Urinary incontinence is an involuntary loss of urine or the leakage of urine that cannot be controlled. Although as many as 50% of women are believed to suffer from incontinence, many never seek treatment due to embarrassment.
The good news is, that you don’t have to live with urinary incontinence, nor is surgery usually required to treat it. Read on to learn more about urinary incontinence, including what causes it, and what you can do to treat it.
Cause of Urinary Incontinence (Urine Leaks)
Although factors like childbirth, diet, weight gain, smoking, and lack of exercise can contribute to incontinence, the most common cause at the root of urine leaks is weak or poorly coordinated pelvic floor muscles. In some cases the muscles of the pelvic floor can also be too tight, and the lack of mobility around the urethra can lead to leaks.
Another common cause of urinary incontinence is overactive bladder muscles, which is normally the result of nerve damage, abdominal trauma, pelvic injury, or surgery.
How Do Pelvic Floor Muscles Weaken?
The pelvic floor muscles essentially act like a supportive hammock for the pelvic organs. Stretching front to back from the pubic bone to the tailbone and side to side from sit bone to sit bone, they not only support the bladder, rectum, and uterus but also enable them to function correctly.
It is well-documented that the pelvic floor muscles can become overstretched or weakened during pregnancy and childbirth. However, weight gain, bad posture, pelvic injuries, weak abdominal muscles, and ongoing constipation can also weaken the pelvic floor. Low levels of estrogen during menopause can also weaken the pelvic floor muscles.
How Urination Normally Occurs
The brain, bladder, pelvic muscles, sphincter muscles, and urethra normally work together to perform the act of urination. When one or more of these is not functioning correctly, incontinence can occur.
Normally, the bladder, which is supported by the pelvic muscles, stores urine until it is full. At the same time, the sphincter muscles are typically closed around the urethra, which is the tube that excretes urine from the body. When the bladder is ready to empty, the brain sends a signal for the bladder and pelvic muscles to contract, while the sphincter muscles open so that the urine can exit via the urethra.
How Do Pelvic Floor Muscles Weaken?
The pelvic floor muscles essentially act like a supportive hammock for the pelvic organs. Stretching front to back from the pubic bone to the tailbone and side to side from sit bone to sit bone, they not only support the bladder, rectum, and uterus but also enable them to function correctly.
It is well-documented that the pelvic floor muscles can become overstretched or weakened during pregnancy and childbirth. However, weight gain, bad posture, pelvic injuries, weak abdominal muscles, and ongoing constipation can also weaken the pelvic floor. Low levels of estrogen during menopause can also weaken the pelvic floor muscles.
Types of Incontinence
According to the American Urology Association, there are four types of urinary incontinence, with stress incontinence being the most common. Understanding which type you have will help you to seek the proper treatment and start enjoying life again.
Stress Incontinence
Stress urinary incontinence is diagnosed when urine leaks occur due to extra pressure on the bladder. Urine leaks of this nature are generally linked to weak pelvic floor muscles, typically caused by pregnancy, childbirth, pelvic injuries, or obesity. However, it’s normally the extra pressure on the bladder from coughing, laughing, exercising, jumping, or lifting heavy objects, that triggers the urine leak.
The main symptom of stress incontinence is leaking urine when you are physically active, sneezing, laughing, or coughing.
Overactive Bladder (OAB)
Also known as urgency incontinence, urine leaks associated with overactive bladder occur due to overactive bladder muscles or because the brain is instructing the bladder to empty when it is not full. Women with OAB usually need to urinate frequently, even during the night.
This type of incontinence can be caused by a bladder infection, pelvic injury, nerve damage to bladder muscles, or a neurological disorder that results in a miscommunication between the brain and the bladder.
The main symptom of OAB is a sudden need to pee that you can’t control. Depending on how far away you are from a bathroom, this sudden urge can cause urine leaks.
Mixed Incontinence
Mixed Incontinence is when more than one type of incontinence is occurring. It usually means a combination of stress incontinence and OAB.
Mixed incontinence typically includes symptoms of needing to pee urgently as well as urine leaks when physically active, sneezing, or coughing.
Overflow Incontinence
Overflow incontinence is diagnosed when the body is making more urine than the bladder can hold, or when the bladder fails to completely empty during urination. Although rare in women, it is known to occur.
The main symptoms of overflow incontinence include a constant dribble of urine during the day and night, or frequent peeing in small amounts.
Read: How Kegels Help Women With Bladder Leakage
How to Treat Urinary Incontinence
Because the pelvic floor, abdominal, and glute muscles are all vital for bladder control, one of the best places to start treatment for urinary incontinence is with a pelvic floor physical therapist.
After evaluating your condition and symptoms, a pelvic physical therapist will understand the type of incontinence you have and what muscles require strengthening or relaxing, to cure it.
