You probably don’t think much about your bladder. That is, of course, until it stops working properly. Issues such as painful urination or accidental urine leakage, known as urinary incontinence (UI), can catch you by surprise. Urinary incontinence can keep you from doing activities that you enjoy because you do not want to be too far away from a bathroom. In this article, we explain what you need to know about urinary incontinence and strategies for coping with this uncomfortable issue.
The Facts About Urinary Incontinence
Pregnancy, menopause, prostate problems, obesity, and poor overall health may increase the risk of UI. However, UI is not hereditary and is not an inevitable consequence of aging. Also, most importantly, you are not alone. UI, which affects millions of people every year, is highly treatable.
If you’re struggling with UI, the first step is to make an appointment with a urologist. Although no single treatment works for everyone, you can work with your doctor to find the best treatment for you.
In addition to making an appointment with a urologist, there are many things you can do to improve your UI symptoms, including doing Kegel exercises to strengthen the muscles that support the bladder and setting a schedule for urination. Also, caffeine, alcohol, constipation and not drinking enough water can worsen problems with UI.
Your bladder looks like a balloon with a rounded shape when full. When empty, it looks a bit like a deflated balloon. Your kidneys work continuously to filter between 120 to 150 quarts of blood daily to produce about 1 ½ quarts of urine every day. The urine is stored in your bladder until you have an opportunity to go to the bathroom. It’s a simple storage function, but when it goes wrong, life can get complicated.
For this system to work properly, the nerves that signal the brain to empty the bladder and the bladder muscles themselves need to work together to hold urine and release it when the time is right. Factors such as childbirth, prostate surgery, stroke, diabetes or other diseases can damage nerves and nerve pathways, and in these cases, your urologist will recommend treatment.
Common types of UI
Urge incontinence – This is also known as overactive bladder or spasmodic bladder and happens when the bladder contracts at inappropriate times, caused by an overwhelming immediate urge to urinate.
Overflow incontinence – When the bladder does not empty fully, it can overflow, leading to frequent urination and urine leakage, usually in small amounts.
Men and women have different anatomy surrounding their urinary systems, and these differences can be the cause of varying UI symptoms.
Urinary Incontinence in Men
Benign prostatic hyperplasia (BPH), as well as specific treatments for prostate cancer, can cause UI in men. BPH, or prostate enlargement, commonly occurs in men as they age, affecting over 50% of men in their 60s and up to 90% of men in their 70s and 80s. An enlarged prostate can pinch the urethra blocking the passage of urine. Over time, this type of obstruction may weaken the bladder muscle, causing retention of urine. Urine retention can lead to overflow incontinence, urinary frequency, urgency and decreased flow.
Urinary Incontinence in Women
Pelvic organ prolapse, a shifting of the normal position of the bladder, rectum and/or uterus, can cause urine to leak, leading to incontinence.
Women are also more prone to urinary tract infections after menopause due to declines in estrogen levels. This decline in estrogen affects vaginal pH, which increases the risk of getting a UTI. A UTI will typically cause the urgency of urination, which, if bad enough, can lead to another type of UI in women known as urge incontinence.
Visit a Urologist
The first step to take to help treat urinary incontinence is to make an appointment with a urologist. Your urologist will review your medical history, do a physical exam, and usually order urine and blood tests. Depending on your history, tests may be suggested to measure the function of the nerves and muscles of the bladder. Based on these test results, the doctor will develop a treatment plan that works best for you.
Although the urologist may suggest a trial of medication, men and women may be able to see improvement in UI by using these other strategies:
Pelvic floor muscle or Kegel exercises
With age, the pelvic floor muscles supporting the bladder lose strength, and the bladder may shift position. This loss of strength makes it much more difficult for the sphincter (the muscle which holds the urine in) to stay closed. Fortunately, you can strengthen the pelvic floor muscles by doing Kegel exercises:
- Lie down. To find the right muscle imagine that you are trying to stop passing gas.
