Living Well with SoHum Health: When You Gotta Go

SoHum Health aims to minimize harm and maximize vitality by providing an informative column to the community.

Ranking pretty high on the list of conditions people don’t like to share about, urinary incontinence is nevertheless rather common, with about 200 million people worldwide suffering from it, up to 80% of whom are women.

The condition increases in incidence with age, but about 25% of people over 18 have experienced some form of loss of bladder control in their lifetimes. The adult incontinence product industry is worth over $15 billion annually in the US, and as the baby boomer population continues to age, is expected to rise another 8% by 2032.

The urethral sphincter is the ring-shaped muscle at the bottom of the bladder that is most responsible for blocking the exit of urine, and it is supported by a web of pelvic floor muscles that also support the bladder. The sphincter can be weakened by childbirth or other trauma or damage to the area, neurological causes or spinal cord injury, serious disease such as cancer or multiple sclerosis, or inability to completely void the bladder resulting in leakage. The muscle can also be weakened by overindulgence in alcohol, some medications, and chronic urinary tract infections.

The most common type of incontinence is stress incontinence. This is when the bladder leaks due to some kind of physical stress placed on it such as a sudden sneeze or cough, lifting a heavy object, bending suddenly at the waist, or obesity. Later stages of pregnancy, as well as menopause causing loss of muscle tone due to drops in estrogen levels, make a woman much more susceptible to the condition.

The next most common form of the condition is urge incontinence, the sudden need to go followed by involuntary leakage. This form of the condition may result in the need to get up many times during the night to void and many more trips to the loo during the day than are normal. This type can be caused by an infection, neurological issue, or even diabetes. Cystitis, or the inflammation of the bladder’s lining, can also be a factor, causing the bladder to feel full before reaching normal capacity.

Overflow incontinence is when you cannot completely empty the bladder when urinating, resulting in the remainder leaking involuntarily. There may be an occasional or constant trickling of leakage. This type of the condition is more common in men as it is often caused by an enlarged prostate gland partially blocking the urethra (the tube leading from the bladder and out of the body) which passes through the prostate.

Total incontinence is when there is no bladder control and urine constantly leaks out of the body as it is produced. This can be caused by birth defect, traumatic injury, neurological disorder, or serious disease.

Overactive bladder is a related condition that can also lead to urinary leakage. It is characterized by frequent urges to urinate, often caused by involuntary contractions of the bladder even when not full. Bladder stones or tumors, neurological disorders, enlarged prostate, menopause, infection, or more serious disease may be to blame.

See your provider to rule out more serious causes if bladder leakage affects your quality of life. There are medications that can be helpful, and in some cases, the insertion of medical devices to support the bladder and surrounding structures can be helpful. There are surgical options if the symptoms and causes warrant them.

Popular and effective home-remedy interventions include stress reduction, bladder retraining, and pelvic floor exercises.

Lifestyle changes such as reducing consumption of alcohol, caffeine, and acidic foods, all bladder irritants, can help. Stress and anxiety are often experienced with overactive bladder, so stress reduction through relaxation techniques, exercise, time spent in nature, enjoying a hobby or positive social interaction can help reduce stress, as can a healthy diet and plenty of quality sleep.

Bladder retraining involves gradually putting off urination until more normal intervals between voiding can be achieved. Journaling can help with spacing out trips to the bathroom and can give you a sense of progress.

Conditioning the pelvic floor muscles can not only improve symptoms of urinary incontinence, but can also help with bowel control, help with recovery after childbirth, with the drop in estrogen levels in menopause, aid in recovery after prostate surgery or disease, reduce risk of prolapse (a bulge of the bladder into the vagina), and improve sexual function.

The most often recommended exercise is the “kegel”, a very specific drawing up and in through the pelvic floor that a couple generations of women have now been learning to tone and prepare the birth canal during pregnancy. Men can also activate the same muscles despite the structural differences in the region. It is best to avoid tensing the glutes, thighs or abdomen to better isolate the pelvic floor.

Recently, a more global approach to strengthening the pelvic floor has included strengthening nearby structures. Deep squats, side lunges, bridging with an inner thigh squeeze, zipping the navel in towards the spine to create a corset-like bracing of the core, pelvic tilt, and the ever popular 80’s revival of the clamshell are all becoming standard for incontinence-reducing strategies.

If you are experiencing incontinence issues, don’t be shy! Your provider has plenty of experience helping people with this very common problem.

In Southern Humboldt Community Healthcare District’s sponsored Restorative Movement classes, these exercises are routinely included as part of the general movement and strength-building routines offered on Zoom several times a week.

For more info, please contact Ann at [email protected]