Have you ever had to cross your legs during a sneeze to avoid leaking a little pee? Have you experienced this while laughing, coughing or perhaps picking something up? Do you wear panty liners because you are worried that at any point you might “dribble a little”? Do you rush to the washroom with the sudden urge to go pee? Do you avoid social activities that are longer in time because you are afraid of having an accident?

You are not alone! One in four women over 18 experience urinary leakage, and more than half of women over 45 years old experience urinary incontinence (Swanson et al., 2005). Although it is common for women, urinary incontinence is not a normal condition you have to live with! There are ways to help reduce your symptoms and even cure your peeing problem- we’ve got answers.

Types of Incontinence:

Top 3 types of urinary incontinence experienced by women are stress, urge/overactive bladder, and mixed incontinence.

  1. Stress incontinence: This type does not have anything to do with stress- rather it is caused by pressure on the urinary bladder such as by being overweight, pregnant, sneezing, lifting heavy objects, exercise as well as some medical conditions. Many women experience stress incontinence during pregnancy or after childbirth. Stress incontinence occurs when the pressure inside your bladder due to filling becomes greater than the strength of the urethra. This is why any sudden increase in pressure will cause leakage! Women with weak pelvic floors will experience this.
  2. Urge incontinence or Overactive Bladder: If you experience an extremely strong urge to pee to the point that you usually have a tough time making it to the toilet-  it is likely you are experiencing urge incontinence or overactive bladder. This type is usually due to injury to nerves or muscles which help to control urinary flow. The urgent and frequent need to pass urine can be caused by a problem with the detrusor muscles in the walls of the bladder (these muscles allow the bladder to fill when relaxed, and empty when contracted). If the detrusor muscles contract too often, you’ll feel like you need to go to the washroom now. Peeing more than 8 times in 24 hours or more than once during the night can be classified as urge incontinence.  Some causes include:
    • Drinking too much alcohol or caffeine
    • Poor fluid intake
    • Constipation
    • UTI
  3. Mixed Incontinence: it is possible to leak urine due to two types of urinary incontinence, most often stress incontinence and overactive bladder. This most commonly affects women.

Other Types:

Overflow: People with overflow incontinence have difficulties emptying their bladder. This type usually affects men

Functional Incontinence: urine leaking with this type of incontinence most often affects individuals who have functional limitations, such as the elderly. Some conditions that cause functional incontinence include Alzheimers and arthritis.

Total Incontinence: severest type of incontinence marked by complete loss of bladder resulting in a constant urine leakage

Nocturia: Peeing more than once during the night. (Continence Foundation, 2011)

Medications that may cause Incontinence: there are also a few medications that may cause incontinence or make incontinence symptoms worse such as (NHS Choices, 2017):

  • ACE inhibitors
  • Diuretics
  • Some antidepressants
  • Sedatives

Treatments

Not surprisingly, there are a lot of treatments out there for incontinence. Panty liners are not a treatment, they mask the symptoms. Medications may help- but this also may not address the issue. If you are having issues with incontinence, talk about it with your general practitioner, gynecologist or seek help from a pelvic physiotherapist.

Medical/Surgical Options

There are different surgeries that can help with urinary incontinence such as a bladder neck suspension or a sling procedure. If you are interested in learning more, please check out: https://www.coloplast.ca/surgical-urology/patient/women/urinary-incontinence/#section=Surgical-treatment-options-for-incontinence_116264

As with any surgery, there are many risks involved such as pain, infection, nerve/vascular injury, obstruction and painful intercourse after the procedure. Your GP will refer you to a specialist to determine if surgery is the right option for you.

Medications
Medications differ depending on the type of incontinence you have.

  1.  Stress: A medication called duloxetine has been introduced for stress incontinence which helps by increasing the muscle tone of the urethra to help keep it closed (meaning the leakage during a sneeze should improve). With any medication there are side effects- common to duloxetine includes nausea, dry mouth, extreme tiredness, constipation (MFMER, 2018).
  2. Urge/overactive bladder: antimuscarinics help relax the bladder from contracting/spasm-ing which is one of the reasons the sensation to pee/ inability to hold the bladder once the contracting begins, occurs. Some include oxybutynin, tolterodine, and darifenacin. These medications have side effects as well including dry mouth, constipation, blurred vision and fatigue (MFMER, 2018).
  3. Topical estrogen cream: For women, applying low-dose, topical estrogen in the form of a cream used in the vagina, may help tone and rejuvenate tissues in the urethra and vaginal areas. (MFMER, 2018).

