Bladder Leaks Aren't A Normal Part of Aging

You may think leaking a bit of urine when you laugh, cough or sneeze or feeling like you have to pee all the time, is part of the aging process. Many women even believe it's just one of many unpleasant consequences of childbirth. And although urinary incontinence plagues many women, bladder leaks aren't something you have to endure.

Regaining full bladder control and stopping a leaky bladder is possible, and you can often do it without medication, says Therese Eutsler, a Franciscan Health  a physical therapist who specializes in pelvic floor issues  at Franciscan Health in Lafayette, Indiana.

Instead of seeking treatment for a leaky bladder, many women try to deal with bladder dripping on their own by changing their exercise routines, trying Kegel exercises, even resorting to wearing sanitary napkins to absorb bladder leaks.

“Unfortunately, instead of getting medical treatment a lot of women try to deal with urinary incontinence on their own," said Eutsler. "They might stop running or doing other exercises that cause bladder leaks, or otherwise modify their lifestyle. Or, women might try doing Kegels at home or just resort to wearing pads."

Half of women who have a leaky bladder never mention to their doctors out of embarrassment, or because they think bladder leaks are a normal part of the aging process. Getting older does increase the likelihood of experiencing bladder leaks, or making it worse, in part because muscles – including those in the pelvic floor – lose tone as we age.

If you've experienced consistent bladder leakage for at least three months, you should seek medical treatment. Your primary care doctor, gynecologist (OBGYN) or urologist can guide your incontinence care.

“There are multiple strategies we can use to help people address urinary incontinence," Eutsler said. "The first step though, is opening up to your doctor about it.”

What Is Incontinence?

Urinary incontinence is when you leak urine by accident. You may become unable to control the flow of urine or lose bladder control. Incontinence can range from being a minor problem to something that greatly affects your daily life. In any case, it can get better with proper treatment.

"It's the kind of thing that it's a sneaky little guy because it starts off just a little bit once in forever," said Brent Suozzi, MD, a urogynecologist who chooses to practice at Franciscan Health Indianapolis. "And then, it just keeps getting worse and worse over time. So, we're very focused on quality of life and the impact that has with these conditions."

Stress Incontinence

Experiencing bladder dripping during activities is called stress incontinence, and it's the most common type of incontinence among young and middle-age women.

"When we say that, we're not necessarily talking about being stressed out," Dr. Suozzi said. "It's more of a mechanical stress on the system that's causing the leakage."

Stress incontinence is often the result of scar tissue in the perineum from an episiotomy or prolonged pushing during childbirth. Other reasons for incontinence in females include pelvic radiation treatment, chronic constipation that leads to frequent straining and recurrent urinary tract infections.

"Patients can do actually quite well with things like weight loss, sometimes some physical therapy can help with that and occasionally, we need to resort to surgical management," Dr. Suozzi said. "The good news there is that the cure rates for those surgeries are fairly high, up to about 85%. So, you can make a massive improvement in somebody's quality of life with a pretty quick and simple intervention.

"You take somebody who's running around chasing their kids and having issues and holding back. You know, they're not getting on the trampoline, they're not playing volleyball, they're not dancing at the wedding, those kinds of things because of fear of leakage. And then, you know, if you can do a 20-minute procedure and then undo that, then you really give people a tremendous amount of quality of life back to them."

Overactive Bladder

Another type of incontinence is when you feel like you need to urinate all the time (like every 30 minutes). That's called urge incontinence or overactive bladder.

"Overactive bladder is a condition that's more neurologic in nature, that would be defined as leaking urine with strong urge to void that's uncontrollable," Dr Suozzi said. "That's the classic gotta-go. You know, you get a strong urge, you can't hold it back, you're trying to get to the door, but can't get the keys in the door fast enough, that kind of thing. Or you get close to the toilet and the closer you get, the worse you have to go and you can't quite get to the toilet in time and, you know, urine starts coming out before you can even get there. And that's also very treatable and what we see an awful lot of, you know, both forms of incontinence. And that disease condition is managed fairly successfully with some conservative interventions."

