Fixing Urine Leaks: Common Mistakes and Solutions
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Some 40 percent of midlife women and up to 50 percent of older women experience urine leaks, according to research.
This can be bothersome and embarrassing, but it can be fixed. Yet a whopping 61 percent of women with this condition don’t seek treatment, scientists studying 1,300 women with this problem reported in the journal Menopause in 2018.
This is a mistake, says Leslie Rickey, MD, MPH, an associate professor of urology and obstetrics-gynecology at the Yale School of Medicine in New Haven, Connecticut. “Women have a lot of options for how to deal with this.”
Types of Bladder Leaks
There are three kinds of urinary incontinence (UI). Stress incontinence occurs when some pee leaks during sudden exertion. This might involve coughing, bending, lifting, exercising, or stepping on uneven surfaces.
Urge incontinence is when you have a sudden, strong urge to go — even if you’ve recently peed. This can lead to accidents if a bathroom is not around. A mixed urinary continence can also occur, with a combination of urge and stress incontinence, according to Mayo Clinic.
Read on for five of the most common mistakes women make when they’re dealing with a leaky bladder, and how you can avoid them to end this unwanted condition.
1. You Think a Leaky Bladder Is a Normal Part of Aging
More than half the women with urinary incontinence in the Menopause study didn’t seek medical help because they thought their urine leaks was a normal part of aging.
“Many women are not getting asked about it in the doctor’s office. Plus they see ads for pads on TV so they think it’s normal and common,” Dr. Rickey says.
While it’s true that reduced levels of estrogen due to menopause can dry and weaken tissue (a reason why the average age for this problem is around 50), you shouldn’t just accept it as inevitable, Rickey adds.
Many women who come to the office of pelvic floor physical therapist Abigail Abbott, who has a private practice in San Miguel de Allende, Mexico, have suffered for years, thinking UI is normal.
“If you have to regularly wear a panty liner or pad, that’s not normal and you shouldn’t just accept it,” Abbott says.
2. You’re Embarrassed to Bring It Up With Friends or Doctors
In the ideal world, your primary care doctor or gynecologist would include urine leaks in the list of symptoms they regularly ask about, but many do not. “A lot of doctors are afraid of women’s bodies,” Abbott says.
Some 55 percent of the women in the Menopause study said their healthcare provider never asked them about leakage.
But if they don’t mention it, you should, Abbott says. You should feel comfortable doing so, knowing that as common as leaky bladder is, you won’t be the first case your provider has seen.
Most often, your primary care doctor will refer you to a pelvic floor physical therapist or a urogynecologist (a specialist in urology and gynecology). “There are a growing number of specialists like me, and this is what they do day in and day out,” Rickey explains.
Don’t shy away from discussing the topic with female friends or relatives, Abbott says. If you do share your symptoms, you’ll likely get a knowing nod.
“People don’t talk about it enough,” Abbott says, but why should talking about pelvic leaks be any different than discussing a headache or shoulder pain?
3. You Think the Problem Is Loose Muscles When You’re Actually Too Tense
While the loss of estrogen in midlife women can lead to muscle tissue that is loose, often the problem is the opposite: your pelvic muscles are too tight, Abbott explains. She attributes this at least in part to socialization (such as women always sitting with legs closed) and unprocessed emotions (especially a collective history of marginalization).
This can cause pelvic muscles to shorten and tighten, the way your hand muscles would if you clenched your fist all day.
Pelvic floor physical therapists are trained to assess whether tension is part of the problem. If that proves to be the case, breathwork and other exercises designed to relax the pelvis will likely be part of treatment.
4. You Know to Do Kegels, But You Do Them Wrong
Most people have heard of Kegels, subtle exercises for the pelvic floor. But “almost everyone does them incorrectly,” Abbott says.
The most common mistake: pushing the muscles out, as if you’re sitting on the toilet, rather than pulling everything up and in.
Abbott tells clients to imagine they’re squatting over a box of tissues and trying to pull one out of the box with the vagina. Other pelvic floor therapists use the image of sucking up a blueberry.
You’ll want to do both short and long holds. For the short movements, try to do up to 25 quick internal flicks a day. Longer holds mean pulling the tissue in for 10 seconds; longer and the muscles will tire.
Pay attention to your breath while doing the Kegels, Abbott says, keeping it long and slow to keep the area relaxed.
Women often think they should do Kegels forever, but this is not the case, Abbott says. These exercises are to be done early in the treatment phase for leaky bladder, while you also build up the surrounding muscles of the abdominals, hips, and back.
“Once those muscles are stronger, you don’t have to continue with Kegels, because pelvic floor muscles unconsciously know what to do,” she says.
5. You Fear Surgery Will Be the Only Solution
Lifestyle changes and nonsurgical medical interventions are often very effective, Rickey says. “There’s no reason for anyone to be suffering with this because they fear needing surgery,” she says.
Rickey advises starting by finding a physical therapist who specializes in the pelvic floor, or by talking to a urogynecologist.
Pelvic floor PTs are trained to evaluate the problem, educate the client on what’s going on, and provide exercises and breathing techniques to strengthen both the pelvic floor and the surrounding muscles.
A review of research published by Cochrane Library in 2018 concluded that pelvic floor physical therapy is effective in improving symptoms of UI, especially by reducing the frequency and amount of leakage.
Another review, published in Current Opinion in Obstetrics and Gynecology in 2019, pointed to the method’s “clear benefit as a first-line treatment for most pelvic floor disorder.”
For many women, just one to six visits are sufficient when accompanied by exercises done at home, Abbott says.
If several months of pelvic floor physical therapy don’t yield sufficient results, other medical interventions that don’t involve surgery will likely be tried. These include low-dose vaginal estrogen and, for urge incontinence, medicines including Mirabegron (a beta-3 adrenergic agonists) and VESIcare (solifenacin).
Another effective treatment is Botox injected into the bladder, says Jian Jenny Tang, MD, an obstetrician-gynecologist at Mount Sinai Hospital in New York.
Extreme cases of incontinence may eventually require surgery — although advances in surgical repair mean most are minimally invasive now, Rickey notes.
For stress incontinence, this most commonly involves placing small mesh sling under the urethra. Alternative procedures involve inserting wires near the bladder or via needles placed near the ankle as a way of altering nerve signals.
“When people come to me, we discuss all the options and weigh the risks and benefits. Then they choose what is right for them,” Rickey says.
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