Facts About Bladder Control
Bladder Control and Urinary Incontinence
If you or someone you know struggles with loss of bladder control, or urine leakage, you are not alone:
Urinary incontinence affects men and women, although it is nearly twice as common in women.
Bladder control problems affect 30 to 50% of women.
Although the rates go up with age, urinary incontinence among young women is common.
Though common, urinary incontinence is NOT “normal” at any age.
Bladder control problems are health issues, which impact your ability to void with normally:
Urine leakage (urinary incontinence, or UI).
Loss of urine that occurs at the same time as physical activities that increase abdominal pressure such as sneezing, coughing, laughing, and exercising (stress incontinence, or SUI).
Inability to hold urine long enough to reach the restroom (urinary urge incontinence, UUI).
Frequent urination during the day and night (urge frequency).
Frequent need to void—a combination of both urgency frequency and urge incontinence (overactive bladder).
Difficulty emptying their bladder (voiding dysfunction).
Am I at Risk?
Certain events or conditions may make a woman more likely to experience urinary incontinence. Sometimes, very clear-cut events such as pregnancy, vaginal delivery, surgery, radiation or accidental injury can lead to urinary incontinence. Other times, causes may be much less well-defined. And, in many cases, there is no obvious underlying reason for why bladder control problems occur.
Genetics
There’s also a family link. Some women are born with a weaker pelvic floor. If your mother or sister have bladder control problems, you are at increased risk.
Health Issues
Some medicines, such as diuretics, put you at greater risk for urinary incontinence. Also, certain health conditions increase your chances of developing incontinence:
Chronic constipation—which causes excessive bearing down during a bowel movement.
Obesity—certainly has an effect.
Lung conditions—ones where pressure from breathing disorders can increase the pressure in the abdomen and pelvis.
Neurological conditions—for example multiple sclerosis or spina bifida, where nerves and/or muscles may not function correctly.
Kidney or bladder stones, or even some forms of cancer—can cause the bladder to leak urine. However, this is uncommon.
Life Choices
Life choices can also increase your risk. Women who smoke are at higher risk for developing bladder control problems. Drinking lots of caffeine can also bring on the urge to void. In addition, occupations and physical activities that require heavy lifting or exertion increase your risk.
There are different types of urinary incontinence (UI) in women. The most common types of women's incontinence are stress urinary incontinence (SUI) and urge incontinence, also called overactive bladder (OAB). Many women often have symptoms found in more than one category (i.e., mixed incontinence).
Stress Urinary Incontinence
Stress urinary incontinence (SUI) is loss of urine that occurs at the same time as physical activities that increase abdominal pressure (such as sneezing, coughing, laughing, and exercising). For women with stress incontinence:
These activities can increase the pressure within the bladder, which acts like a balloon filled with liquid.
The rise in pressure can push urine out through the urethra, especially when the support to the urethra weakens.
The result is incontinence caused by the stress.
Some women leak occasionally. For example, when they exercise aggressively, have colds or allergies, or their bladder is very full. Other women have a great deal of leakage with simple activities such as getting up out of a chair, or simple walking. Although the severity may vary, many women find that these symptoms begin to limit their physical or social activities, and can have a serious impact on quality of life.
Pregnancy Link
With the joys of childbirth also comes increased weight pushing on your pelvic floor. This added pressure can lead to urine leakage. Pregnancy incontinence is not an official type of incontinence, but incontinence related to pregnancy often resolves in the first few months after delivery. Urinary incontinence associated with pregnancy may signal the development of more troublesome incontinence in the future. That said, overall the risks of vaginal birth are generally significantly less than Cesareans.
Urge Incontinence (Overactive Bladder/OAB)
Overactive bladder (OAB) is a complex condition affecting about 15 percent of women across all ages. Also called urge incontinence, overactive bladder is leakage of urine accompanied by a sensation of the need to urinate, or the impending sense that a large leak is going to happen. Other symptoms include:
Frequency—the need to rush to the bathroom, more than 8 voids in each 24 hours.
Urgency—that gotta-go now sensation, a powerful urge to urinate, which is difficult to put off.
Nocturia—waking up twice or more at night to urinate.
Unlike stress incontinence, OAB usually means a bladder "squeeze" or contraction occurs at an unwelcome time. You may notice severe urgency and leakage when driving into the driveway, placing the key in the front door, running water, or with temperature changes. Some women with OAB also have urinary incontinence. OAB is a very common condition.
