Living with Urinary Incontinence
Urinary incontinence affects 200 million people worldwide. People who develop incontinence experience urine leakage, lack of bladder control, and the frequent urge to urinate. It mainly affects older, pregnant, or postpartum women. Although many women choose to live with the discomfort, urinary incontinence can be reversed by improving one's lifestyle and incorporating regular pelvic muscle exercises.
Urinary incontinence brings discomfort to many women. Since there's a stigma attached to it, some women choose to live with the condition without receiving appropriate treatment. However, with the right diet, lifestyle changes, and exercise routine, you can eradicate most of the uncomfortable symptoms and improve your life.
What is urinary incontinence?
Urinary incontinence causes a lack of bladder control and urine leaks. Incontinence isn't a disease, but a condition that develops due to reproductive events, lifestyle changes, and health issues. The condition affects women to a greater extent than men, mainly because of pregnancy, childbirth, and hormonal changes during menopause.
If you suffer from urinary incontinence, you might feel the urge to urinate or release some urine while laughing, sneezing, coughing. Leaks occur when the bladder muscles suddenly tighten and the sphincter muscles are not strong enough to close the urethra.
According to the National Association for Incontinence, 25 million adult Americans suffer from incontinence, 75–80% of which are women. Although age is one of the leading indicators for incontinence (affecting 40% of women from age 60 to 79, and 50% of women older than 80 years old), many women experience urinary leaks regardless of age.
How does urinary incontinence develop?
In general, women are more susceptible to developing urinary problems because of female hormones and reproductive events such as pregnancy, childbirth, and menopause. Changes in hormones, certain sports, and lifestyle habits can also alter the pelvic floor muscles, urethra, and bladder, making it challenging to control urine release.
Urinary incontinence falls into two categories:
- Stress incontinence. It happens when pressure is applied to pelvic floor muscles or bladder. Chances of stress leakages increase during pregnancy, after giving birth, or because of strenuous physical activity, obesity, chronic coughing. Stress-induced urine leaks are more common among younger patients, especially pregnant and postpartum women.
- Urge incontinence. This type causes a woman to feel an urging need to urinate and might lead to uncontrollable leaks. Bladder spasms can be a result of an infection or nervous system disease.
Treatment methods
One thing to remember is that urinary incontinence isn’t a natural part of being a woman or something that you have to accept as a sign of aging. There are many approaches to consider that can reverse the symptoms and strengthen your pelvic floor.
Training your bladder
Set a urination schedule to train your bladder. Your body should eventually get used to releasing urine at specific times throughout the day. The recommended frequency for toilet breaks between other daily activities is approximately once every 2 hours. When the time comes, take a toilet break and try to urinate even though you might not feel like it. The goal is to gradually extend the interval, adding a few minutes before your next toilet break to gently strengthen your bladder control. Eventually, you should feel less pressure to urinate frequently and less concern that you may leak urine between breaks.
You can also train your bladder by controlling the urge to urinate. Often, the need to pee is psychological, therefore, mindfulness techniques can help you delay toilet breaks. For instance, some people feel triggered to go to a toilet after lying down in bed or before leaving home. This doesn’t mean that your bladder is full—it’s a bodily response to the association between an action (such as leaving the house) and urination. Some of these associations were likely formed in childhood, as parents will often establish a routine that helps them avoid having to find a bathroom for their child during a shopping trip, for example. Occupying your mind with unrelated thoughts can help ease the urge.
Pelvic exercises
Exercises for the pelvic muscles or pelvic floor can help reverse incontinence and improve sexual function. More on that below.
Medication
Certain medications have been found helpful for gaining control of urine release:
- Topical oestrogen is used to rejuvenate deteriorating vaginal and urinary tract tissues, providing temporary relief from incontinence, especially in menopausal women.
- Anticholinergics are used to block the neurotransmitter acetylcholine from signalling to the brain that it’s time to pee again—it is used to treat an overactive bladder in particular.
- Imipramine is an antidepressant that also causes the bladder to relax while making the smooth muscles and bladder neck to contract, thus preventing leaks. However, imipramine causes drowsiness, so it’s generally administered in the evening for those suffering from mixed (stress & urge) incontinence.
- Botulinum toxin type A (botox) can be injected into the bladder muscle to resolve overactive bladder complaints, but this is generally tried if other medications are unsuccessful.