- Contract the muscles and hold for 3 seconds, then rest for 3 seconds. Start with just one set of 10 reps. Work up to 3 sets of 10 reps, and eventually, you can do these exercises three times per day. Don’t overdo Kegel exercises as this can tire out the muscles and keep them from functioning properly.
- Try not to tense other muscles such as facial muscles or thigh muscles when doing this exercise. Focus on the right muscle.
- Once you’ve been doing the exercises for a few weeks, you can do them sitting or standing.
- It may take about 3 to 6 weeks to see improvement. Keep doing them!
If you have pain when you do Kegels, or, if you need help with performing pelvic floor exercises correctly, speak to your physician about a referral to see a physical therapist.
Biofeedback is a non-invasive therapy that can help you understand how your body functions so that you gain greater control over your incontinence symptoms. It may involve collecting information about your urinary habits and developing personalized techniques. Speak with your doctor for further details on this strategy.
Bladder training is a type of behavior therapy that can be very effective in treating urinary incontinence. The goal is to increase the amount of time between emptying your bladder and the amount of fluids your bladder can hold. This type of training may require you to follow a schedule of when to drink water and when you go to the bathroom to urinate. You may need to go to the bathroom even when you don’t think you need to go!
Don’t rush. Take your time in the bathroom
Try to urinate in a relaxed position and take enough time to allow your bladder to completely empty. This can help you avoid retaining urine in the bladder which may cause a UTI that can lead to UI.
For women, don’t hover over the toilet seat! This position causes you to tense the pelvic floor muscles which does not allow you to relax and completely empty your bladder. Is the toilet seat really that dirty that you shouldn’t sit down? Toilet seats that are cleaned regularly typically don’t accumulate dangerous bacteria.
Diet and Lifestyle Changes
Drink enough water every day
Many people struggling with incontinence will mistakenly restrict their water intake, and this can make it hard to develop a routine of urinating on a regular schedule, at least every 3-4 hours. Drinking enough water may actually help you avoid leakage because it can help you establish this regular schedule of urination.
A formula that some healthcare professionals use to determine how much water to drink is to take one-third of your body weight to set a target number of ounces of water to drink daily. For example, if you weigh 150 pounds, you can drink 50 ounces of water daily. But be sure to discuss your health history with your urologist before deciding on how much water is appropriate for you.
Restricting water intake can also cause a buildup of waste products in the urine, causing irritation in the bladder that can contribute to UI. If you have highly concentrated, dark yellow, strong-smelling urine, this can be a sign that you need to establish a schedule for drinking more water.
Drink less caffeine and alcohol
Caffeine can irritate the bladder and lead to problems with UI. It’s also a diuretic, meaning it will cause your kidneys to temporarily produce more urine. Caffeine can be found in coffee, tea, chocolate, sodas and even some over-the-counter and prescription medications.
Studies have suggested that reducing caffeine intake may be beneficial. Experiment with how much you can tolerate. Many people can tolerate some caffeine, such as one cup of coffee per day, without causing UI.
Alcohol is an irritant to the bladder and is also a diuretic, which can increase urine production. Consider limiting yourself to no more than one drink per day if you are struggling with UI, or eliminate alcohol altogether if necessary.
Keep your bowels moving
There is a close relationship between the muscles and nerves that control bladder functions and those that control bowel movements. Also, the bladder and the colon are located close together in the body so being constipated can cause UI.
Constipation can cause hard stool in the rectum to press against the bladder causing it not to fill as much as it should, or to contract when it is not supposed to, or it may press against the urethra pinching it and making it difficult for urine to pass. Try to keep your bowels regular by including at least 25 grams of fiber into your daily diet, drinking enough water, and see your physician for laxative recommendations if necessary.
While it may feel like an embarrassing topic, know that you are not alone! Speak up and discuss your concerns with your doctor and healthcare team so you can get the help you need.
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