Peeing your pants during jubilant laughter is one thing. Peeing your pants because you chuckled, coughed or went for a jog something else entirely. Urinary incontinence doesn’t get a public face. Where testicular cancer has Lance Armstrong and osteoporosis has Sally Field, there’s no relatable spokesperson for loss of bladder control.
But it’s fact: UI is no less common than parking tickets.
“I tell gals, ‘Hey! This is super common. This keeps me working 9-to-5, every day,’” says Krista Kahl, a certified physician assistant at Northwest OBGYN. “Girls don’t realize how prevalent this is. This keeps us in business seeing women morning and night.”
Dr. Jason M. Reuter of Spokane Obstetrics & Gynecology says the subject used to be more taboo.
“Years ago, women were ashamed about it, but today there’s more education. More women are coming forward,” he says. “It’s an incredibly common thing … we see it on a very routine basis.”
According to the National Association for Continence, UI is a “stigmatized, underreported, under-diagnosed, under-treated condition that is erroneously thought to be a normal part of aging.”
The association says females experience UI twice as often as men, mostly because of pregnancy, childbirth and menopause. One in four women over the age of 18 will experience episodes of leaking urine involuntarily and, on average, women will wait 6.5 years from the time they first experience symptoms before seeking diagnosis and treatment.
There are approximately three different types of UI: Urge (overactive bladder), stress and flow.
Kahl says urge incontinence frequently appears in the tri-menopausal period, and is suspected to be hormone-related. It happens when the bladder sends premature signals to the brain before hitting capacity and spasms without permission.
“Women will come in with feelings of urgency, like they have to urinate all the time,” says Kahl. “As that process progresses, they’ll say, ‘Gosh, Krista, I’ve had problems with my bladder for three years, but I lost it in Walmart the other day.’”
Kahl says dietary irritants like coffee, sugar substitutes and citrus in alcohol contribute to this by putting added stimulation on your pipes.
Stress incontinence, on the other hand, is activity related, and results from damage and tone loss to the pelvic floor’s supporting ligaments and nerves. It can be caused by childbirth, violent smoker’s cough, obesity or genetics.
“A lot of women have to wear pads because of it,” says Kahl.
The third kind, overflow incontinence, can appear in women who are elderly, have back problems or diabetes.
In this scenario, the bladder will fill, and then overfill — but the sensation and signals of, ‘Hey! I’m full!!’ aren’t sent. The bladder just involuntarily contracts and empties itself out.
Aside from eliminating dietary irritants (something to discuss with your physician), pelvic floor physical therapy is a common treatment, as it strengthens and tones weakened muscles of the pelvic floor.
But for some, identifying which muscles to target — and performing the exercise correctly — can be tricky.
Luckily for us, this is 2010. Nifty gadgets can help you worry less about pee and more about play.
Pelvic floor stimulation therapy, for example, is a method of treatment using an electrostimulation device which, when inserted into the vagina, sends intermittent stimulation to the pelvic floor nerve and muscle tissues.
You can also work your vagina out, so to speak, with a vaginal cone kit.
“It’s great for women who don’t have time to attend formal physical therapy,” says Kahl. “It sounds crazy, but it actually works pretty darn well.”
The cones are like weighted tampons, each with an increased mass. Kahl suggests popping one in while cooking breakfast (or some other household task) and seeing how long you can hold it. “Some don’t get results, because their symptoms are beyond that point, but some get great results,” she says.
Other treatments include medication (a common route for many women), Botox injections or a minimally invasive surgical procedure.
“After childbirth and menopause, and with the aging process, that pelvic floor atrophies and there’s nothing for the urethra to hit and snap it shut. We can put a sling in, and it bulks up that little area, giving something for the urethra to push down and close against,” says Kahl.
“The surgery is very straightforward,” says Reuter. “It’s about a 15-minute procedure in the O.R., and there’s just one small vaginal incision. And usually if that’s the only thing I’m doing, the patient usually goes home the same day.”
Just remember, Kegels are your best friend.
“When you’re urinating, if you try to stop the urine stream, those muscles you’re using target the pelvic floor,” says Kahl.
She suggests doing three sets of kegels day — perhaps while you’re stuck at a red light.
“It’s preventative,” says Kahl. “For gals who are entering menopause, estrogen cream is good, too, as it can keep the vaginal area in good shape.”
Dr. Reuter emphasizes the same: “I always tell my postpartum women that doing Kegels can potentially prevent incontinence at a later time.”
“‘I’m getting old, I have to live with this,’ is a misconception,” says Kahl. “The gals who say, ‘No way! I’m not gonna take this,’ are the ones who end up in our office.”