As if new moms and women who’ve gone through menopause don’t have enough to deal with, many of us are also living with a leaky bladder.
It wasn’t until one night when I was hanging out with a multi-generational room full of women that I realized just how common it is.
Several of the women, including some new moms, were sharing their most embarrassing moments of leaking while sneezing, jumping, laughing, coughing — even hiccuping!
I think for many of us, it was the first time we realized that we were far from alone.
In one study of women ages 20 to 80, 45 percent reported having some urinary incontinence (UI). Whether your leaks are related to pregnancy, childbirth, or menopause, they shouldn’t derail your life.
To help you get a handle on your leaky bladder, we asked a few experts to explain the most common types of bladder leaks, what causes it, and how you can get through the day without having to change your underwear.
There are several different types of bladder leaks. The two most common types of bladder leaks are stress incontinence and urge incontinence, according to Dr. Michael Ingber, a urologist who is board certified in female pelvic medicine and reconstructive surgery at The Center for Specialized Women’s Health.
Stress incontinence refers to leakage that happens from things like coughing, sneezing, laughing, or exercising. In other words, the leak is caused by some sort of abdominal straining or exertion.
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“This loss of support causes the urethra (the tube that the pee comes through) to be mobile, and when it moves during coughing, sneezing, exercising, or other activity, urine leaks out,” he says.
Urge incontinence is a bit different. “This occurs when women feel the desire to urinate, but before they can find a toilet, the urine leaks out,” says Ingber.
Mental aspects can also play a role in urge incontinence.
“We often hear from women that they leak urine when they see or hear running water, or when they put their house key in the door. They feel the urge to urinate, but before they can even turn the key, the urine is leaking,” explains Ingber.
Urge incontinence is also known as an overactive bladder. It’s common in women who are going through menopause, according to Dr. Kecia Gaither, MPH, FACOG, an OB-GYN and maternal fetal medicine expert.
This onset of incontinence may be due to a dramatic drop in estrogen levels women experience in menopause. The combination of this with aging in general can mean weakened bladder muscles.
Some women have both stress and urge incontinence at the same time, according to Dr. Jennifer Linehan, a urologist at the John Wayne Cancer Institute at Providence Saint John’s Health Center.
Many women will change their lifestyle to avoid the problem, says Linehan, which can be challenging if they love to exercise (stress incontinence) and enjoy traveling (urge incontinence).
Yes, dealing with UI can be an inconvenience. But the good news is that women have many options to deal with a leaky bladder.
At Ingber’s health center, they typically start with simple interventions.
“Sometimes, we find that people are drinking a liter or more of coffee during the day, or too much soda and the acidity and caffeine can negatively affect the bladder, so habits like cutting down on coffee can help,” he explains.
Lifestyle modifications that can help reduce leakage include:
- weight loss
- limiting caffeinated and alcoholic drinks
- smoking cessation
- constipation management
- scheduled bladder emptying
Pads and other urinary incontinence products for daily leaking
A simple yet effective way to manage a leaky bladder is to wear a protective pad or liner during the day.
There are specific pads available for bladder leakage, which are different than the ones you’d wear during menstruation. For example, Poise Ultra Thin pads have thin, protective layers that are made specifically to absorb urine.
You can also try an insertable product such as a pessary. This is a small, plastic device that you insert into your vagina to put pressure on the urethra. Pessaries aren’t common, but they’re low risk and low cost compared to surgery and medications.
Results are fairly immediate but these devices aren’t for everyone, specifically those with pelvic infection, vaginal ulcerations, allergy to product materials, or those who cannot commit to using them regularly.
Disposable inserts, which are like tampons, are another way to prevent leakage. Poise makes one called Impressa.
There are also reusable underpants that are similar to disposable pads, but you can wash and wear them multiple times.
Pelvic floor muscle training or therapy
Exercises that strengthen the pelvic floor, commonly known as Kegel exercises, can be extremely effective for both types of UI.
If Kegels aren’t enough, pelvic floor muscle rehabilitation programs are another common treatment option for women with incontinence.
One research review found that women with stress incontinence responded positively to pelvic floor muscle training (PFMT), with a decrease in leakage episodes. PFMT involves increasing pelvic floor muscle strength, endurance, power, and relaxation.
Typically, urology offices will have specially trained staff such as a pelvic floor physical therapist or nurse. These staff members can help teach women how to strengthen their pelvic floor and reduce incontinence.
When simpler solutions aren’t enough and incontinence is significantly impacting your everyday life, Ingber says you may want to try medication.
In general, prescription drugs are used to either increase the amount of urine your bladder can hold or help relax the bladder muscles. Ingber says there are eight or nine different medications available and more in development.
If you’ve tried changing your lifestyle and see no improvement, ask your doctor if there’s a medication they’d recommend for you.
Other medical options
When medications don’t work, Ingber says the next step is to explore additional medical options.
Surgical placement of a midurethral sling, which goes beneath the urethra to support it, is the gold standard for stress incontinence, according to Linehan.
In fact, the American College of Obstetricians and Gynecologists says the midurethral sling is the most common type of surgery to correct stress incontinence. This is typically an outpatient procedure with a fairly quick recovery time.
Treatment options for urge incontinence, says Linehan, include inserting a device that delivers nerve stimulation. These treatments work by delivering electrical impulses to nerves in the bladder to change how they respond.
Botox injections are another medical therapy for an overactive bladder or urge incontinence. According to the Food and Drug Administration (FDA), Botox is injected into the bladder muscle to help relax the bladder, which may increase its ability to store urine.
However, there may be serious side effects associated with this procedure, so make sure to talk to your doctor about the pros and cons of Botox injections.
Living with a leaky bladder can be a nuisance or a major disruption. But you don’t have to accept it and live with frequently wet underwear.
“Our general recommendation is that when it gets to the point where it affects your life, do something about it,” Ingber explains.
For example, if you have to use more than one pad during the day, or if you can’t sit through a 2-hour movie without missing part of it, Ingber says to talk to your doctor.
From simple lifestyle changes, to devices and pads, to prescription medication, you can find a solution that works for you.