reduction in hormones after menopause (when your period stops).
What are the signs of bladder control problems?
The two types of incontinence most common in women are stress incontinence and urge incontinence. Stress incontinence is the spontaneous, uncontrolled leakage of small amounts of urine with exertion such as coughing, sneezing, straining, lifting or playing sport (in the absence of any desire to go to the toilet). Urge incontinence causes a sudden, overwhelming urge to urinate (pee). If you can't get to the toilet in time, and experience an involuntary loss of urine, you said to have urge incontinence.
Many women experience a combination of urge and stress incontinence.
What can I do if I have bladder control problems?
Bladder control problems don't have to hamper your lifestyle. Talk to your doctor for advice or contact Continence New Zealand.
Issues with bladder control can be annoying but there are a few simple measures that can help women with mild to moderate bladder control problems.
Reduce coffee, tea and alcohol intake.
Reduce intake of bladder irritants such as fizzy drinks, fruit juices and artificial sweeteners.
Do pelvic floor muscle exercises – these can strengthen the muscles that empty your bladder. 7 out of 10 women with stress incontinence can become dry or significantly improve by doing pelvic floor exercises.
Train your bladder to hold more urine without leaks. Bladder training is sometimes combined with medication.
Use continence products to help you manage urine leaks.
If you experience ongoing problems with urinary incontinence that is not helped by the self-care measures above, your doctor may prescribe you an anticholinergic medication, such as oxybutynin, solifenacin or tolterodine. These act on your bladder muscles to help improve bladder control.
Credits: Health Navigator Editorial Team . Reviewed By: Andreea Dumitru, Senior RN from CCDHB, SIDU - Capital & Coast & Lower Hutt
Last reviewed: 31 Oct 2015
What women can do to improve bladder control
Just a few adjustments to your lifestyle may improve your bladder control.
If rushing to the toilet and needing to go often are a problem, try reducing your coffee and tea intake. The caffeine in these drinks can irritate your bladder, making you go more urgently.
Assess how much fluid (such as water, juice, coffee, tea, fizzy drinks) you drink in total each day. Usually 5 to 6 drinks a day in total is enough. There is no ‘right amount’ to drink – frequently people think they should drink a lot more than they need. Reduce drinking in the evening if going to the toilet at night is a problem.
Try to break the habit of rushing to the toilet as soon as you arrive home; instead, go before you head home. Also, wait a few seconds until the urgency settles before moving to the toilet.
Try to keep your bowel movements regular.
As your bladder and bowel are next to each other, a full bowel will affect bladder function.
Many people find their bladder control problems are worse if they are constipated, which can happen if you don’t empty your bowel regularly or don’t eat enough fibre.
Also avoid straining while emptying your bowels as this can overstretch the muscles of the pelvic floor and may eventually result in weakness occurring.
Try to maintain a healthy weight, as being overweight puts extra strain on your pelvic floor muscles.
If you smoke, quit smoking. Research suggests that smokers are more likely to experience urinary incontinence and this is due to the excessive strain that repetitive coughing puts on your pelvic floor.
Pelvic floor muscle exercises
These exercise aim to strengthen the muscles that empty your bladder. Speak to your doctor or nurse for advice on how to do pelvic floor muscles exercises. The following is a guide:
Stand, sit or lie down with your knees slightly apart. Relax.
Find your pelvic muscle. Imagine that you are trying to hold back urine or a bowel movement. Squeeze the muscles you would use to do that. DO NOT tighten your stomach or buttocks.
Tighten the muscles for 5 to 10 seconds. Make sure you keep breathing normally.
Now relax the muscles for about 10 seconds.
Repeat 12–20 times, 3 to 5 times a day.
Keep doing the exercises. You should begin to see results after a few weeks. Like any other muscle in your body, your pelvic muscles will only stay strong as long as you exercise them regularly.
As a guide, a person who drinks 5 to 8 cups of liquid per day should be able to wait at least 2 hours between bathroom visits. If you’re going to the bathroom more often, are getting up more than once or twice during the night, or can’t delay the urge to empty your bladder for at least 30 minutes, bladder retraining may be helpful.
Bladder training involves changes to your toileting habits that may help improve your bladder control. The 2 main strategies are:
Keep a regular toilet schedule (this is called “timed voiding”), where you visit the toilet to urinate (pee) at set times and slowly increase the time between visits.
Learning to suppress the urge to urinate (pee) by doing strong pelvic muscle contractions and distracting yourself with something else, like counting backwards.
If non-surgical treatment options were tried and have been unsuccessful, surgical treatment options can be considered. Surgical treatment can be further divided into procedures that do not involve a mesh and procedure that use a mesh. Procedures not involving mesh are summarised in the table below.
Procedures not involving mesh
Type of surgery
Open or keyhole surgery through your abdomen to lift your vagina underneath your urethra using permanent synthetic stitches or sutures.
Natural or biological tissue sling
Open surgery through your abdomen to lift your urethra using a sling from your own abdominal wall.
Type of slings that are used include:
natural sling such as fascia
biological sling such as biological material of animal origin.
Urethral bulking agents
Vaginal operation where a synthetic ‘bulking’ material is injected in or around your urethra to improve the seal. This material may be permanent or absorbed by your body.
Procedure involving mesh
A mesh is a synthetic implant that is usually made from a non-absorbable polypropylene (plastic) material. It is known as multiple names such as a tape, sling, patch, ribbon, graft or hammock. A mesh is used to support and hold your urethra, similar to the function of ligaments that are weakened in the case of incontinence. It will stay in your body permanently as it is non-absorbable.
The procedure involving mesh is commonly known as mid-urethral sling (MUS) procedure. In this procedure, the mesh is placed like a sling under your urethra to support it. There are 2 ways that the mesh can be inserted. These are:
from behind your pubic bone (retropubic method)
where the mesh comes out in your inner thigh on each side (transobturator method).
Both these methods have been shown to have an average success rate of 80% up to 5 years. The diagram below shows how the mesh is inserted in the MUS procedure.
Not everyone will undergo the same procedure. Your doctor or surgeon may recommend one method over the other due to different clinical reasons. Discuss with your doctor or surgeon to find out which procedure is most suitable for you. Your doctor or surgeon will consider all relevant issues, including your previous surgical history and your wishes.
Unfortunately, all surgical procedures have complications and risks. The most common complications from mesh surgery include:
mesh erosion through the vagina (also called exposure, extrusion or protrusion)
pain during sexual intercourse
These complications can also happen in procedures not involving mesh, except mesh erosion. Read more about surgical mesh, including questions to ask your doctor before considering a surgical mesh implant.