Originally Posted on AWHONN Connections
By Susan A Peck, RNC, MSN-APN
What do a 30-year-old pregnant woman, a 67-year-old who has 3 children -- all delivered vaginally -- and a 45-year-old who has never been pregnant have in common? They are all experiencing light bladder leakage and each of them feels embarrassed to discuss it. Bladder leakage is very common and can occur in any woman, of any age, and of any pregnancy status!
Light bladder leakage also known as urinary incontinence, is an involuntary loss of urine. It is estimated to occur in up to 1 in 4 women. The two most common types of incontinence include stress incontinence and urge incontinence, but some women can have a combination of both types.
- Stress incontinence is the loss of urine (small or large amounts) from activities that cause pressure on your bladder such as coughing, running, jumping, or sneezing. It happens when the pelvic floor muscles- that support the bladder -- weaken. The weakened muscles can be caused by pregnancy, previous vaginal births, obesity or being overweight or chronic urinary tract infections. Sometimes, incontinence may occur without any of these risk factors.
- Urge incontinence is the frequent sudden need to urinate that often causes bladder contractions and the loss of small or moderate amounts of urine. It happens from bladder irritants such as caffeine or alcohol, excessive hydration, use of certain medications such as diuretics (water pills), or neurological conditions. In some women, this may be called an overactive bladder.
Both of these women were surprised to know how common bladder leakage is, but very happy to know they are not alone. During their pelvic examinations, I asked them to each perform a Kegel exercise -- by contracting the pelvic floor -- so that I could assess their pelvic floor tone. The Patient A did the Kegel correctly, but had poor tone. Patient B did not perform the Kegel correctly -- instead she was bearing down/pushing out. I routinely test my patients for their pelvic floor tone and at least 50 percent of the time, tone is poor, or the exercise is not performed correctly.
Below are some tips to help maintain good pelvic floor muscle tone, which is is critical to prevent or improve bladder leakage.
- Kegel exercises are the easiest way to strengthen these muscles, as well as pilates exercises which focus on strengthening the core. Here is a link from the Mayo Clinic to assure you're practicing them correctly.
- Weight loss is very important in the management of bladder leakage. Even just a 5-10 lb loss can relieve some abdominal pressure against the bladder.
- Try to reduce exposure to bladder irritants such as caffeine and alcohol and to not let your bladder get too full -- even during busy days!
- For some women, referral to a physical therapist that specializes in pelvic floor physical therapy can also be very helpful. Yes, there are physical therapists that specialize in this important muscle group! In situations where these conservative measures do not help sufficiently, there are urogynecologist physicians -- who are gynecologists who have a sub-specialty in pelvic floor medicine -- who may offer other treatments including surgery.
- Light bladder leakage is a common complaint among women of all ages. If you are experiencing this, please mention it to your nurse or health care provider, if they don't ask about it first. Many women believe it is a normal part of ageing or a normal consequence of pregnancies or childbirth -- but there are ways to help, so do not feel embarrassed or uncomfortable bringing up the subject and asking for help.
Susan A. Peck, RNC, MSN, APN is a practicing Women's Health Nurse Practitioner. For 20 years, Ms. Peck's career has focused on women's health care, first as a labor and delivery staff nurse and for the last 16 years as an Advanced Practice Nurse. She currently works in the Department of Obstetrics & Gynecology within Summit Medical Group, a large multi-specialty practice group in Northern New Jersey.
Ms. Peck's areas of expertise include contraception, osteoporosis, general gynecology and prenatal care. She has spoken at several national and state conferences including the AWHONN National Convention.