Ever wondered if your toilet habits are normal? Here’s the inside scoop on bladder health
How often do you go for a wee over the course of an average day? Three times? Four? Maybe it’s more? In the UK alone, it’s estimated that 70 percent of women over 40 have a weak bladder. As you age, bladder problems are a natural occurrence, but they can also be impacted by childbirth and cause a lot of distress if you’re not sure of the root cause. To help you find out more, our panel of women’s health pros explain what might be causing frequent toilet visits – and how you can relieve the problem (so to speak)…
What is stress incontinence?
Ever laughed so hard you thought you were going to wet yourself? Stress incontinence is when you cough, sneeze or laugh and you feel a little bit of wee come out. “This usually develops as a result of weakened pelvic floor muscles or damage to the opening of your bladder,” explains gynaecologist Dr Shree Datta (intimina.com). “It can happen because of an increased pressure on your tummy – if you are overweight or pregnant, for example. But you can also develop stress incontinence from damage during childbirth or from certain medical conditions, such as multiple sclerosis. Some medications can also cause stress incontinence.”
The most common symptom of stress incontinence is when you leak urine because your bladder is put under sudden pressure (a simple cough, laugh or sneeze is often the culprit). The amount of urine you pass is usually small, but it can be large depending on how full your bladder is.
“Treatment for stress incontinence ranges from simple lifestyle changes such as reviewing your caffeine or fluid intake, or losing weight,” says Dr Datta. “You may also benefit from strengthening your pelvic floor muscles. Activities such as heavy lifting – either at work or in the gym can also affect your symptoms, along with smoking. If these simple lifestyle changes do not work, you may be prescribed medication and vaginal creams to see if these improve your symptoms.”
Still not sure why you’re bathroom-bound so often? Fear not: pelvic floor expert Wendy Powell is here to help
Q: Why does it feel like my bladder is struggling as I get older?
A: “Reduced levels of oestrogen can cause the thinning of the lining of the urethra (the short tube that passes from the bladder to out of the body),” says Wendy. “As a result, women at midlife and beyond are at increased risk of urinary incontinence or involuntary leaking. Other factors at play include how many children you’ve had and how strenuous your labour was. Women of all ages can suffer from urinary incontinence, whether that be immediately after childbirth or decades later. It’s important to address this issue with professionally supported daily exercises that are specifically proven to strengthen your pelvic floor.”
Q: Can bladder incontinence be inherited?
A: “Pelvic floor dysfunction may be a result of the muscles or ligaments being too loose or slack, or they may be hypertonic (too tight),” explains Wendy. “The correct pelvic floor exercises will help train the muscles to be fully functional again. However, there are also studies to suggest that urinary incontinence is genetic. A report in Norway found that women whose mothers had urinary incontinence had a 30 percent greater chance for incontinence herself. This doesn’t take away from the fact it is still a wholly treatable condition, though.”
What is urge incontinence?
“Urge incontinence is different to stress incontinence – it’s when you feel a sudden intense urge to urinate and you’re unable to delay going to the toilet,” says Dr Datta. “This may be triggered by a sudden change of position, such as during sex or even by the sound of running water. This may be due to an overactive bladder, which is when the detrusor muscle is more active than normal, causing frequent urination, both day and night. The detrusor muscle contracts to release urine when you go to the toilet and relaxes to allow the bladder to fill with urine, so if it contracts too frequently, you’ll feel the need to empty your bladder. Causes of urge incontinence include a high caffeine intake, constipation, urinary tract infections and certain neurological (brain) conditions.”
“The main symptom of this type of incontinence is urinary leakage with, or immediately preceded by, the urgent need to empty your bladder,” says Dr Datta. “As a result, you will notice urinary leakage on your underwear or clothes.”
“Before considering medications for your symptoms, there will be a review your fluid intake and how much caffeine and alcohol you drink, as these may be affecting you,” explains Dr Datta. “You may also be asked to keep a diary to monitor your symptoms. In some cases, we will refer you for urodynamics investigation (a test to find out how your bladder is working). After this, treatment options include reducing your caffeine intake, bladder retraining, medication or surgery. Bladder retraining involves learning how to wait longer between needing to urinate and passing urine when prompted, and it takes 6-8 weeks to become fully effective. In some cases, medication or surgical procedure is also an option.”
What is overflow incontinence?
“Unlike urge incontinence, when the bladder detrusor muscles contract too often, overflow incontinence means they don’t contract enough, which may lead to incomplete emptying of your bladder,” says Dr Datta. “This can lead to frequent urinary leaks. It may be caused by an obstruction or blockage, so while the bladder can fill up with urine as usual, the obstruction means you are unable to get rid of it all when you sit down to go for a wee. These sort of blockages may be caused by bladder stones.”
Signs and symptoms of overflow incontinence include:
- Difficulty in starting to urinate
- A weak urinary stream
- A frequent need to empty your bladder
- Feeling that the bladder is not empty even after urinating
You may find that despite going to the toilet to empty your bladder frequently, you have a weak urine flow and still experience urinary leaks, which can be very frustrating.
“You will be referred to see a gynaecologist or urologist, who may test your urine to exclude infection or perform a bladder scan to confirm urinary retention,” says Dr Datta. “Treatment may involve evaluating the position you adopt on the toilet to urinate or selfcatheterisation (where you insert the catheter into your urethra by yourself) to make sure the bladder is emptied completely. In the longer term, you may need a suprapubic catheter, where a catheter is inserted through your tummy to the bladder to prevent infections.
A beginner’s guide to pelvic floor exercises
How often have you been instructed in a fitness class or by a medical professional to ‘engage your core’ or ‘do your pelvic floor exercises’? If you have no idea what they’re talking about, here’s the ultimate run-through from Wendy.
You can do these exercises sitting on the floor, kneeling, or lying on your back/side, depending on whatever feels most comfortable. Lying on your back with your knees bent up and your feet on the ground, inhale and let your stomach muscles and pelvic floor relax.
- Next, exhale as you lift and gently squeeze your pelvic floor.
- To find the right muscles, imagine you’re trying not to pass wind by engaging the back passage muscles. Imagine picking up a grape with your vagina – nothing forceful, just a gentle squeeze and lift.
- Then breathe in and fully relax and release your muscles, being careful not to push down or away. Again, this isn’t a forceful movement – just release and fully let go.
- Repeat five times, in rhythm with your own breath, always relaxing and releasing on the inhale, drawing upwards, then gently squeezing on the exhale. Perform these exercises a couple of times a day, every day.