You & Your Pelvic Floor: Let's Talk About Urinary Incontinence
November 25, 2020
Urinary incontinence is a classic example of cognitive dissonance. 54% of women have experienced unexpected leakage while running, laughing, sneezing or coughing. And yet, 79% of the women from that SAME study say that they have never experienced urinary incontinence. (And unfortunately, it is disproportionately a women's health problem, with the prevalence considerably higher in women than in men).
There are a few reasons for this. One is simply a lack of awareness about what exactly urinary incontinence is (technically it is any unintentional flow of urine or loss of bladder control). But it’s surprising that awareness is so limited, considering that if you have this kind of problem you are definitely not alone. The National Association of Incontinence reports that over 33 million people in the United States suffer from some type of urinary incontinence or bladder condition.
The other problem is probably related to cultural and societal perceptions of both the phrase “urinary incontinence” and the symptoms. It is generally considered to be something embarrassing, and discussing it is often treated as a taboo that people are unwilling to break. And we get it. But this reluctance to face up to incontinence and engage with it constructively is so strong that it can have a huge (and unnecessary!) quality of life impact on people who experience it. Because while incontinence is a common problem, it should not be considered inevitable, or a normal part of aging/being postpartum/menopause/any other life stage.
Urinary incontinence by the numbers
Here are some interesting stats from The National Association of Continence’s survey of 1,100 people living with incontinence:
- 80% of respondents deal with incontinence either every day or 3 to 5 times per week.
- 90% of patients report feeling either isolated, depressed, or hopeless as a result of their condition.
- 27% of respondents have not spoken with their doctor about their incontinence symptoms, and 50% are uncomfortable talking with close friends or family members about it.
Causes and types of urinary incontinenceBladder control problems can manifest themselves in multiple ways. Some of the common scenarios are:
- Overactive bladder (OAB): feeling the sudden / frequent / strong urge to urinate, even if you just emptied your bladder.
- Urinary retention: difficulty starting to pee. Also often associated with a weak flow once you do start, a frequent need to pee, and bladder leakage (since generally in this case the bladder is not emptying properly when you go).
- Stress urinary incontinence (SUI): loss of urine caused by weak pelvic floor muscles or a deficient urethral sphincter during any body movement that puts intra-abdominal pressure on the bladder (coughing, sneezing, running, jumping, etc).
- Mixed incontinence: a combination of stress and urge (OAB) incontinence
- Multiple types of incontinence can increase the risk of secondary bladder health problems such as urinary tract infections
Meanwhile, the list of potential causes is considerably longer and more varied than the list of types of urinary incontinence. It ranges from pelvic floor muscle weakness to nerve damage and far beyond, so it’s important not to see incontinence as a one-size-fits-all problem.
Effects of urinary incontinence
Urinary incontinence is a huge deal in terms of quality of life and overall health and wellness.
First of all, there are direct / physical impacts. For instance, many people who struggle with bladder control issues avoid any activities where constant bathroom access is not available. Think hiking, restaurants, many types of travel, etc. Likewise, people frequently cut certain activities out of their life that can trigger leakage -- exercise, like running or sports, is a great example, since the impact when the foot hits the ground while running or jumping is a common cause of stress incontinence. This is a double whammy, as it both robs them of something they enjoy and also of the health or other benefits of those activities.
Second of all, there are indirect / psychological impacts. Building on the above regarding avoiding activities where bathroom access is not available, often people will avoid activities even when bathrooms are available if they are too visible and the people fear feeling embarrassed if they are seen using them too frequently. And the finding in the survey referenced above (90% of sufferers feeling isolated, depressed, or hopeless as a result of their urination challenges) is stark and quite disheartening. If even a sneeze can cause you anxiety, it's easy to see how the psychological effects could be a real problem.
These issues are exacerbated by the embarrassment and taboo around urinary incontinence, since it means that sufferers frequently feel like they have to deal with things alone and can’t talk to either friends/family or even their doctor. And the ripple effects reach beyond just urinary or pelvic health. A 2005 study found that incontinence sufferers have worse self-perceived health overall than people in the same age range but without urinary incontinence.
A look at incontinence support forums reinforces the magnitude of the quality of life impact:
- “Socially, it definitely does impact me in what I do and where I go… I have to say yes [that it has affected my self-esteem]. Not being able to manage your own body functions can be so frustrating.”
- “I guess for me, the emotional effects of incontinence is something that causes me great difficulty.”
How to manage urinary incontinence
This all sounds kind of depressing. But there is good news too! We mentioned it at the beginning of the article but it bears repeating: urinary incontinence is common, but it is NOT inevitable and should not be seen as normal, regardless of your age. You do not have to “accept it” or “just deal with it”, and you don’t have to try to only manage the symptoms (e.g. by using pads) -- there are usually steps you can take to address the root causes.
Having said that, dealing with urinary incontinence if it’s being caused by something like nerve damage is very different from dealing with it if it is caused by pelvic floor muscle weakness, and there is no one-size-fits-all solution. It should probably go without saying, but the first thing you should do is talk to an expert -- your GP can provide a referral to a pelvic floor physical therapist, or a urologist, or you can see one directly. But talking to the pros is the gold standard in terms of finding the right course of care for each person, whether that’s physical therapy, lifestyle changes or other treatment options.
In parallel, there are also a number of best-practice tips that may be worth considering. Those could include:
- Do some pelvic floor exercise (if your muscles are too weak). Your pelvic floor muscles make up a kind of hammock at the base of your pelvis and are responsible for preventing urine leakage out of your bladder and urethra. When they’re weak it can lead to incontinence. Kegel exercises and other pelvic floor therapy are not a one-size-fits-all solution for pelvic dysfunction, but they do have their place.
- Get some rest! Research has found that sleeping poorly or too little is associated with more severe urinary incontinence (Ge 2017).
- Be thoughtful about your diet. Some of your choices can either help or exacerbate problems with incontinence and related pelvic dysfunction.
- Practice your breathing. Diaphragmatic breathing can help keep your pelvic floor in tip top shape (and has benefits beyond your pelvic health too).
- Check your posture. Whether standing or sitting, your posture can impact your pelvic floor fitness, for better or for worse.