Have you begun to experience a little something extra when you sneeze, cough, laugh, or lift something heavy? Yes, you guessed it; we’re talking about uncontrollable bladder leaks. And it can even happen seemingly out of the blue, without an obvious trigger. Chronic bladder leakage, aka urinary incontinence, is a vexing problem that can be, at times, a source of embarrassment and frustration, not to mention a hygiene challenge, leaving you to wonder “why can’t I hold my pee”?
Part of the answer lies in women’s anatomy. While urinary incontinence occurs in both women and men it is nearly twice as common in women. This is due to factors such as pregnancy and childbirth, which place considerable physical stress and pressure on a woman’s bladder. Additionally, a woman’s urethra is shorter, which increases risk for urinary tract infections and provides less muscular control of the flow of urine making it more vulnerable to loss of function when injured or damaged.
Fortunately, there are a number of proven solutions. Following is a rundown of the main categories of female incontinence, their symptoms, causes, and treatment options.
Stress Incontinence, is caused by weakness of the muscles of the pelvic floor, which normally provide support to the pelvic organs and hold them in place. Weakness of the urethral sphincter also contributes to stress incontinence. This is the muscle that surrounds the urethra and opens and closes like a faucet to control the flow of urine. Conditions that can lead to weak pelvic floor and urethral sphincter muscles include pregnancy, pelvic or low back surgery, and obesity.
Symptoms of stress incontinence occur with sudden physical exertion such as coughing, sneezing, or laughing. In some instances, even positional changes, such as bending or stretching can bring on a type of incontinence known as postural stress incontinence.
The most common type of urinary incontinence, the age range of women affected by stress incontinence includes younger women, particularly those who participate in high impact sports or who simply exercise a lot.
Urge Incontinence results from irritation of the bladder due to infections, inflammation, or neurologic conditions that impair bladder control, such as multiple sclerosis, Parkinson’s disease, or spinal cord injury. Urge incontinence mostly affects older women.
Mixed Incontinence occurs when the causative factors for both stress and urge incontinence are present at the same time. In some women mixed incontinence stems from a combination of bladder and urethral sphincter dysfunction. For others a urethral sphincter problem alone leads to both types of symptoms. In this scenario, the weak sphincter allows urine to leak from the bladder into the urethra triggering the urge to urinate and also increasing the susceptibility to stress incontinence. Symptoms can be stress-predominant, urge-predominant, or equally both, though one study found stress-induced urgency incontinence to be the most common pattern.
Mixed incontinence falls in-between stress and urge incontinence in terms of prevalence, but shares some risk factors of both. Like urge incontinence, rates of mixed incontinence generally skew towards older women. However, like stress incontinence your risk for developing mixed incontinence increases during pregnancy.
In addition to the causative factors of urinary incontinence there are secondary, or contributing factors. Identifying and managing these to the best of your ability can help reduce your symptoms. These include:
- Diet and Lifestyle – Habits such as caffeine, alcohol, artificial sweeteners, and soda consumption can irritate the bladder and trigger urge incontinence symptoms, as can spicy and acidic foods, chocolate, and sugar.
- Obesity – Excess abdominal weight places pressure on the bladder, contributing to stress incontinence and bladder leakage.
- Type 2 Diabetes – Can damage the nerves that control the bladder. A study found that women with metabolic syndrome, a cluster of risk factors that lead to type 2 diabetes and certain other chronic illnesses, develop urinary incontinence at nearly twice the frequency of women who don’t have metabolic syndrome.
- Hormone Replacement Therapy – In some women, hormone replacement may contribute to urinary incontinence by causing bladder contraction. This has been found to occur more often from the use of systemic (oral) hormone replacement vs. vaginally administered therapy.
Several categories of medications can cause urinary incontinence or worsen existing symptoms.
- Diuretics – By increasing urine production these drugs increase incontinence symptoms.
- Blood pressure meds – Particularly those that lower blood pressure by dilating blood vessels.
- Antidepressants and Analgesics – Some of these prevent the bladder from emptying completely. They can also cause constipation, leading to increased pressure on the bladder.
- Sedatives – Can decrease your awareness of the urge to urinate, increasing your risk of experiencing episodes of incontinence.
A variety of both at-home and medically administered treatments can help with urinary incontinence. Your doctor can help guide you in deciding on the best options for your individual needs.
- Pelvic muscle exercises – Known commonly as Kegel’s, these involve consciously contracting and relaxing the pelvic muscles to strengthen them. This process can take a few weeks before you see results. Additionally, controlling pelvic muscles can be tricky. There’s a bit of a learning curve to this exercise and it’s easy to get it wrong if you are practicing on your own. For this reason, pelvic muscle exercises are best done with the guidance of a knowledgeable pelvic physical therapist.
- Bladder Training– Involves scheduling frequent trips to the bathroom to help avoid accidents. When combined with pelvic exercises, scheduled bathroom breaks can be lengthened as muscle strength improves. This technique can be helpful for women with urge or mixed incontinence; however, its benefits will be lost if you discontinue it, so it needs to be used as an ongoing therapy.
- Biofeedback –Provides visible and audible cues to help guide and improve pelvic muscle control. Biofeedback is non-invasive and painless and can be used in combination with pelvic muscle exercises, to assess muscle strength, and to tailor an exercise program. In a study of women ages 55-92, biofeedback in combination with Kegel exercises improved bladder leakage symptoms in 10% more participants than Kegel’s alone.
- Pessaries – Custom-fitted prosthetic devices that are placed in the vagina to provide support to the bladder and other pelvic organs to help reduce symptoms of stress incontinence. A pessary may be a good option for you if you are pregnant, if your incontinence occurs with strenuous exercise or activity, if you have had previous bladder surgery that failed, or if you are not a candidate for surgery due to advanced age. Pessaries should not be used if you have an active pelvic infection, or if you have an allergy to silicone or rubber.
- Low-Grade Electrical Stimulation – Gently activates and strengthens the pelvic muscles via a device inserted in the vagina that emits a mild, tingling sensation. Can be self-administered to individual comfort level.
- Medications – Several types of medication can help with bladder leakage, including:
- Antispasmodics – Prevent bladder leakage by reducing bladder contractions. These provide moderate improvement for urgency symptoms; however, they are also associated with a high rate of side effects, including dry mouth, constipation, blurred vision, and fatigue, leading many women choose to discontinue using them.
- Estrogen replacement – Helps restore supportive tissues around the bladder that may atrophy after menopause. Particularly effective for this purpose is vaginally applied estrogen therapy.
- Botox Injections – Can offer significant benefits for patients with overactive bladder and urge incontinence. It’s effective for about 65% of patients. Treatments last 6-12 months, so need to be repeated, as needed. There are potential adverse effects to consider. These include urinary tract infection and incomplete bladder emptying, which may require self-catheterization.
- Surgery – Can be performed to lift the bladder and urethra if pelvic muscles are weak and unresponsive to conservative treatments. It is usually reserved as an option for post-menopausal women with stress incontinence.