Non-Surgical Options

Now you might be thinking, but what can I do right now? The good news is, is that with the right adjunctive therapies and lifestyle adaptations, your urinary issues can improve! This is a recommended first step before going with medical/surgical options.

Diet/Lifestyle

If you are experiencing urge incontinence, there are some lifestyle adaptations that will be helpful in decreasing the number of bladder spasms you are experiencing.

  1. Limit alcohol, caffeine, soda and aspartame intake (I know it’s tough!). These are bladder irritants and will cause your bladder to spasm more than normal.
  2. Ensure adequate fluid intake– a lot of individuals think they should limit how much they are drinking in order to avoid the frequency of bathroom trips… this actually causes the urine in the bladder to be more acidic causing irritability!
  3. Stop smoking. Nicotine is an irritant to the bladder. Smoking also causes coughing which increases incidences of stress incontinence- so stop!
  4. Avoid constipation. This increases pressure on your bladder increasing the urge to pee.
  5. Follow the correct dosages of vitamin C for your body. Too much vitamin C can contribute to bladder spasms because it can make the urine more acidic.
  6. Take adequate magnesium. Magnesium is important for muscle and nerve function. It helps to relax smooth muscle which is what your bladder is made up of.
  7. Take your Vitamin D! Vitamin D helps with the uptake of calcium which has shown to decrease incontinence.
  8. Lose weight. If you are overweight, pressure on your bladder will be increased.

(Health Media Ventures Inc., 2017; Reuters, 2018)

Pelvic Muscle Exercises

Ever heard of a kegel exercise? Likely you have- however it is unlikely you are doing them correctly. Thankfully there are devices that can help us with our kegall-ing. External Affairs has two of these devices: ApexM and Intensity.

ApexM uses mild muscle stimulation (high frequency and low frequency through 10 settings you can choose from, up to your comfort level) to contract your pelvic floor muscles better and more efficiently than you can do on your own. This is important for stress incontinence. For overactive bladder, ApexM sends a calming signal to the muscle that surrounds the bladder to prevent spasms, reducing urgency. For a lot of women, doing a proper kegel may not be the hard part- the relaxation of the pelvic floor is a difficult task requiring you to truly relax.

The Intensity works similar to the Apex but is technically not a medical device and is used for women with sexual dysfunction. Intensity also uses high and low frequencies to stimulate muscles in the pelvic floor thus increasing vaginal tone. Tightened and toned pelvic floor muscles help increase the intensity and power of the female orgasm (Pourmoi, 2018).

I find the following technique taught to me by a physiotherapist specialized in pelvic floor muscle training to be helpful:

  1. Perform exercises on the toilet as sitting in this position will help relax the sitz bones
  2. Upon exhale clench the inner vaginal muscles as if you are trying to “pick up a jelly bean”
  3. Hold for only a few seconds (2-5) and relax, breathe out and focus on the muscles letting go like a flower opening
  4. Perform 10 repetitions, three times a day

External Affairs Vaginal Rejuvenation

Now that you know urinary incontinence is not normal, and not something you have to “live with”, or an uncomfortable topic we shouldn’t talk about- let us introduce to you one of the services offered by External Affairs that along with other women’s health issues, helps to improve urinary incontinence: EA Vaginal Rejuvenation!

EA Vaginal Rejuvenation is also for those of you who find sex uncomfortable from vaginal dryness or you find it difficult to have an orgasm (clitoral or vaginal- did you know there is a difference?), or perhaps you have low libido, or vaginal atrophy- EA Vaginal Rejuvenation will benefit you.

External Affairs Bio-Identical Hormone Replacement Therapy (BHRT)

External Affairs does Bio-Identical Hormone Replacement Therapy (BHRT) to determine if you have deficient hormone levels. If needed, topical estrogen cream will be prescribed by one of our doctors or physician assistants which can help with incontinence issues.

All the best!