assuming it is normal; her mother and grandmother both lost urine while laughing or coughing, as do most of her girlfriends. The common fallacy that incontinence is a normal and acceptable part of aging and that

nothing can be done to help anyway, supports her decision to start wearing a pad daily, and crossing her legs when she sneezes. She restricts her fluid intake and voids frequently in attempt to keep her bladder empty, she starts voiding "just-in-case", especially as she is about to leave the house, even when she did not need to go to the bathroom. Her symptoms are 'not that bad' and easily hidden, it really is only a drop now and then. This continues until she is hit with a bad cold leading to several days of intense coughing. This is the insult that puts her pelvic floor muscle over the edge. Her weakened and neglected muscle cannot tolerate the continuous stress of coughing and suddenly her rare dribbling becomes uncontrollable urinary leakage that does not resolve when her cold is over. This may all have been avoided with proper exercise and education when her symptoms were minimal.


Here is another common scenario but this time the leakage is more extreme than just a few drops with coughing, laughing and sneezing. Often women will initially try to ignore the fact that they are incontinent. They frequently become quite creative in finding ways to hide their symptoms while they suffer in silence. Their social world becomes smaller, activities less frequent, and black becomes a standard colour of clothing.

Slowly they may experience the beginning sensations of urgency; the strong desire to void immediately. Often they will compensate for this by restricting their fluid intake and voiding more frequently to keep their bladder empty. But as their bladder shrinks in volume and their urine becomes more concentrated, the bladder lining becomes even more irritated and the urge and frequency actually increase instead of decreasing. The vicious cycle continues.


By this point women are often consumed with thoughts of their bladder. They consider their bladder problems before making vacation plans, before playing tag with their children or grandchildren, and while socializing with friends.


The final straw comes when they experience the most embarrassing situation of all, a flood. Many women recall such and event; it is usually a special evening that ends in humiliation. Here is one woman's story.


She was dancing with her husband, relaxed and having a wonderful time. The children were home with a baby sitter allowing them to enjoy a rare, romantic night together. They had a nice dinner earlier, with wine and coffee. Suddenly, while on the dance floor, she is consumed with the strong feeling of bladder urgency, and this was immediately followed by complete bladder emptying, in public, and on her beautiful dress.


I have heard similar stories over and over again. Women recount their embarrassment with tears and horror. Some women have experienced this flood at work, others while playing golf. It can happen anywhere. I remember one woman relating her episode of flooding while singing a solo at the front of church.


There is no reason for you to experience this stressful and embarrassing situation. We are all susceptible to the life changes that contribute to U.I. and therefore it is vital that we keep our pelvic floor muscles as strong and healthy as possible. By being pro-active you may prevent an experience like this as well as possibly preventing the need for future surgery such as bladder lifts or hysterectomy.

The biggest treat for me is to watch the personality changes of the women I see for physiotherapy treatment. When we first meet they are often quiet and reserved and dressed in dark clothing. Some women are also quite skeptical and believe that nothing will help. As they are given the tools to help themselves and gradually see improvements to their symptoms, it is amazing to see the transformation. Their confidence and self-esteem builds and joy and happiness are easily seen.


The statistics showing how many women experience urinary incontinence are alarming yet what is even more disturbing is that this topic is so prevalent and yet it is never discussed. It is critical that we build awareness regarding bladder and pelvic floor muscle health!


During routine physiotherapy assessments we question patients on bowel and bladder leakage as an indicator of nerve damage for injuries such as low back pain. As a new graduate I was shocked to hear women answer repeatedly,

"Oh sure I leak when I cough or laugh, but that’s normal".

They would often confess this with a slightly embarrassed laugh and then follow with,

"It is normal, isn't it?"


Since then, I have spent my career attaining education around the world, treating patients and involved in pelvic floor medicine research. I work solely with patients experiencing problems specific to the pelvic floor musculature.

What I hear now repeatedly is:

"I wish I had known sooner that there was treatment for incontinence."

Well, you can know how to help yourself!


While this book title, I Laughed So Hard I Peed My Pants!, tries to bring levity to the subject by using a phrase that many women identify with and quote frequently, I am compelled to remark that urinary incontinence is in no way a laughing matter. Loss of bladder control can inflict immense pain and devastating emotional consequence to women affected as well as their loved ones. Sadly, it can diminish one's self-esteem and impede both social and physical activity.

Thankfully, there is much that can be done to prevent and improve this situation and most women show significant reduction or even resolution of their symptoms with simple home exercises and diet adjustments. Others who may have extensive weakness or damage to the pelvic floor musculature may require medical attention in addition to their home exercise program.

This book was written to educate women about all of the options and opportunities available to them for both the correction and prevention of incontinence. This self-help guide explores the negative effect lifestyle and life events—such as high impact sport, childbirth and menopause—have on bladder health. There is a section on diet factors and how things like caffeine, aspartame and alcohol can be irritating to the bladder lining and contribute to the intense feeling of urgency. This book offers easy to follow, illustrated instruction that encourages readers to gain the skills and knowledge necessary to begin a proper home exercise program, since we know that over 50% of women that do "Kegels" do them incorrectly. This guide also presents information regarding medical options in the areas of pelvic floor physiotherapy, pharmaceutical, and surgical treatment.

I would like to remind us all that knowledge is power, and that motivated women can bring about amazing changes. Please help to spread the word to the women in your life, your mothers, your daughters, your sisters, your friends. Make sure they are aware of the importance of a healthy pelvic floor muscle and what they can do for themselves to ensure it's good health.  www.ilaughedsohard.com