- Stress incontinence occurs when some urine leaks during sudden exertion. This might involve coughing, bending, lifting, exercising, or stepping on uneven surfaces.
- Urge incontinence is when you have a sudden, strong urge to go — even if you’ve recently passed urine. This can lead to accidents if you don’t have a bathroom nearby.
- Overflow incontinence leads to constant or regular urine leaks when your bladder doesn’t empty all the way.
- Functional incontinence means you have another health problem that prevents you from getting to the bathroom in time, like impaired mobility.
- Mixed urinary continence can also occur, which means you have more than one type of incontinence.
But according to Leslie Rickey, MD, MPH, an associate professor of urology and obstetrics-gynecology at the Yale School of Medicine in New Haven, Connecticut, it doesn’t have to be this way. “Women have a lot of options for how to deal with urinary incontinence,” she says. Learn about five of the most common mistakes women make when dealing with a leaky bladder — plus, how to avoid them.
1. You Think a Leaky Bladder Is a Normal Part of Aging
Many women who come to the office of pelvic floor physical therapist Abigail Abbott, MSPT, who has a private practice in San Miguel de Allende, Mexico, have endured UI for years, thinking it’s normal.
“If you have to regularly wear a panty liner or pad, that’s not normal, and you shouldn’t just accept it,” Abbott says.
2. You’re Embarrassed to Bring It Up With Doctors or Friends
Most often, your primary care doctor will refer you to a pelvic floor physical therapist or a urogynecologist (a specialist in urology and gynecology). “There are a growing number of specialists like me, and this is what they do, day in and day out,” Rickey explains.
Don’t shy away from discussing the topic with female friends or relatives, Abbott says. If you do share your symptoms, you’ll likely get a knowing nod. “People don’t talk about it enough,” Abbott says. She also questions why talking about urine leaks should be any different than discussing a headache or shoulder pain.
3. You Think the Problem Is Loose Muscles When You’re Actually Too Tense
While the loss of estrogen in middle-aged women can lead to loose muscle tissue, Abbott explains that the problem is often the opposite: Your pelvic muscles are too tight.
She attributes this, at least in part, to socialization (such as women always sitting with their legs closed) and unprocessed emotions (especially a collective history of marginalization). This can cause the pelvic muscles to shorten and tighten, much like your hand muscles would if you clenched your fist all day.
4. You Know to Do Kegels, But You Do Them Wrong
Most people have heard of Kegel exercises, subtle exercises for the pelvic floor. “But almost everyone does them incorrectly,” Abbott says. The most common mistake: pushing the muscles out, as if you’re sitting on the toilet, rather than pulling everything up and in.
Abbott tells clients to imagine they’re squatting over a box of tissues and trying to pull one out of the box with the vagina. Other pelvic floor therapists use the image of sucking up a blueberry.
Pay attention to your breath while doing Kegels, Abbott advises, keeping it long and slow to keep the area relaxed.
Women often think they should do Kegels forever, but Abbott says this is not the case. These exercises should take place early in the treatment phase for leaky bladder, while you also build up the surrounding muscles of the abdominals, hips, and back. “Once those muscles are stronger, you don’t have to continue with Kegels, because pelvic floor muscles unconsciously know what to do,” she says.
5. You Fear Surgery Will Be the Only Solution
Lifestyle changes and nonsurgical medical interventions are often very effective at managing leaky bladder, Rickey says. She reassures patients that “there’s no reason for anyone to be suffering with this because they fear needing surgery.”
Rickey advises starting by finding a physical therapist (PT) who specializes in the pelvic floor or by talking to a urogynecologist.
Pelvic floor PTs are trained to evaluate the problem, educate the client about what’s going on, and provide exercises and breathing techniques to strengthen the pelvic floor and surrounding muscles.
Doctors may also apply electrodes to the vagina or rectum to stimulate the pelvic floor muscles. This might require several treatments across a course lasting months.
Another effective treatment is Botox injected into the bladder, says Jian Jenny Tang, MD, an obstetrician-gynecologist at Mount Sinai Hospital in New York.
Extreme cases of incontinence may eventually require surgery, although advances in surgical repair mean most procedures are minimally invasive now, Rickey notes.
However, the sling is for stress incontinence, and nerve stimulation is for urge incontinence — so they may not be suitable for the type you have. “When people come to me, we discuss all the options and weigh the risks and benefits. Then they choose what is right for them,” Rickey says.
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