Why Do I Leak Urine All The Time?

You probably aren't the only person in your book club or gym class that worries about leaking urine. Look no further than the number of bladder control products on the market. That's because one in four women between 18 and 59 years of age have involuntary leakage. And more than 4 in 10 women over the age of 65 experience a leaky bladder, according to the U.S. Office of Women's Health. There are many reasons why women may experience bladder leaks, Dr. Suozzi said.

"Some things are things that you just can't control. After you've had a baby, you can't unhave a baby. So, those kinds of risk factors are important, but may not be modifiable," Dr. Suozzi said. "There are other risk factors which are modifiable, and those things are kind of all the things that make life worth living. Caffeine is a big risk factor for developing leakage. Sometimes alcohol consumption can cause people to leak. Being a little overweight can cause people to leak. And so, those are modifiable risk factors. Sometimes two people can have a weak pelvic floor musculature that can result in some leakage. And those are things that can be changed."

Even if you have risk factors for bladder leaks that you can't modify, it doesn't mean bladder incontinence is inevitable in your future.

"Urinary incontinence is not an inevitable result of childbearing or menopause," said Sarah Randolph-Kaminski, a physical therapist at Franciscan Health Indianapolis. "Even high school or college women athletes may have issues."

How Do You Fix A Leaking Bladder?

After an initial evaluation with your healthcare provider, you’ll receive a treatment plan to follow at home. Recommended therapies for bladder leakage may include dietary changes, pelvic floor exercises and/or medication. Surgery is often a last resort for treating incontinence.

Lifestyle changes to improve bladder health

"A lot of times when we do a self-check of our own poor habits, there's some room to clean up there with caffeine consumption, perhaps tobacco use; once again, being a little overweight can play a role in there," Dr. Suozzi said. "And so, those things are reversible and patients do get better when they adopt a healthier lifestyle."

Other lifestyle changes may include:

• Avoiding bladder irritants like caffeine, carbonated beverages, alcohol, and spicy or acidic foods. For example, you might need to scale back on caffeine since the stimulant can sensitize your bladder and increase your urge to urinate. Other foods like milk, tomatoes, avocados and certain fruits can stimulate your urinary tract in a similar way, too.
• Timing your urination.
• Limiting fluids in the evening before bedtime.

Pelvic floor physical therapy

Often, you can reduce incontinence with pelvic floor physical therapy. Your first session with a pelvic health physical therapist includes an internal and external assessment of the alignment, flexibility and muscle tone in your pelvic area. Based on that exam, your therapist creates an exercise program and goals for you to work on.

Pelvic health physical therapists at Franciscan Health are specially trained to assess and treat musculoskeletal conditions with a specific focus on the functions of your core stabilizers and your pelvic floor muscles.

Pelvic floor exercises increase your range of motion and muscle strength. Your pelvic health physical therapist may use biofeedback, an electronic monitoring tool that shows how much pressure or contraction you can generate with your pelvic floor.

The best part about getting physical therapy for a leaky bladder? You can see significant improvement in three to four months, Eutsler said.

Surgery for incontinence

"Occasionally, we need to resort to surgical management. And the good news there is that the cure rates for those surgeries are fairly high, up to about 85%," Dr. Suozzi said. "So, you can make a massive improvement in somebody's quality of life with a pretty quick and simple intervention.

"It's one of my favorite conditions to treat just because your impact factor is so high. You take somebody who's running around chasing their kids and having issues and holding back. You know, they're not getting on the trampoline, they're not playing volleyball, they're not dancing at the wedding, those kinds of things because of fear of leakage. And then, you know, if you can do a 20-minute procedure and then undo that, then you really give people a tremendous amount of quality of life back to them. And so, that's a very gratifying thing."