What you really want to know about “urinary leakage” (Part I)

You’ve got urinary leakage. You’re doing high intensity interval training and … oops! You’re lifting a heavy weight to combat bone loss…and oops! You’re in pilates doing a roll up and suddenly…oops!  You, essentially are doing all things with good intentions and trying to improve your health but risk embarrassment of leaking. 

I get this question often. Not frequently, but often. You’re not alone. I asked my friend Dr. Anna Cabeca (you may remember her from this podcast) to share her thoughts. As the expert in women’s reproductive health, she’s got insight for you. This is part I, please watch for part II coming soon. 

By Dr. Anna Cabeca

A woman’s reproductive hormones naturally decline as she ages. Starting in her 20’s and worsening over time, along with the hot flashes, mood changes, skin problems and other menopause-related symptoms; natural downward shifts in estrogen cause a lot of our issues “down there”.

As we age, along with sometimes painful – and often embarrassing – vaginal issues, such as severe dryness and discharge, many of us will suffer at some point from urinary leakage.

Yuck, I know. But an important topic as it happens to many – perhaps even most – of us. The medical term for this is called incontinence, the involuntary loss of one’s bladder control.

A quick “101” on the loss of bladder control

Here’s a quick rundown on the different types of incontinence:

  • Stress incontinence (Stress Urinary Incontinence or SUI): This is the most common type of incontinence that women experience. You’ve all been there, you laugh or cough and you feel a little urine trickle out. A lot of women will experience stress incontinence when they do their favorite sport or workout, or when they squat or lift something heavy. Anything that puts pressure on your abdomen can cause stress incontinence. I’ve had numerous clients also have issues with loss of urinary control during intercourse.
  • Urge incontinence (Overactive Bladder or OAB): Are you always searching for the nearest bathroom? This is that feeling that you must urinate NOW…and can often come on quickly and unexpectedly.
  • Painful urination: A burning sensation when urinating; this is likely to be a urinary tract infection but may cause difficulties relating to leakage.  This can also be from dry or irritated skin around the urethra.
  • Nocturia: Have to get up in the middle of the night because you simply must pee? But then, you often find you don’t have to? This is called nocturia and can significantly disrupt your sleep quality.

Women may suffer from one or more of these, and these issues can keep you from doing the things you love to do.

Worse, incontinence symptoms can be signalling to you that your pelvic floor is weakening, which can result in pelvic prolapse issues. These can be life-impacting, even requiring surgical intervention down the road.

What causes urinary leakage issues?

Whether YOU will experience urinary leakage depends on several things:

  1. How your body reacts to the natural hormonal changes that occur as you age
  2. Your lifestyle decisions relating to diet, exercise, stress and more…
  3. Your overall health (being at your ideal/healthy weight, medications you may take, etc.)
  • The vaginal tissue becomes less elastic.
  • Muscles start to deteriorate and weaken; in particular, the pelvic floor muscles that support your bladder and urethral tube (the tube that empties urine out of your bladder).
  • The lining of your urethra begins to thin.
  • Different women experience varying hormonal shifts…much of this influenced by the lifestyle decisions they make.
  • Obesity (and in particular, an unhealthy BMI) is one of the greatest risk factors as it increases intra-abdominal pressure. It can also lead to diabetes which is also a risk factor. Diabetes can cause nerve damage which can result in incontinence.
  • Sitting/exercise – Too much sitting is so bad for your health, and that includes your pelvic health. And too little exercise, or doing exercises incorrectly (using too much abdominal pressure, like during squats) can also increase your risk. Not doing pelvic floor exercises – or doing them incorrectly – can also increase your risk.
  • Smoking – A persistent cough can create a chronic abdominal pressure that can cause incontinence.
  • Certain drinks (especially alcohol and caffeine!) can worsen incontinence, including carbonated drinks and citrus drinks. Spicy foods, too.  These act as stimulants or irritants to the bladder.
  • Chronic health conditions
  • Childbirth: experts disagree how much this directly impacts the development of incontinence (I feel that pregnancy and childbirth does create wear and tear on things, especially after multiple childbirths but vaginal births are worth it for many reasons relating to your and your baby’s health!).
  • Surgery: Additionally hysterectomies or other pelvic surgeries can cause greater risk due to nerve damage.
  • Chronic bladder infections or other abnormal urinary tract issues, including recurrent urinary tract infections.
  • Certain medications can cause incontinence symptoms (by relaxing bladder).

As you can see, at least some of these are the result of decisions YOU make! Some worth it, others not so much.

Can you prevent (or improve) urinary leakage?

Just like with the other muscles in your body, there are ways to decrease or even halt many incontinence issues through exercise, nutrition, lifestyle and maintaining a healthy weight.  

Here are the things you CAN START DOING TODAY.

  • Maintain a healthy weight: Talk with your doctor or nutritionist about what the optimal weight is for YOU and how best to achieve progress towards that goal. Any excess weight you lose can help.
  • Cut back on the vices! Alcohol, caffeine and smoking.
  • Talk with your doctor proactively about natural hormone options that can help: As a long-time gynecologist I have seen thousands of women just “deal” with their incontinence symptoms. In fact, women “peeing a bit when they laugh” seems to be a commonly accepted everyday thing…I say “NO!” to this. You often can do something about these symptoms, ladies…so be proactive and vocal, and get help.
  • Keep a “bladder journal” if you’ve noticed leaking. When are you having the problem? Just at night? While exercising? Have you just had something in particular to eat or drink? Do you barely make it to the toilet? All of this info will be handy for you to discuss with your doctor.
  • Locally applied DHEA: My new Julva® restorative cream for the vulva (do you know where your vulva is?) contains DHEA which research has shown improves the musculature of all three layers – the deeper layers – of the vagina. This increases the density of collagen fibers in the vaginal wall and stimulates the muscle layer. Julva addresses vaginal dryness, too.

In my next blog I’ll talk about another important and EASY thing you can do to reduce your risk for bladder leakage.

HINT: It involves an exercise with your pubococcygeus muscle (my what?) that MOST women do incorrectly!

Dr. Anna Cabeca Bio:

Dr. Anna Cabeca is an Emory University trained gynecologist and obstetrician, a menopause and sexual health expert and international speaker and educator.  She created the top selling products Julva – an anti-aging feminine cream for women, MightyMaca® Plus – a superfood hormone balancing health drink, and online programs Magic Menopause, Women’s Restorative Health and SexualCPR.  

Read her blog at DrAnnaCabeca.com, and follow her on Facebook, Twitter and Instagram.

Was this helpful? I know incontinence is a tricky not sexy topic, but so important, and not abnormal, that we can do something about! Comment below! Dr Anna will be back next week right here! 

Ready for the Next Post?

Link to Part II of Dr. Cabeca’s guest post is here

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