A Delicate Conversation on a Common Concern

Throughout November, the observance of Awareness draws a spotlight on bladder cancer, incontinence and various urotraumatic injuries. Bladder problems appear in many different forms, in both women and men, and the individuals suffering from these conditions are diverse. According to the American Urological Association, overactive bladder (OAB) affects 33 million Americans, and Stress Urinary Incontinence (SUI) impacts one-third of all women under 60 and half of all women over 65. When these issues arise, they affect many areas of life, including home, work and social aspects. Bladder dysfunction can lead to embarrassment and avoidance of activities for fear of leakage. Due to the nature of the problem, many people are reluctant to seek assistance or just assume that it is part of the normal aging process. Bladder issues are relatively common and can be treated in a variety of ways.

While the bladder functions to store and empty urine, the pelvic floor, the abdominal muscles or core, the brain and the bowels must all be considered in maintaining good bladder health. As the bladder fills, the muscle lining of the bladder stretches and then contracts, which creates the urge to go to the bathroom. The brain can suppress this urge if needed, and pelvic floor muscle contractions can also be used to quiet the bladder urges. Once a person decides to go to the bathroom, the pelvic floor muscles and sphincters should relax and for the bladder muscle to contract and empty the bladder.

Imbalance with these mechanisms can lead to a variety of problems, including several types of urinary incontinence:

• Stress urinary incontinence is leakage that occurs with coughing, sneezing, laughing or exercise.

• Urge urinary incontinence is leakage that occurs with the urge to go to the bathroom.

• Mixed urinary incontinence is a combination of both urge and stress, usually with one type being more predominant.

• Overflow incontinence is more common in men and often occurs when the bladder is overfull and there is no urge present.

• Functional or disability-associated incontinence can occur when someone has difficulty with mobility getting to the restroom.

• Positional incontinence is leakage that happens with a change in position.

• Overactive bladder is when a person has increased urinary urgency, which can lead to increased frequency. This can happen with leakage or without.

Other factors can contribute to incontinence. Constipation can aggravate urinary symptoms of urgency and leakage. Caffeine, carbonation, alcohol and chocolate are all examples of bladder irritants, which can increase urinary bother. Attempting to urinate when there is no urge, often known as “just in case” voiding, can train the bladder to go frequently, increasing urgency.

Modifications to these lifestyle factors are simple ways to start improving bladder health.

Pelvic floor muscle tone is another factor relating to the bladder or pelvic symptoms. The timing and coordination of pelvic floor muscles’ contraction can help prevent leakage with a sneeze or cough. Fast contractions of the pelvic floor can help defer a bladder urge as well as distracting thoughts not related to emptying the bladder. Over-activity of the pelvic floor muscles can also lead to difficulty emptying the bladder and pelvic pain.

Healthy voiding should not involve bearing down or straining to empty, and rushing to empty the bladder can lead to incomplete emptying. Hovering over the toilet can also make it difficult to relax the pelvic floor and contribute to incomplete emptying. Finding a balance of not holding urine for too long and avoiding urinating too frequently is necessary to maintain a healthy bladder.

While there is certainly a place for continence aids and other strategies to handle incontinent episodes, they simply manage the problem and not address the underlying cause. At times, the cause of the incontinence may be musculoskeletal, where muscles are either too tight or are unable to contract appropriately. In many of these cases, there are non-surgical options that can improve bladder function and help to restore quality of life for those affected. If you have experienced urinary incontinence or have altered your lifestyle to avoid the risk of embarrassment associated with an incontinent episode, consider consulting with your urologist or a pelvic health therapist.

Amanda Mahoney, PT, DPT, is a board-certified specialist in orthopaedic and women’s health physical therapy, clinical assistant professor of physical therapy at LSU Health Shreveport.