Bladder & Pelvic Health
Millions of women are dealing with a secret that they may be too embarrassed to bring up with friends, family, or even their doctor – bladder leakage. What you may not realize is that this leakage is a real medical condition known as urinary incontinence – and it affects nearly 1 in 4 women. If you’ve ever experienced leakage when you exercise or have difficulty making it to the bathroom, you may be suffering from incontinence.
In this edition of Candid Consult, Dr. Tess Crouss, a urogynecologist with Axia Women’s Health – Center for Urogynecology and Pelvic Health, explains the different types of urinary incontinence, the most common causes, and the variety of treatment options available.
Bladder leakage, or incontinence as it’s more formally known, can come in several forms. Some of the most common forms of incontinence include stress urinary incontinence, or leakage triggered by activity such as exercise/cough/laugh/sneeze, and urge urinary incontinence, a strong urge to urinate and inability to make it to the bathroom. Many women I treat will experience a mixture of both, known as mixed urinary incontinence.
Stress urinary incontinence is often caused by a weakening of the muscles and ligaments that support the bladder and the urethra. This is common after childbirth and as we age. Urge urinary incontinence is part of the overall syndrome of overactive bladder, which is also common with older age and may be related to other underlying health conditions like diabetes or obesity.
It’s common for women to develop incontinence after childbirth and as they age after menopause.
During childbirth, the muscles can become weakened and injured. In particular, experiencing an operative vaginal delivery like a vacuum or forceps assisted delivery, can lead to muscle damage. This weakening can make it harder to contract the urethra and stop the flow of urine.
With menopause, it’s common for women to experience vaginal atrophy, or a thinning and weakening of the vaginal tissue, due to fluctuating hormone levels. A drop in estrogen can cause a shortening of the vaginal canal, a shortening of the urethra, and a weakening of the pelvic floor muscles, making loss of bladder control more common.
Most of the time, we can diagnose incontinence by evaluating a woman’s health history and recording her symptoms. We can typically provide treatment without needing extensive testing. However, if patients are unsure about what they’re experiencing, there are several different tests we can do both in the office and at home.
To test for stress urinary incontinence, we can perform an in-office test where you cough or do an exercise like jumping to see if this triggers leakage. We can also perform a pad test at home where you take a pill that will turn your urine a greenish-blue color. This helps distinguish between urine leakage or vaginal discharge.
It’s also important that we rule out other things like a urinary tract infection or other type of bacterial infection. When in doubt, we encourage women to come in to see us so we can provide a full evaluation.
The first thing I like to focus on is education. It’s important to me that my patients understand what is normal when it comes to bladder function, and to help them become more aware of their bodies. From there, we’ll take a stepwise approach that’s tailored to their goals and their specific type of incontinence.
Pelvic floor physical therapy is a first line of treatment for both stress and urge urinary incontinence. Pelvic floor physical therapy combines breathwork, muscle coordination, and functional exercises to help retrain the muscles to work properly.
For stress urinary incontinence, if additional interventions are needed, we can offer a variety of over the counter (OTC) or surgical options. OTC options include things like a silicone incontinence pessary that helps provide a backbone to support the urethra. There are also OTC inserts that can help with stress urinary incontinence. Surgical options include the insertion of surgical mesh to provide support or urethral bulking, where a substance (such as collagen) is injected to build up the wall of the urethra so that it seals more tightly.
For urge urinary incontinence, after education, we offer a range of conservative and procedural options depending on the severity of incontinence and what a patient has tried in the past. Behavioral training is a method of retraining the bladder to void at more manageable intervals. Kegel exercise training to help prevent incontinence is another conservative treatment method. Many patients will prefer more of an individualized and hands on approach to pelvic floor muscle training, which is offered through pelvic floor physical therapy. If these initial methods don’t work, or if a patient prefers to start with other treatment methods, we can prescribe medications that relax the bladder wall and make it easier to make it to the restroom. There’s also a host of surgical/procedural options from Botox to help relax the muscles to other advanced technologies like sacral neuromodulation or percutaneous tibial nerve stimulation to help control bladder function.
While you can’t necessarily prevent incontinence, you can start incorporating Kegel exercises before and after childbirth, which can help to strengthen your pelvic floor muscles. It’s also recommended to make lifestyle changes like avoiding bladder irritants such as coffee, carbonated drinks, spicy foods, and artificial sweeteners. Additionally, avoiding excess weight gain and the development of diabetes helps to decrease a patient’s risk for incontinence.
If you’re postpartum, I would suggest discussing your concerns with your OB/GYN at your 6-week checkup. If you’re experiencing bladder leakage at any other stage of your life, it never hurts to contact your OB/GYN right away to get it checked out, especially since it could be a sign of a urinary tract or vaginal infection.
While bladder leakage is common, it doesn’t mean you have to suffer in silence. You don’t have to go through life trying to conceal your symptoms by using pads or wearing dark clothing to disguise signs of leakage. Talk to your Axia Women’s Health provider to learn more about treatment options, so you can get the condition under control and get back to enjoying life!
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