As a first step, talk to your medical provider or bladder specialist, like a urogynecologist or urologist. Discuss when and how often you leak urine. A physical exam helps identify other conditions that influence the bladder, such as prolapse.
Bladder Control Quiz
It’s quick, easy, and informative! And, for your eyes only—unless you choose to share it with loved ones or your doctor. Take the Bladder Control Quiz can help you determine if you are experiencing bladder control problems associated with possible pelvic floor disorder. It also provides advice on the next steps to take in order to improve your pelvic health.
Seven Categories of Urinary Incontinence
1) Stress Incontinence
Urine leakage occurs with increases in abdominal pressure. For example, when you cough, laugh, sneeze, or lift a heavy object.
2) Urge Incontinence (Overactive Bladder)
Inability to hold urine long enough to reach restroom. Women often describe a sudden urge to urinate followed immediately by leaking. Some leak on the way to the bathroom or while they are taking off their clothes.
3) Mixed Incontinence
Two or more causes contribute to urinary incontinence. For example, if a woman has the combination of stress incontinence (leaking with coughing, sneezing, exercise, etc.) and urge incontinence (leaking along with a need to get to the bathroom), the diagnosis may be mixed urinary incontinence. Often, you first experience one kind of leaking and the other begins to occur later.
4) Overflow Incontinence
Leakage or “spill-over” of urine when the quantity of urine exceeds the bladder’s capacity to hold it. Usually due to some blockage or obstruction preventing the bladder from emptying. This stops the bladder from emptying well and so, small amounts of leakage happen frequently. Overflow incontinence is less common among women, unless they have had bladder surgery, vaginal prolapse, or a neurologic problem.
5) Functional Incontinence
Leakage (usually resulting from one or more causes) due to factors impairing your ability to reach the restroom in time because of physical conditions (e.g., arthritis or using a walker). This may or may not represent a problem of the pelvic floor, but your health care provider can offer potential solutions.
6) Fistula
This is an abnormal connection between the vagina and the urinary tract, which results in urinary incontinence. This usually happens after some types of surgery, trauma, or radiation to the area. Urinary incontinence due to fistulas is relatively uncommon.
7) Diverticulum
Urine collects in a pouch within the urethra and tends to dribble out.
No one is sure exactly how to prevent urinary incontinence. Many of the risk factors are difficult or impossible to change. For example, genetics or pelvic floor problems due to other diseases.
Good News! There are certain things that can reduce the likelihood or severity of incontinence.
Eat Healthy
A diet with plenty of fiber and fluids keeps your bowel working normally.
Constipation and chronic straining during a bowel movement can weaken muscles and nerves and stretch the connective tissues of the pelvic floor.
This increases your risk of developing incontinence.
Move—Exercise Your Body and Your Pelvic Muscles
Regular exercise is important for maintaining healthy bowel function. It also helps keep your weight in check.
Do your Kegel exercises to keep your pelvic floor muscles in shape, too.
On the flip side, avoid heavy lifting and repetitive strenuous activities. Learn how to lift safely by using your leg and arm muscles.
Maintain a Normal Weight
Lose weight, if you are overweight.
Overweight women have a greater risk for developing incontinence.
Carrying excess weight also worsens the severity of urinary incontinence.
Don't Smoke
Smoking increases your risk of UI.
And, seek medical attention to evaluate and treat a chronic cough.
Something to Talk About
Many women who have bladder control problems are reluctant to discuss them with anyone. They are embarrassed to acknowledge that they have a problem, even to themselves.
Some people think that these conditions are a normal part of aging. And, that since bladder control problems are rarely life-threatening, they are not really a problem. Family and friends, even some healthcare providers, may share this view.
The truth is that UI can have a very significant impact:
We know that UI can undermine your sense of well-being and self-worth, and your ability to live your life the way you want.
Scientific studies indicate that quality of life measures significantly decrease when a woman experiences these kinds of bladder control problems.
After experiencing these problems, women may begin to stop exercising or participating in physical or social activities, which can further reduce health and quality of life.
Work activities, travel and intimacy also may suffer as a result.
The good news is that 80 to 90% of women who seek treatment experience significant improvement. Providers, like urogyns, work with women on treatments, ranging from lifestyle and diet changes to nerve stimulation and surgery, help women recover parts of their lives they may have lost.
Learn more, get evaluated and review treatment options appropriate for your urinary incontinence. The more you know, the more confident you will be in choosing the direction of treatment.
