Incontinence

Incontinence: The loss of urine control is a common concern for over half of the population in the United States, and 1 in 5 women have moderate to more severe symptoms. (2) Even among women in their 20s, the prevalence of any urinary incontinence is greater than 1 in 3, and it exceeds two-thirds among women in their 70’s. (2). Additionally, about 17% of women over 18 years old have overactive bladder (OAB), and an estimated 12.2 million adults have urge incontinence (2). These findings highlight the importance of addressing this condition and providing appropriate care for affected individuals. 

Urinary Incontinence can be slight or severe, depending upon the severity of the case and the reasons for the incontinence.  Many women in their 40s and 50s have experienced it at some point in their lives, and it can limit their desire to live life to its fullest based on the simple concern of whether they will have an issue with continence or not.  Some women will work around it.  They may always carry a change of clothes wherever they go, just in case they sneeze, laugh too hard, or lift something heavy.  Some may wear pads or protective underwear daily.  Others may not leave the house for fear of an accident.  Does any of the above sound familiar?  If it does, don’t lose hope.  Many things can be done to reduce your chance of an issue and improve your quality of life. 

What are the Types of Incontinence?

• Stress Incontinence: is urine leakage caused by pressure on the bladder. Some examples are laughing, coughing, lifting something heavy, and exercising. Pressure from the abdominal region can strain the bladder, causing urine leakage. 
• Urge Incontinence:  There is a sudden urge to urinate followed by possible leakage.  You may have the urge and/or need to urinate frequently through the night.   This can be caused by emotional stress, illness, infection, diabetes, or even a neurological condition. 
• Mixed Incontinence: is a combination of Stress and Urge Incontinence
• Functional Incontinence: A physical or mental impairment that keeps you from making it to the toilet in time. For example, if you have severe arthritis, you may be unable to unbutton your pants quickly enough.
• Overflow Incontinence: there is a constant dribble or overflow of urine secondary to incomplete bladder emptying. 

In weighted analyses, 61.8%  of US women had urinary incontinence, corresponding to 78,297,094.  32.4% of all women report symptoms at least monthly. Of those with Urinary incontinence, 37.5% had stress urinary incontinence, 22.0% had urgency urinary incontinence, 31.3% had mixed symptoms, and 9.2% had unspecified incontinence. (1) 

What Causes Incontinence?

There can be many causes of incontinence, and to determine the source of the causes, it is important to understand what kind you are experiencing.  Some possible causes can be:

Dietary and Lifestyle Factors:

• Diet: Consuming many foods or beverages considered bladder irritants may contribute to incontinence. Some foods are caffeine, hot peppers, alcohol, artificial sweeteners, and acid foods like citrus juice.
• Hydration: It is a common misconception that I won’t have an accident if I drink less water. However, when dehydrated, urine becomes more acidic and irritates the bladder. Staying well hydrated is important to prevent urine incontinence. Click here for our FREE Hydration Urine Chart PDF (We recommend printing it and keeping it in your bathroom for easy reference).
• Constipation: Constipation goes hand in hand with hydration.  The rectum and the bladder are controlled by many of the same nerves. The stool in your rectum causes these nerves to become overactive and increases urinary frequency.
• Overweight: Increased weight increases the weight and pressure applied to the bladder, reducing the functional ability to get to the bathroom on time. 
• Smoking: Smoking has been shown to increase incontinence.

Medical and Health-Related Conditions

• Medications: Muscle relaxers, pain medications, sedatives, heart medications, and more can affect the bladder’s ability to retain urine. Click the link here for a list of medications that contribute to incontinence.
• Illness or Urinary Tract Infection: Illness and UTIs can irritate the bladder and cause the urge to go often. However, they can often be resolved with antibiotics or medications. 
• Pregnancy and delivery: During pregnancy, hormone changes and the baby itself place a great deal of pressure on the bladder, resulting in frequent trips to the bathroom.  After delivery, depending upon the delivery method, the mom may be dealing with a lot of trauma, pain, nerve damage, and muscular weakness, resulting in issues of continence.   It is common post-delivery for moms to experience pelvic floor prolapse, where the bladder, uterus, rectum, or small intestine can get pushed down from the usual position and protrude into the vagina. 
• Menopause/Perimenopause: With the hormonal changes in menopause, women produce less estrogen. Estrogen is a major contributor to the health of the urethra and bladder linings.  
• Changes with Age:  As we age, the urgency to urinate increases as we cannot hold the volume of urine we did when we were younger. 
• Tumor: Tumors along the urinary tract can cause issues with full emptying of the bladder urinary flow, resulting in possible overflow incontinence. 
• Neurological Conditions: Many neurological disorders, such as stroke and Parkinson’s disease, can influence continence by affecting the nerve impulses sent to the bladder from the brain, resulting in incontinence. 

What Can I do to Make it Better?

If urinary incontinence keeps you from participating fully in life, you can try many options to improve your urine control.

• Talk to your physician.  Reassess your medications with your physician to determine if you are taking anything that would promote incontinence and if there is an alternative.
• Visit a Pelvic Floor or Women’s Health Physical Therapist for a personalized program to strengthen the pelvic floor muscles.
• Practicing pelvic floor training exercises such as kegels or modalities can promote pain reduction and improved strength. 
• Hydrate. This can vary per person, but in general, you should be drinking a minimum of six 8oz glasses of water per day.  Note the color of your urine.  If it is a lighter straw-colored yellow, you are hydrated.  If your urine is dark, you need to drink more fluids. 

• Limit bladder-irritating foods such as caffeine and alcohol.
• Increase daily fiber intake to a minimum of 25-30 g/day. 
• Maintain a healthy weight.  Overweight individuals have a higher chance of having incontinence issues. 
• Don’t Smoke, and seek help if you desire to quit smoking. 

Conclusion:

Urinary incontinence is common, especially among women in the U.S., affecting more than one in three women in their 20s and two-thirds of women in their 70s. It ranges from a minor inconvenience to a major problem impacting daily life. Factors like diet, hydration, constipation, medications, UTIs, pregnancy, menopause, and lifestyle choices such as weight and smoking can contribute. Management includes consulting a doctor, doing pelvic floor exercises, dietary changes, and staying hydrated to improve bladder control and quality of life.