Incontinence treatment with a physical therapist generally takes as little as three months and for continued results, they usually prescribe exercises that can be practiced at home.
By committing to regular physical therapy sessions and habitually practicing the prescribed exercises at home, bladder control improves, the urge to pee lessens, and urine leakages normally cease.
Because the abdominal muscles and glutes support the pelvic muscles, physical therapists will often instruct women with incontinence on how to strengthen these. Posture-correcting exercises may also be included to get all muscle groups working together for improved pelvic support.
And one specific exercise that may be recommended by physical therapists for urinary incontinence, is a Kegel.
Treating Incontinence With Kegels & Kegel Weight Training
Kegels are a type of exercise that involves contracting and relaxing the pelvic floor muscles to strengthen them. Performed by intentionally squeezing, lifting, and holding the pelvic floor muscles in repetitive intervals, Kegels are most commonly practiced re-train weak pelvic muscles after childbirth, pregnancy, menopause, or a pelvic injury.
That said, physical therapists have often found that women frequently perform Kegels incorrectly, or they don’t do the right amount- sometimes doing too many, sometimes too few to address their unique issues.
To help those with weakened pelvic floor muscles, physical therapists recommend Kegel Weight training. Designed to be easily inserted and held in place by contracting the pelvic floor muscles, Kegel weight training can be done while you get on with your household chores.
For best results, a set of ascending Kegel Weights is considered the most effective. And according to the FDA, Kegel Weights made with medical-grade silicone, like these by Intimate Rose, are the most body-safe. Check with your physical therapist to determine which size Kegel Weight is right for you to start with, and for how long you should hold it in place per day.
Diet, Weight & Hormones
Weight gain and obesity are also important factors to consider when treating urinary incontinence. If either is an issue, consider upping your exercise, improving your diet by eating more whole foods and less processed foods, as well as drinking more water instead of sugary or caffeinated drinks.
Another factor that can influence the onset of urinary incontinence is hormonal fluctuations during menopause. The drop in estrogen during menopause can cause the pelvic floor muscles to weaken and result in a loss of elasticity in the vaginal walls and urethra - each of which can contribute to urine leaks.
To treat the drop in estrogen during menopause without the risks associated with HRT, female health experts recommend a natural supplement called Chasteberry, which mimics the effects of estrogen in the body.
Additional Questions
Is Leaking Urine Just Part of Getting Older?
Many women with urinary incontinence believe it’s a part of getting older, but that is far from the truth. While it’s true that leaking urine is more common as women age, factors like childbirth, weight gain, abdominal strength, posture, smoking, muscle control, and overall fitness also play a role in urinary incontinence.
Urinary incontinence is not just a medical condition either. For many women, it becomes emotionally, psychologically, and socially challenging too, as they internalize the problem and suffer in silence.
Is a Frequent Urge to Pee the Same as Incontinence?
No. Although it might seem like the same thing, these conditions are different. Urinary incontinence is an uncontrolled leakage of urine. Whereas a frequent urge to pee may mean you use the toilet more but it doesn’t necessarily result in leakage.
The two occurrences are also caused by different factors. Urinary incontinence, for instance, is typically caused by pelvic floor muscle dysfunction. Whereas a frequent urge to pee is typically due to an overactive bladder, poor nutrition and drinking habits, learned behaviors, or underlying infection like a urinary tract infection. That said, a frequent urge to pee could also be caused by drinking too much caffeine or alcohol.
If you’re feeling the urge to pee more often than usual, but are not experiencing urine leakage, consider your beverage intake and speak with your doctor about testing for an underlying infection.
Conclusion
When uncontrolled urine leaks or incontinence are preventing you from living your best life, you don’t have to accept it as part of aging. Although absorbent products, medication, and surgery are often recommended to treat urinary incontinence, pelvic floor physical therapy and Kegel Weight training are proving to be successful treatment options.
References
American Urology Association - What Is Urinary Incontinence - https://www.urologyhealth.org/urology-a-z/u/urinary-incontinence
National Association For Continence - What Is An Overactive Bladder - https://nafc.org/overactive-bladder/
Web MD – Menopause & Bladder Control Management - https://www.webmd.com/urinary-incontinence-oab/womens-guide/bladder-control-menopause#1
Physiotherapy Journal – Is Pelvic Floor Muscle Training Effective for Symptoms of Overactive Bladder Symptoms in Women - https://www.physiotherapyjournal.com/article/S0031-9406(18)30289-X/fulltext
Intimate Rose – Pelvic Floor Exercises - https://www.intimaterose.com/blogs/kegel-exercise/pelvic-floor-exercises
Medline Plus – Kegel Exercises - https://medlineplus.gov/ency/patientinstructions/000141.htm
Pelvic Floor First – Is Posture Important for Incontinence? https://www.pelvicfloorfirst.org.au/news/647/is-posture-important-for-continence/