Urinary leaking is a difficult subject for many women. They’re embarrassed to talk about it, and resigned to believing that it is normal.
There are numerous causes of urinary leaking, and in today’s post, I’ll be addressing one of them – urge incontinence.
What is urge incontinence?
Urge incontinence occurs when you have a VERY strong urge that you cannot ignore, which often comes with a feeling of discomfort in your lower abdomen or pelvis, followed by variable amounts of leaking.
If you suffer from urge incontinence, instead of just casually walking to the bathroom, you may have to run to make it in time!
The leaking occurs due to the inability of the pelvic floor muscles to maintain a consistent contraction and generate pressure to resist the strong urges from the bladder.
The stronger the urge, the more likely you are to experience leaking.
Urge incontinence occurs in approximately half of all people with an Overactive Bladder.
Why does urge incontinence develop in some people?
For a refresher on how the bladder should function, check out my previous post on “The Happy Bladder”.
The bladder depends on the interaction of the Autonomic Nervous System along with the voluntary control of your pelvic floor muscles.
The “symphony” of the bladder relies on seamless interactions between these two systems.
There are multiple neurological loops that allow your bladder and brain to communicate.
The pelvic floor should already be in a semi-contracted state as your bladder is filling. This happens subconsciously.
This brain-bladder loop maintains continence by keeping pressure on the urethra without your awareness or effort.
If your pelvic floor is weak or lacking coordination or muscle tone, it may not have the closing pressure needed for continence to avoid leaking.
What causes unnecessary urges?
Pain in the pelvic floor can mimic bladder pain or feel like a UTI, leading to more frequent voiding.
In the absence of bacteria in testing for urinary tract infection, the culprit can often be trigger points (tightness) and pain in the pelvic floor musculature.
Trigger points can refer pain to in different parts of the body. In this case, your brain misinterprets the input and perceives that the pain is coming from the bladder rather than the muscles in the surrounding area.
You can feel these pains and mistakenly take them for urges, leading to frequent voiding despite the bladder not truly being full.
The truth is, most women I meet have been dealing with these issues for years.
They are embarrassed and often feel alone.
Their solution has been to “just to deal with it” and wear a pad to avoid embarrassing leaks.
There is a misconception in our culture that because you are a certain age, or had a child, that this is just a normal part of life.
That is absolutely not true!
So, what can you do about it?
One of the best ways to begin addressing issues with the bladder is to use a Bladder Diary.
This gives great insight into not only the physical aspects of how often and how much you are urinating but also some behaviors that may be contributing to your symptoms.
Your bladder is VERY responsive to routines and behaviors, and this also means that your bladder is responsive to re-training.
So what exactly does a bladder diary track?
- How often do you urinate?
- How much are you drinking?
- What are you drinking? (citrus, caffeine, carbonated beverages are all common bladder irritants that can make the bladder lining feel irritated and give you the feeling you need to void more often).
- How much total urine is voided?
- What is going on at the time of the leaking (cough, sneeze, urgency)
- What level of urge did you feel?
- Was it difficult or painful to void?
- Did any leaking occur, and if so, and how much?
Once you identify them, you can begin addressing “triggers” or the context in which the increased urgency and leaking occurs.
Here are some common examples of triggers:
- Pulling your car into your driveway
- Checking the mail
- Turning the key in the door when you get home
- Turning on the water for a shower
- Going every time before you leave the house (otherwise known as the “just in case” pee)
- And many more!
In these instances, you know, based on your diary, that you just recently went to the bathroom, and this cannot possibly be an “urgent” situation.
Your bladder is not full, and, physiologically, you can ignore the signals and wait.
However, your bladder is telling you a different story.
Since you have been voiding when your bladder is only slightly full, you have essentially trained your bladder to follow this unhealthy pattern.
The brain begins to associate voiding with specific activities, and, over time, these patterns begin to solidify and become habits.
Instead of slowly increasing intensity and urges, your bladder is YELLING at you all the time!
Are you ready for the good news?
You can “re-program” your body to learn to wait until your bladder is appropriately full and tell your bladder who is boss!
The next time you feel these strong urges, even though you know you recently went to the bathroom, try a few of these techniques:
- Do 10 quick pelvic floor contractions.
- Perform 20 calf raises.
- Do some type of mental math – basically, keep your brain occupied
- Take 10 slow, deep breaths allowing your belly to fully relax.
- Remind yourself of how your bladder works and that you recently used the bathroom. Give yourself confidence that you can wait.
To help decrease the response to triggers, practice “triggering” activity when you have no urge to void your bladder.
For example, put the key in the door multiple times a day.
Go into the bathroom and turn on the water and let it run for a few seconds.
Psychologically, you want to break the association your bladder has developed with these activities.
Is my diet the problem?
In regards to nutritional changes, there are certain foods and beverages that have a tendency to irritate the lining of the bladder.
Some of the “primary offenders” that decrease your urinary pH include citrus, caffeine, carbonation, coffee, tea, spicy food, and tomatoes.
Foods that are high in Arylalkylamines (avocado, lima beans, beer, and wine) may also cause bladder irritation.
Using a food journal can help us identify what may be contributing to your symptoms.
However, this is very individualized and we are all unique.
There is no such thing as a “bladder diet” that is best for everyone.
What about the pelvic floor?
You also may want to explore what role the pelvic floor may be playing in your increased urgency, pain, and leaking.
Pelvic Floor Therapists assess the whole body, and we are trained to assess factors such as movement limitations, breathing patterns, joint, and soft tissue mobility, as well as the integrity of the external and internal pelvic floor.
Impaired soft tissue mobility in the abdomen and pelvis can contribute to bladder symptoms and can increase tightness in the pelvic floor muscles.
So what should I expect from a pelvic floor therapist?
A pelvic floor assessment is a unique evaluation that is very different from what you have experienced with your Gynecologist.
Pelvic Floor Therapists are highly skilled and trained in understanding how to diagnose and treat pelvic floor dysfunction.
We can address weakness by teaching you how to correctly perform pelvic floor muscle contractions, and we can help decrease pain by helping tight and painful areas to elongate and relax.
We also incorporate tools such as biofeedback and corrective exercise into your treatment plan.
In order to be successful, you must improve your understanding and comfort with your body while reducing any shame or stigma associated with the pelvic floor and the symptoms you have been experiencing.
I find that many women have never even looked at their vulva, nor do they really have an understanding of their pelvic anatomy.
Techniques such as nervous system down training and breathwork, as well as a referral to counseling may also be part of your treatment plan in order to care for you as a whole person, not just a body part.
So maybe I can hold it a little longer?
Urge Incontinence is a multifactorial condition, and thus, so is the appropriate treatment.
Addressing issues within the pelvic floor as well as dietary changes, stress management, and behavioral modification are all important components of a successful treatment program.
Putting all these puzzle pieces together allows a pelvic floor therapist to develop a specific plan for you, getting to the root of your issues rather than just treating the symptoms.
It’s amazing how quickly you can begin to see improvement when you use the right approach and account for all of the contributing factors!