Evelyn Lyles, MD
Michelle LeBlanc, MD
James Theofrastous, MD
Nancy Howden, MD
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Evelyn Lyles, MD Michelle LeBlanc, MD James Theofrastous, MD Nancy Howden, MD
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Bladder Control Problems Bladder control problems can disrupt every aspect of your life. While many women feel that few other women have their problem, it is thought that over 13 million women in the United States experience loss of urine. While urine control problems most often start in a woman's 40's or 50's, it does 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. This is a major quality of life issue for millions of women in the US. Most 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 things for you, often without surgery. Many doctors do not ask about bladder control problems because they are also not aware that they can be treated. 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, eliminating the use of sanitary pads, or traveling. Our goal for your treatment is for you 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!); but jumping on a trampoline or strenuous weight lifting with a full bladder without leakage is probably not a realistic goal. 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. Depending on what is causing your leakage, treatment options can include exercises, 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. Types of Leakage Problems The medical term for bladder 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 is usually due to a problem with the opening of the bladder (the urethra) losing support & "dropping" into the vagina. This problem is usually caused by a combination of childbirth injury, genetics, & time. It is common for women to develop this problem 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. This diagram shows normal pelvic support from the side:
When the uretrha drops down when you cough or strain, more pressure is exerted on your bladder than the opening of your bladder. With enough urine in your bladder, & with enough force, this will result in urine leakage, typically a spurt. It is similar to squeezing a balloon full of fluid without squeezing the opening enough to prevent fluid from coming out. This is demonstrated in this diagram which shows loss of support of the opening of the bladder & leakage with straining:
Treatment for this type of leakage usually starts with pelvic muscle exercises, also called "Kegel" exercises. These exercises are simple & can improve your bladder control. If the exercises do not work, surgery may be an option. For more information about pelvic muscle exercises click here. For more information about surgery for bladder control click here.
Overactive Bladder is the other major type of leakage problem, & is due to the bladder having spasms. No one knows what causes this problem, but it is common & men can get it to. It is rare in younger women & becomes more common with age. In this condition, the bladder is normally sized, but it acts like it is a lot smaller. Normal bladder capacity is around 15 ounces; but women with overactive bladder may only be able to hold as little as 2 or 3 ounces before having a strong urge to urinate. In this condition you get the sensation that your bladder has to go when it really is not that full, so you end up going more often. Once your bladder has a spasm you have reached "the point of no return," & it is difficult to stop the leakage of often large volumes of urine as the bladder empties. Night time can be a particular problem because fluid collects in our legs during the day, & when we go to bed & elevate our legs the fluid goes into our circulation & right to the bladder. This can cause leakage at night, having to get up several times at night to empty, or severe urgency & leakage when arising in the morning. The symptoms of Overactive Bladder include having to empty your bladder or "void" frequently (less than 2 hours between voids), feeling like you have to go all the time ("urgency"), having to get up more than once overnight to void, & having a strong urge to void & not making it to the bathroom in time ("urge incontinence") . The treatment of Overactive Bladder consists of teaching your bladder to hold more urine without having spasms. This usually consists of a combination of medications which decrease spasms & performing bladder training. For more information about bladder training click here.
Click here for more information about bladder testing to determine what type of problem you may have.
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