Urinary Incontinence Is Nothing to Be Ashamed Of - Causes and Solutions for Women

Urinary Incontinence Is Not Unusual - What the Numbers Show

When you sneeze, when you lift something heavy, when you laugh. Leaking a little urine in an unguarded moment is a problem that many women carry without being able to talk to anyone about it. The number of women who experience it grows from around the age of 40, yet most of them never make it as far as a doctor's office. In a nationwide survey that used a questionnaire designed by the Japanese Continence Society (published in 2006, with 4,570 men and women aged 40 and over responding), only 18% of those who said urinary symptoms were interfering with daily life had actually consulted a medical institution. Urinary incontinence is a physiological change that accompanies aging and childbirth, and it is neither shameful nor something you have to put up with. With the right approach, it is a symptom that can improve a great deal.

The Two Main Types of Urinary Incontinence

Stress Urinary Incontinence

This is the most common type of urinary incontinence in women. Urine leaks during movements that raise abdominal pressure, such as coughing, sneezing, laughing, exercising, or lifting something heavy. The cause is weakening of the pelvic floor muscles. The pelvic floor is a group of muscles that supports the bladder, uterus, and rectum like a hammock, and it also plays a role in closing the urethra. When pregnancy and childbirth, aging, obesity, or a chronic cough (smoking) weaken the pelvic floor, it can no longer close the urethra firmly enough at the moment abdominal pressure rises.

Urge Urinary Incontinence

This is the type in which a sudden, strong urge to urinate arrives and the leak happens before you can reach the toilet. The mechanism behind the leak differs from that of the stress type. The cause is an overactive bladder, in which the bladder muscle (the detrusor) contracts excessively and produces a powerful urge even though the bladder has not yet filled with enough urine. It can be triggered by specific stimuli, such as hearing running water, washing your hands, or unlocking your front door.

Mixed urinary incontinence, in which the symptoms of both the stress type and the urge type appear together, is also common. If neither description feels like a perfect fit for what you experience, consider this form as well.

Why the Pelvic Floor Weakens

The single largest factor in the weakening of the pelvic floor is pregnancy and childbirth. During pregnancy the weight of the fetus places a sustained load on the pelvic floor, and in a vaginal delivery the pelvic floor is stretched considerably. The damage is greater when labor is long, when vacuum extraction or forceps are used, or when the baby weighs 4,000 g or more at birth.

Aging is another important factor. From the 40s onward, the collagen content of the pelvic floor declines and muscle strength drops. After menopause, falling estrogen makes the tissues of the pelvic floor thinner and weaker still. Weight gain raises abdominal pressure chronically and adds to the burden on the pelvic floor. On training methods, our article on pelvic floor strengthening exercises may also help.

How to Do Kegel Exercises Correctly

Kegel exercises (pelvic floor muscle training) are the most effective nonsurgical treatment for improving stress urinary incontinence. Many people find their symptoms ease once they manage to keep the exercises up with the correct technique, which makes this well worth trying before you consider medication or surgery.

Step 1 - Find Your Pelvic Floor

Try stopping the flow midway while you are urinating. The muscles you use to do that are your pelvic floor. Note, however, that this is only a way to identify the muscles: repeating it during urination has an adverse effect on bladder function, so limit yourself to one or two checks.

Step 2 - The Basic Contraction

Lie on your back with your knees bent, tighten the pelvic floor slowly for 5 seconds, then release it slowly over another 5 seconds. Do not use the muscles of the abdomen, buttocks, or thighs; focus on the pelvic floor alone. Keep breathing naturally rather than holding your breath. Ten repetitions make one set, and three sets a day is the target.

Step 3 - Progressive Strengthening

Every two weeks, extend the contraction by one second, working up to a 10-second hold. Once you are used to it, you can also do the exercise sitting or standing. It takes 4 to 8 weeks of consistency before you feel the effect.

Improvements You Can Make in Daily Life

Alongside Kegel exercises, changes to daily habits are also effective in reducing leaks. Caffeine and alcohol irritate the bladder, so cut back on how much you drink. Do not restrict fluids too severely; aim for 1.5 to 2 liters a day, spread evenly through the day. Constipation loads the pelvic floor because of the straining involved, so prevent it with dietary fiber. For women carrying extra weight, losing some is effective: in a randomized trial reported in 2009, the group that lost an average of 8% of their body weight over a six-month program saw a significant reduction in the frequency of leaks. Pelvic alignment improvement is another topic worth reading about, since the tilt of the pelvis also relates to body shape.

Signs You Should See a Doctor

Consider a visit to a urologist or a gynecologist (urogynecology) in the following cases: when 8 weeks or more of Kegel exercises bring no improvement; when the volume of leakage is large enough to require pads; when you get up to use the toilet twice or more at night; when urination is painful or there is blood in your urine; and when leaking is restricting your daily life or your social activities. At a medical institution, tests such as urinalysis, measurement of residual urine, and urodynamic studies can be performed, and treatment suited to your symptoms (medication, electrical stimulation therapy, surgery) can be proposed.

Advice by Age Group

In your 20s and 30s, training the pelvic floor in preparation for pregnancy and childbirth is the single best preventive measure. Women who begin pelvic floor exercises before giving birth have been reported to have a significantly lower rate of postpartum leakage. In your 40s and 50s, the drop in estrogen that comes with menopause accelerates the weakening of the pelvic floor, so making Kegel exercises a habit and managing your weight both matter. From your 60s onward, rather than giving up on leakage as something that cannot be helped at your age, seeking treatment actively can improve your quality of life a great deal.

Conclusion - Don't Carry This Alone

Urinary incontinence is a common symptom that many women experience, and it can improve with the right approach. Kegel exercises can be started at home without anyone knowing, and consistency can be expected to bring substantial results. If they still do not help, consulting a specialist opens the door to more effective treatment such as medication or surgery. Continuing to endure leakage because it feels shameful only lowers your quality of life for no reason.