Medical devices
Sometimes a mechanical device can provide a solution:
- A urethral insert is a small, disposable, tampon-like device that is inserted into the urethra before a demanding activity, such as playing tennis, to prevent leaks. It is removed before urination.
- A pessary works in a similar fashion but is designed for women with uterine prolapse—it is a stiff ring that can be worn all day to keep the bladder from pressing down on the urethra.
- Electrical nerve stimulators of various kinds have been used to treat both stress and urge incontinence by sending a mild electrical current to the nerves involved in urination or to the bladder, however the results from electrical stimulation seem similar to results obtained through non-invasive exercise.
Surgery
If none of the other available treatments have given results, surgery is an option. One procedure involves inserting a mesh under the neck of the bladder to relieve pressure on the urethra and stop urine from leaking out. Another procedure involves surgically lifting the neck of the bladder. And a third option is to insert an artificial sphincter that regulates urine flow from the bladder to the urethra.
Many women reverse incontinence without surgery or medication by strengthening their pelvic floor muscles and adopting positive lifestyle changes. The simplest and often most effective way of improving your pelvic health is through small lifestyle adaptations and a little exercise.
How can I strengthen my pelvic floor muscles?
Before you begin training your pelvic muscles, consider your existing routine physical activities. Some of the most stressful sports for the pelvic area are heavy lifting, trampoline jumping, running, ab exercises, and Zumba dancing. These physical activities put a lot of pressure on pelvic muscles, which actually loosens them in the long run. To strengthen your pelvic floor, create a training routine that doesn't put excessive pressure on your pelvic muscles.
Studies show that training pelvic muscles helps eliminate urinary incontinence, uterine prolapse, and leakage. It can also improve your experience of pregnancy, ease childbirth, and boost sexual satisfaction.
Pelvic floor exercises are also known as Kegel exercises. You can do them anywhere as they don’t require special preparation. The first step is to identify the muscles you want to train. A common hurdle for people who are new to Kegels is finding the right muscles! The ones you want are the ones you use when holding back a fart or stopping pee mid-stream. These are the muscles that surround the urethra and anus.
While they can be done in any position, it may be easiest to start lying down. Tighten/contract your pelvic muscles and hold for three seconds. Then let your muscles relax for three seconds. Some women find it helpful to imagine sitting on a marble and then tighten their muscles as if lifting the marble up and into the vagina. For best results, tighten the pelvic muscles only, while keeping the abdomen, buttocks, and thighs relaxed. Remember to breathe. Repeat the set 10 or more times each day. Usually, women see results in 4 to 6 weeks after starting a Kegel exercise routine.
There are also a number of Kegel training devices on the market—from Kegel weights to insertable electrical stimulators. If you have questions, talk to your doctor or gynaecologist about the options best suited for you.
Helpful lifestyle changes
A healthy diet
A well-balanced diet is crucial in keeping your pelvic floor strong and reducing incontinence symptoms. Vitamin D-rich foods are known to improve muscle tissue and immune system. Foods such as fatty fish, avocados, oysters, egg yolks can strengthen the pelvic floor and boost your sexual function. In cases where a person is overweight, urinary incontinence may be worse due to the extra weight on their pelvic area, bladder, and urethra—losing the extra weight can markedly improve symptoms.
An incontinence-friendly diet has a limited amount of spicy and acidic foods as they irritate the bladder. You might also choose to avoid diuretic beverages such as alcohol, caffeine, and strong teas as they trigger the urge to urinate. Although hydration is crucial in regulating your bodily functions, it's recommended to limit your water intake to 1.5 litres a day. Remember to increase your fluid intake when engaging in heavy physical activity.
Going smoke-free
Smoking has many adverse side effects on health, including making incontinence worse. Toxins found in cigarettes disrupt blood and oxygen circulation, limiting oxygen transfer to your muscles, which can contribute to weakening the pelvic floor. Many smokers develop a chronic cough, which puts a lot of pressure on the pelvic muscles and bladder.
Treating constipation
Forced bowel movements put stress on pelvic muscles, worsening leakages. Since constipation is often temporary, you can avoid it by eating fibre-rich foods such as vegetables, fruits, legumes, and seeds.
Urinary incontinence affects many women, regardless of age, but too many suffer in silence. If you experience urine leakages, a lack of bladder control, or an all too frequent urge to pee, check in with your doctor. No one should have to live with urinary incontinence, and the symptoms can often be reversed by treating your body like the temple it is.
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