Silences Women Keep: Urinary Incontinence

Picture this: Happy hour with your closest group of girlfriends. The drinks are delivered, and the mood is cheery. A number of topics occupy the conversation as you catch up on the recent events of each other’s lives, from promotions to parenting, romance, exercise routines, vacations and…urinary incontinence? Hold the margaritas. Who’s talking about bladder problems? Don’t these issues only affect women of a certain age?

In a word, no. Urinary incontinence (UI) is a common problem that affects women of all ages, from collegiate athletes to new moms to women transitioning into menopause. According to the National Association for Continence, one in four women over age 18 experience episodes of leaking urine involuntarily—altogether, a total of approximately 18 million in the United States. Do the math, and it’s very likely the face of UI is sitting across the table enjoying a half-priced drink and contemplating an order of bruschetta.

Identifying the Causes of UI

UI isn’t a disease; it’s a symptom. According to experts at Mayo Clinic, there are several types, and identifying each correctly is important in order to address the potential causes.

Type: Stress urinary incontinence

Definition: Leakage of urine when there is increased pressure on the bladder, which can happen with cough, sneeze, and laugh or during exercise.

Causes: Lack of support and weakness of the pelvic floor muscles. Potential contributing factors include: pregnancy, childbirth, injury or trauma to the lower back/hips or tailbone, pelvic surgery and deconditioning. Hip strength is also an important factor.

Type: Urge urinary incontinence

Definition: Leakage of urine when a person feels a sudden urge to urinate

Causes: Weak or ”under active” pelvic floor muscles, OR “Overactive” pelvic floor muscles, where the muscles are chronically held tight resulting in the shortening of the muscle and development of trigger points in both the muscle and fascia.

Type: Mixed urinary incontinence

Definition: Includes symptoms of both stress and urge urinary incontinence.

Causes: Varied depending on type.

Type: Functional Urinary Incontinence

Definition: Occurs when the person cannot physically get to the toilet in time.

Causes: Contributing factors include: joint pain, general muscle weakness, difficulty with mobility and dementia/confusion.

UI Type and causes information provided by Niki Cookson.

Debunking the Myths

Many women believe that it is normal to have incontinence. “They think it is just an accepted part of aging,” says Laura Meihofer, PT, DPT, ATC, a pelvic floor physical therapist and certified athletic trainer who treats women in Mayo Clinic’s Department of Physical Medicine and Rehabilitation. “But this is entirely not true. Just because you delivered children or are of a certain age does not mean you have a life sentence of wearing incontinence pads.”

Understanding the myths of UI is key to addressing it comprehensively.

Myth 1: Incontinence is just a normal part of aging. Women are not destined to have urine leakage once they reach a certain age. Pelvic floor muscles can be strengthened, just like biceps or quadriceps.

Myth 2: Childbirth causes irreversible problems “down there.” While women often do experience a loss of bladder control after pregnancy, it’s usually temporary and can be resolved with therapy and other interventions.

Myth 3: You just have to live with it. In most cases, urinary incontinence can be greatly reduced or eliminated through therapies, medications or, in a few cases, surgery.

Unfortunately, many women choose to suffer in silence. Not only must they contend with the physical symptoms of UI, they also bear a great deal of emotional pain. According to the experts, it is important to seek treatment for both sides of the issue.

“Many women feel a loss of control and a great deal of embarrassment,” says Meihofer. “But they benefit greatly from addressing their issues in safe space where they feel comfortable to share, and from receiving education and tools to feel empowered and encouraged about their outcomes.”

Seeking Solutions

While there is not exactly a cure for UI, there are many avenues for treating it. (And we’re talking about much more than Kegels). Women today have access to a spectrum of interventions, including physical therapy, behavioral techniques, medications, medical devices and, in some cases, surgical procedures.

Pelvic floor physical therapy is a common, non-invasive treatment for UI that includes evaluation and treatment of joint dysfunction, muscle tightness, weakness and muscular imbalances of the pelvis. According to Niki Cookson, PT, DPT, an instructor of physical therapy at Mayo Clinic trained specifically in pelvic health, “The most important goal for women suffering from UI is to optimize the health of their pelvic floor muscles. This can be done with targeted exercises to improve muscle strength and reduce faulty patterns of muscle recruitment.”

Meihofer concurs. “I employ researched-based methods to improve or resolve the effects of UI,” she says. “Beginning with hip, stomach and gluteal strengthening, which works in conjunction with the pelvic floor muscles, then typically transitioning to behavior modification.”

Behavior modification can include monitoring or modifying the amounts and types of fluid and food we consume each day. According to Meihofer, “Eating and drinking certain things can irritate the bladder, and when bladder lining is irritated it will give us the urge to urinate. I liken it to squeezing a lemon in your eye; you have no other choice than to blink to get the irritant out of your eye.”

For some women whose symptoms don’t respond to conservative treatment, surgery may be an option. While UI surgery is invasive and has a higher risk of complications than many other therapies, it can also provide a long-term solution in severe cases. Jack Perrone, MD, is a board certified obstetrician and gynecologist at Olmsted Medical Center, specializing in urogynecology, pelvic organ prolapse surgery, incontinence surgery and minimally invasive gynecological surgery, among other procedures.

Resources and Recommendations

In the process of addressing UI, knowledge is empowering. Knowing the statistics and scope of their issues helps women normalize their condition, experts say, giving them confidence to open the conversation with others and discover they are not alone.

If UI is seriously impacting your life, talk to a qualified expert who will provide an unbiased review of your options. Above all, experts say, find someone with whom you feel comfortable and who will develop a comprehensive solution or program to address your goals. To start your research, Cookson recommends the following resources:

Laurie Simon is a freelance writer living in Rochester, Minnesota.

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