While urine control problems most often start in a woman’s 40’s or 50’s, they can occur in women in their 20’s or 30’s. It is hard to feel confident in your social, exercise, or sexual activities when you have to worry about leaking urine or being close to a bathroom. Unfortunately, leakage problems usually get worse with time, & many women find that they give up more & more activities as their leakage worsens. It is not uncommon for women to stop exercising due to leakage. This can lead to weight gain which worsens the leakage & results in a vicious cycle. Many women do not seek treatment because they don’t think that anything can be done about it, or they have been told that it is “just part of being a woman.” This is just not true! There are almost always some treatment options which can improve your bladder control, often without surgery.
Goals for the Treatment of Bladder Control Problems
It is important to have goals for your treatment. These goals may include resuming specific social or exercise activities, being to go longer between using the bathroom , getting up less overnight to void, eliminating the use of sanitary pads, or traveling. Our goal for your treatment is for you to be able to resume the activities which you enjoy, & be comfortable & confident about your bladder control.
For some women, the complete cure of leakage may not be realistic, however much we would like it be so. The tissues, muscles, & nerves are never going to be as healthy as they were a couple or a few decades ago; but treatment still should provide you with a major improvement in your bladder control. Activities such as walking, running, hiking, golf, & sex can usually be engaged in without leakage (although it is still a good idea to empty your bladder first). Jumping on a trampoline or strenuous weight lifting with a full bladder without leakage are probably not realistic goals. Amazingly enough, recent studies have shown that up to 80% of young college women athletes who have never been pregnant have leakage with intense exercise. This tells us that even when the tissues are healthy bladder control can still be a problem.
Types of Leakage Problems
The medical term for urine leakage is “incontinence.” In most women, leakage problems are usually due to either a problem with bladder support (“genuine stress incontinence” ) or a problem with bladder spasms (“overactive bladder”). Some women may have both problems (“mixed incontinence”).
Genuine Stress Incontinence
Genuine Stress Incontinence is usually due the opening of the bladder (the urethra) losing support & “dropping” into the vagina. In women, the urethra is only about an inch long, so it does not take much loss of support to result in leakage. The urethra is weakened by a combination of childbirth injury, genetics, & time. It is common for women to develop this problem after child birth or around the time of menopause, but many women develop it in their 30’s or even their 20’s. In some women, the nerves & muscles to the opening of the bladder can be damaged & contribute to their leakage.
The most common symptom is the loss of urine with physical stress such as coughing, sneezing, exercising, hiking, straining, lifting, standing, bending, or sex. With time, it takes less & less to cause the leakage, & many women give up activities which they enjoy.
Detrusor Overactivity (“bladder spasms”)
This type of leakage is due to the bladder not holding as much urine as it should. This can cause the sensation of having to go all time & having a strong urge with leakage before you can make it to the bathroom. It is often worse at night, making you have to get up a few or several times to void. THis type of leakage can be very embarrassing in public as you can lose a large volume of urine all at once.
We do not understand what causes this common type of leakage. Men can get it as well, & it becomes more prevalent with time. Recent research has shown that urge leakage may be due to the bladder not communicating with the brain properly, & telling the brain it is full when it really isn’t. This condition worsens without treatment with some women having to void 2 or 3 times an hour to avoid leakage. It’s hard to get a good night’s sleep when your are up & down going to the bathroom all night.
Many women with bladder spasms note that certain things in their diet make it worse. Common triggers include caffeinated beverages, soda, citrus, alcohol, & spicy foods. Drinking large volumes of fluid can also keep you in the bathroom more often.
Treatment of Leakage Problems
Depending on what is causing your leakage, treatment options can include exercises, dietary changes, medications, bladder training, or surgery. Our philosophy is that we would like to find treatment other than surgery for you if possible. If medicines are indicated, we would like to wean or eliminate them with time. Working on your pelvic muscles can improve both types of leakage. Bladder spasms can improve by putting your bladder on a regular schedule.
For more about treatment options read this.