My research showed that women wait an average of 9 years before seeking help for urinary incontinence.
For more than 15 years, I have been hearing the same statements from women:
"I thought it was normal after childbirth."
"I always leak a little urine when I cough."
"I stopped running because I was embarrassed."
"I did Kegel exercises, but they didn't help."
Stress urinary incontinence affects millions of women worldwide. Despite this, many women do not seek help for years. They reduce their physical activity, limit their social lives, and sometimes even their sexual lives.
In one of my scientific papers published and indexed in PubMed, Barriers in Entering Treatment Among Women with Urinary Incontinence, I found that women waited an average of approximately 9 years from the onset of symptoms before seeking professional help.
That is an incredibly long time.
During those years, many women stop exercising, organize their lives around access to a bathroom, or simply accept the problem as "normal."
This study made me realize how important education is and how much we need to break the stigma surrounding pelvic floor health.
The topic later became the focus of my PhD research on the prevention and treatment of pelvic floor dysfunction using telemedicine.
It was during this research that I realized urinary incontinence is not simply a problem of weak pelvic floor muscles.
What Is Stress Urinary Incontinence?
Stress urinary incontinence is the involuntary leakage of urine during activities that increase pressure inside the abdomen.
It most commonly occurs during:
• coughing
• sneezing
• laughing
• running
• jumping
• exercise
• lifting heavy objects
Although common, it should not be considered a normal consequence of childbirth or aging.
What Did I Study During My PhD?
The study included:
• women with symptoms of stress urinary incontinence,
• women at risk of developing urinary incontinence,
• a control group.
For 12 weeks, participants performed pelvic floor muscle training at home using a biofeedback device connected to a mobile application.
This allowed them to observe their pelvic floor muscle activity in real time.
Some participants also received remote supervision from healthcare professionals. They received regular feedback, support, and motivation.
The second group trained independently.
The study evaluated:
• urinary incontinence symptoms,
• quality of life,
• pelvic floor muscle strength,
• endurance,
• muscle control,
• adherence to the training program.
Biggest Surprise 1: Women Need Support
Women who received telemedical supervision completed approximately 90% of the prescribed training program.
In the unsupervised group, adherence was only about 20%.
The difference was remarkable.
The study showed me that the problem is often not laziness or lack of motivation.
Women need:
• support,
• feedback,
• a sense of security,
• contact with a professional,
• a system that helps them stay consistent.
Today, I see exactly the same thing in my online programs.
Biggest Surprise 2: The Power of Data
One of the most fascinating aspects of my PhD research was the use of biofeedback, mobile technology, and telemedicine.
For the first time, I was not relying solely on what participants remembered or reported during appointments.
I could see real data.
I could see how often they trained.
I could see when they stopped training.
I could see which women achieved the best results.
I could also see how important consistency and support truly are.
This was the moment I began to understand the value of data-driven healthcare.
It was no longer just about giving women exercises.
It was about understanding how each woman's body actually functions.
I could observe not only the outcomes, but also the process that led to those outcomes.
This experience showed me that the future of pelvic floor therapy is not based solely on exercises.
It is based on personalization, feedback, technology, and data-driven healthcare.
Biggest Surprise 3: Strength Is Not Everything
For many years, pelvic floor rehabilitation focused primarily on muscle strength.
However, my research revealed something very interesting.
When analyzing the relationship between pelvic floor muscle parameters and urinary incontinence symptoms, I found that muscle endurance showed the strongest association with improvement.
It was endurance, not strength, that demonstrated the strongest relationship with positive outcomes in several key measures.
This encouraged me to look at pelvic floor training much more broadly than simply through the lens of strength.
After all, in daily life we do not perform one maximum contraction.
Our pelvic floor muscles work while:
• walking,
• running,
• exercising,
• carrying children,
• coughing,
• sneezing,
• working.
They need endurance as much as they need strength.
Biggest Surprise 4: Women Cannot Relax Their Pelvic Floor Muscles
One of the most powerful experiences during the project came from conversations with participants.
Many women realized for the first time that they were carrying unnecessary pelvic floor tension throughout most of the day.
One participant told me:
"After two months, I realized that my pelvic floor muscles were tense almost all day long. Now I can relax them very quickly."
This observation profoundly influenced my approach to training.
Today, I believe healthy pelvic floor muscles should be:
• strong,
• enduring,
• well-controlled,
• capable of fully relaxing.
How Did My PhD Change Me?
Looking back, my PhD was much more than a research project.
It was the moment I started looking at women's health differently.
I realized that two women with the same symptom may require completely different approaches.
One woman needs to improve strength.
Another needs endurance.
A third needs to learn relaxation.
A fourth needs support and consistency more than anything else.
This was the beginning of my journey toward personalized pelvic floor therapy.
Improved Quality of Life
The study demonstrated not only a reduction in urinary incontinence symptoms.
It also showed improvements in quality of life.
Participants reported:
• greater confidence,
• increased comfort during physical activity,
• reduced reliance on daily pads,
• improved sexual well-being,
• greater body awareness.
This demonstrates that urinary incontinence is not simply a bladder problem.
It affects many areas of a woman's life.
How Did My PhD Lead to the Creation of PelviCoach?
My PhD taught me that women need more than a standard set of exercises.
They need an individualized approach.
They need to know whether their challenge is related to:
• strength,
• endurance,
• muscle control,
• excessive tension,
• or lack of consistency.
These observations became the inspiration behind PelviCoach.
I wanted every woman to have access to training tailored to her body, her needs, and her data.
Because the future of women's health is not about guessing.
It is about understanding your body.
Do You Leak Urine When You Cough, Laugh, or Run?
Do not assume it is simply a normal part of life after childbirth or aging.
In many cases, properly designed pelvic floor muscle training can significantly reduce symptoms and improve quality of life.
Through IntimiFitness and PelviCoach, I help women better understand their bodies and choose training programs tailored to their individual needs.
Because effective training begins with understanding the real cause of the problem.
Summary
If I had to summarize the most important lesson from my PhD, it would be this:
Urinary incontinence is not simply a problem of weak muscles. It is a problem of function.
Healthy pelvic floor muscles should be strong, enduring, well-controlled, and capable of relaxing.
And women need more than exercises.
They need knowledge, body awareness, and the right support.
My PhD research showed that properly guided training can reduce symptoms, improve quality of life, and help women regain control of their bodies.
But the biggest transformation does not begin when a woman performs a stronger contraction.
The biggest transformation begins when she truly understands her body for the first time.