Bladder control problems (when you pee unexpectedly) are commen in women and are often a sign that one of the mechanisms which keeps us dry is not working correctly. Most women with urinary leakage find they can overcome it or improve their control, but many do not seek help.
- In New Zealand, it is estimated that almost 200,000 women have urinary leakage at least twice a month.
- Bladder control problems are 4 times more common in women than men, with many women experiencing some degree of lost control over their urinary actions.
- Two-thirds of women who experience bladder control problems do not seek help as they see this as a 'normal' female problem and think nothing can be done about it.
- However, 70% of women with bladder control problems can become dry or experience significant improvement with the right treatment.
What causes bladder control problems in women?
Factors that contribute to bladder control problems include:
- pregnancy and childbirth
- medications including prescribed medicines, over-the-counter medicines and herbal supplements
- chronic cough
- urinary infection (consult your GP)
- diseases which affect the nervous system and muscular control
- 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. If a person is unable to get to the toilet in time, and experiences an involuntary loss of urine they are 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 the New Zealand Continence Association.
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, such as:
- Reducing coffee, tea and alcohol intake.
- Reducing intake of bladder irritants such as fizzy drinks, fruit juices and artificial sweeteners.
- Doing pelvic floor muscle exercises which can strengthen the muscles that empty the bladder – 7 out of 10 women with stress incontinence can become dry, or significantly improved by doing pelvic floor exercises.
- Training the bladder to be able to hold more urine without leaks. Most urge incontinence can be improved by bladder training, which is sometimes combined with medication.
- Using continence products to help you manage urine leaks.
See self-care for bladder control problems for more detailed information on pelvic floor exercises and bladder training.
If you experience ongoing problems with urinary incontinence which is not helped by the self-care measures above, your doctor may prescribe you an anticholinergic medication, such as oxybutynin, solifenacin, tolterodine. These act on the bladder muscles to help improve bladder control.
Bladder control problems in women NZ Continence Association, 2015
Promoting good bladder and bowel health NZ Continence Association, 2015
Urinary problems NZ Ministry of Health
What women can do to improve bladder control
Just a few adjustments to your lifestyle may improve your bladder control, for example:
- 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 the 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 the 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 the 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 the pelvic floor.
Pelvic floor muscle exercises
These exercise aim to strengthen the muscles that empty the bladder. It is best to 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, three to five 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 at set times and slowly increase the time between visits.
- Learning to suppress the urge to urinate by doing strong pelvic muscle contractions and distracting yourself with something else, like counting backwards.
Pelvic Floor Training for Women Continence NZ
Bladder retraining Continence NZ
Information for health professionals
The following signs and symptoms are cause for concern and require referral to a specialist for further investigation: (1)
|Red flags for referral in people with incontinence
Males and females with urinary incontinence and any of the following factors should be referred to an appropriate specialist (urologist or gynaecologist) within two weeks:
- Macroscopic haematuria without a concurrent urinary tract infection (UTI)
- Unexplained microscopic haematuria if aged over 40 years
- Recurrent or persistent UTI associated with haematuria if aged over 40 years
- A pelvic mass arising from the urinary tract or pelvis, e.g. palpable mass
- Suspected prostatic malignancy (in males)
Consideration for referral to a Urologist or gynaecologist should be given to patients with the following factors(with urgency of referral based on clinical judgement):
- A bladder that is palpable on abdominal or bimanual examination after voiding and/or chronic urinary retention/voiding difficulties
- Pelvic organ prolapse (in females)
- Associated faecal incontinence
- New or worsening incontinence in a person with a neurological disease
- Symptoms of voiding difficulty
- Recurrent UTI
- Suspected or recurrent urogenital fistulae
- Recurrent or continued incontinence following a previous continence surgery
- Previous pelvic cancer surgery or radiation treatment
Red flags for referral BPAC, Oct 2013
Urinary incontinence BPAC, Oct 2013
Primary care management guidelines, Prof Don Wilson, Southlink, 2008
Continence Screening Form for residential care Deakin University, Continence NZ
Continence assessment & care plan Continence NZ
Urinary Incontinence in women NICE Guidelines, UK
Regional HealthPathways NZ
Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information:
- Urinary incontinence BPAC, Oct 2013