Urinary leakage is a surprisingly common health problem, affecting 40 percent of women in the U.S. every year.
For many women, it’s not uncommon to leak urine when laughing hard, coughing, sneezing, or exercising. For some, it’s a once-in-awhile embarrassment, but for others it can be a messier daily dilemma. But the good news is that there are more treatments than ever for female urinary incontinence, from at-home exercises to pelvic floor therapy or surgery. The most important thing to know is that urinary leakage and incontinence is not something you have to suffer silently, and you won’t shock your doctor by mentioning it.
Urinary incontinence (UI) all comes down to the bladder. The bladder, a balloon-shaped muscle, is a complex organ supported by a whole system of pelvic muscles and nerves. Pelvic floor muscles hold the bladder in place, ring-shaped sphincter muscles keep the urethra closed until you’re ready to urinate, nerves carry signals from the bladder from the brain to let you know when it’s full, and hormones keep the lining of the bladder and urethra healthy.
Because the bladder system depends on so many different parts to function, UI arises when any of the muscles or nerves in this system become weak or damaged. Other contributors to UI include medicine, alcohol, caffeine, infection, and excess weight.
Since UI can result from a range of problems, from a temporary medication to serious nerve damage, a range of treatments is available.
Certain foods and drinks may trigger increased urination. The first step to mitigating female UI is small dietary adjustments, like cutting back on alcohol and caffeinated drinks. In addition, weight loss can also help reduce urinary leakage, since it removes pressure from the bladder.
Bladder retraining can help re-establish the brain’s subconscious control over the bladder. The first step is to keep a monthlong bladder diary. Once you have an idea of just how frequently you urinate, you can begin our at-home bladder retraining program, a simple set of steps that helps you regain bladder control. By following the program for a few weeks, you should see significant changes in urination frequency and possibly see a decrease in accidental leakage.
Pelvic Floor Exercises
Another at-home method for preventing urinary leakage is strengthening the muscle system that supports your bladder: your pelvic floor. Pelvic floor muscles normally contract whenever you cough, sneeze, laugh, or exercise, which stops accidental leakage. But if the muscles are weak, they might not be contracting enough to fully stop urine from leaking. This is known as stress urinary incontinence.
Pelvic floor muscles can become weak from under use, damage during pregnancy or childbirth, changing hormonal balance during menopause, obesity, and chronic constipation or coughing.
The International Urogynecological Association has a comprehensive guide to exercising your pelvic floor muscles for better bladder control. Like any form of exercise, it can take anywhere from six weeks to six months to see marked improvement in your pelvic muscles and bladder control. Patience and practice are key.
Sometimes, female urinary incontinence (especially after childbirth or menopause) persists despite bladder training or at-home exercises. Surgery is recommended to strengthen support of the bladder’s neck when the muscles around it become weakened, usually as a result of childbirth or menopause.
The most effective and long-lasting treatment for stress UI is a midurethral slings, which lie under the middle of the urethra and support it whenever stress is placed upon it, such as when you exercise, cough, sneeze, or laugh. Another option involves the injection of bulking agents (like carbon beads or collagen) to the bladder neck and urethral sphincter “bulk up” those muscles.
For women who struggle with overactive bladders or urge incontinence, wherein leaking occurs after sudden, strong urges to urinate, you may be recommended medications taken by mouth, or in more severe cases, BOTA treatments. BOTA is also an ideal treatment for urinary incontinence caused by neurological conditions, such as multiple sclerosis and spinal cord damage. BOTA injections can be done in the office by relaxing the muscles of the bladder wall, resulting in fewer sudden urges to urinate.
Finally, a doctor may recommend a two-stage surgery called sacral neuromodulation for anyone struggling with an overactive bladder or urinary retention problems. This process works directly on the sacral nerves, which are located near the tailbone and are responsible for controlling the bladder’s surrounding muscles. It is like a bladder pacemaker.
Only a urogynecologist can make the right recommendation for bladder surgery. If you or a loved one experience frequent urinary leakage, constant feelings of urgency or discomfort, call The Woman’s Center For Advanced Pelvic Surgery to make an appointment with one of our board-certified urogynecologists or physical therapists. We’re happy to answer your questions and find the treatment option that’s right for you.
Dr. Ryan Stratford is board-certified in Female Pelvic Medicine and Reconstructive Surgery (FPMRS) as well as Obstetrics and Gynecology (Ob/Gyn) with a wealth of clinical and research experience.