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 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.
As a Women’s Health Nurse Practitioner, I ask my patients about bladder leakage and incontinence- because most of the time they will not mention it to me first. Here are two stories which are very similar to real life cases I see every day. The first was a 55 year old fitness instructor who has 3 children, all delivered vaginally. She sees me once a year for her annual well woman exam and this year when I asked her if she had any bladder leakage, she said yes, that it just started about 6 months prior. She was quite surprised by this because she teaches Pilates as well as Zumba and thought she had a pretty “strong core”. But lately, in Zumba class she would feel dribbles of urine coming out. She was embarrassed someone would see it on her pants, so she’s started to wear a pad to class, but hated exercising while wearing one. Patient B is 30 years old, a mother to a 2 year old son born via cesarean section and working full time. When I asked her about incontinence, she told me that since her son was born, she leaks urine each time she coughs or sneezes and notices that it happens more when she drinks coffee – the caffeine she needs because of her busy life! She was also quite surprised that the leakage is happening because “she is young and did not have a vaginal birth”.
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% 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.
Donna is a Perinatal Clinical Specialist at JFK Medical Center in NJ. She has always loved OB nursing and also enjoys teaching. She is currently an adjunct instructor at Kaplan University and Walden University. She was the Hospital Lead for AWHONN’s PPH Project.
There is a moment after labor when you realize that not only is your sweet little baby a patient, but that you are too. At least for me, that was something that hadn’t really registered. On the day that my little baby girl Isla was born I very quickly began to understand we would both need a ton of care in the hospital and at home.
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