What women describe
Incontinence shows up differently for different women. The most common patterns:
- Stress incontinence — a few drops (or more) when you run, jump, lift weights, sneeze, cough, or laugh. Often shows up first postpartum or in perimenopause.
- Urge incontinence — the sudden, urgent need to urinate that won't wait. Many women find themselves planning their day around bathroom locations.
- Mixed incontinence — both at once.
- Postpartum changes — leaking that started after a baby and never went away. "Just because you had a kid" is not a diagnosis.
- Frequency — needing to go more than seven or eight times in a day, even when you haven't had much fluid.
Why "just do Kegels" doesn't always work
The pelvic floor is a sling of muscles that has to do two things really well: hold things in (continence and pelvic organ support), and let things out at the right time (urination, bowel movements, intercourse, childbirth).
When the muscles are too weak, they can't hold pressure during effort — that's classic stress incontinence, and Kegels can help. But when the muscles are too tight or uncoordinated (more common than most people realize), Kegels actually make things worse. They add tension to a system that needs to learn how to relax and respond, not contract harder.
The first job of an evaluation is figuring out which type of pelvic floor you have. The treatment is completely different depending on the answer.
How incontinence is treated at Bremen Pelvic Health
Treatment is built around what your specific evaluation shows. Common components include:
- Whole-body assessment — hips, ribcage, breath patterns, and core coordination, not just the pelvic floor in isolation
- Manual therapy and hands-on release of overactive muscles when present
- Targeted strengthening (when actually indicated) — done correctly, not just generic Kegels
- Coordination training: teaching your pelvic floor to engage and release at the right moments under load
- Bladder retraining and behavioral techniques for urge symptoms
- Education on what to do during exercise, sex, work, and daily life so progress holds
Why three to four visits is the typical answer
Most women with incontinence see meaningful improvement within three to four hour-long visits. That timeline reflects two things: the hour you actually get with Dr. Nicole, and the heavy emphasis on education so you know what to do between sessions.
Some patients are done in two. Some chronic or complex cases — long-standing untreated incontinence, or symptoms tangled up with prolapse or pelvic pain — take six to eight visits. Plans are honest about what your body needs.
If you're an athlete or active patient
Leaking during workouts is one of the top reasons women quietly stop exercising. If you've been modifying double-unders, dropping weight on lifts, or skipping running because of leaking — see the return to sport page for how Dr. Nicole works with athletes specifically.
Common questions
- What is the difference between stress and urge incontinence?
- Stress incontinence is leaking during physical effort — running, jumping, lifting, sneezing, coughing, or laughing. Urge incontinence is the sudden, strong need to urinate that you can't hold off long enough to reach a bathroom. Many people have both (mixed incontinence). The treatment for each is different, which is why an individual evaluation matters.
- I leak during workouts. Is it really fixable?
- Almost always, yes. Leaking with running, lifting, CrossFit, or jumping is one of the most common reasons women stop exercising postpartum — and one of the most fixable issues in the entire pelvic floor world. Most patients see real change inside three to four visits.
- I've been told to "just do my Kegels." Why isn't that working?
- Kegels can help when the underlying issue is true pelvic floor weakness — but they make things worse when the issue is a tight or uncoordinated pelvic floor (which is more common than people realize). An evaluation determines which one you have. Generic Kegel advice is the most over-prescribed and under-personalized recommendation in pelvic health.
- Do I need an internal exam to be treated?
- No. Internal pelvic exams give the most complete picture, but they are never required. Many patients are evaluated and treated entirely externally, especially in the early visits. You stay in control of every decision.