Bladder leaks can be embarrassing but they are more common than we think. But thankfully, there are plenty of options for to manage – and treat – incontinence now, says Kate Dyson
Ever dribbled after sneezing, or felt a gush when you have a cough? Perhaps the risk of bouncing on a trampoline is too much since having kids? If you leak pee to any degree – from the occasional little droplet to a full on, pant wetting flood, bladder weakness can be pretty mortifiying to say the least.
As one of the biggest health taboos, incontinence is a condition that is rarely discussed. But despite the silence and stigma, it’s so common that 1 in 3 women will experience bladder weakness to varying degrees throughout our lives. So why is something so common, so taboo?
1 in 3 of us are peeing ourselves regularly
As unbelievable as it first seems, think about it. How many women joke about peeing ourselves? It’s pretty high, and especially so after we’ve had children. According to NHS data, between 3 and 6 million people in the UK experience some form of urinary incontinence. Up to 32% of women experience postpartum incontinence as a result of pregnancy or birth complications in the first year of motherhood. As we go through perimenopause, our risk of bladder weakness increases due to the change in our hormones, and specifically the decline in oestrogen. This weakens the tissues and muscles of our pelvic floor, bladder and urethra , causing involuntarily leaks and the dreaded urgent dash for the loo.
It’s important to remember that while common, you don’t have to put up with leaks. They aren’t a normal part of motherhood, or menopause – and not something you have to accept as part and parcel of being a woman, either. There are many treatments for incontinence, from physical therapy to natural supplementation, medication and surgical interventions, too.
What causes leaks and incontinence, and can anything be done about it?
Pregnancy and childbirth
Pregnancy and childbirth are significant ‘events’ in our lives that can cause leaks and incontinence. When we’re pregnant, our growing baby puts pressure on the bladder and our pelvic floor is weaker due to hormonal changes. These significant stages are when many of us first experience urine leaks. During pregnancy, our growing baby puts extra pressure on the bladder, and hormonal changes can weaken the pelvic floor muscles that support the bladder.
After giving birth, these muscles can be further stretched or damaged, especially if we’ve had a vaginal delivery or been in labour for a particularly long time. C-sections don’t prevent leaks, either, and in fact can cause other issues due to catheterisation and complications during surgery affecting the bladder, urinary system and pelvic floor.
Most women will find that the leaks they experience after birth resolve by themselves Leaking after childbirth isn’t unusual, and for some of us, it resolves as we recover. However, for others, the lingering effects of weakened pelvic muscles can lead to stress incontinence, where leaks happen when we laugh, cough, sneeze, or lift something heavy.
Perimenopause and menopause
As mentioned before, perimenopause can be a time when many women start to experience leaks – even if you haven’t previously. That’s because, as we approach menopause and our midlife years, oestrogen starts to decline in our body and with it, so does our bladder and pelvic floor strength. This is because oestrogen plays a key role in maintaining the condition, strength and elasticity of the tissues and muscles in our pelvic floor, bladder and urethra.
These leaks caused by the decline in oestrogen and the loss of muscle and tissue strength in our urinary system are part of a wider syndrome called Genitourinary Syndrome of Menopause, or GSM. GSM refers to a collection of symptoms caused by the decline in oestrogen during and after menopause. It affects the bladder, vagina, vulva and surrounding tissues, leading to vulvar and vaginal dryness, discomfort during intimacy, increased urinary frequency, urgency, or leaks.
Without sufficient oestrogen, the pelvic muscles can weaken further. The bladder and urethra can become more sensitive, leading to issues such as recurrent or chronic urinary tract infections (UTIs), and both stress incontinence and urge incontinence, where we feel a sudden, strong need to go and might not make it to the loo in time.
Prolapse
Prolapse – either as a result of pregnancy or birth (or postpartum complications) can be an underlying cause of leaks and urgency, too – although its important to note that this isn’t a complication for every woman who experiences prolapse. Prolapse occurs when the pelvic organs, such as the bladder or uterus, shift from their normal position and press into the vaginal wall, often due to weakened pelvic floor muscles. It can cause symptoms like a feeling of heaviness, urinary leaks, or difficulty emptying the bladder.
If you suspect you have a prolapse, speak to your GP. There are various treatments such as pelvic floor physiotherapy, lifestyle adjustments and medical treatments that can help manage it effectively.
Weight gain (we know)
If you might be carrying a few extra pounds, it unfortunately can have an impact on your pelvic floor no matter what life stage we’re in. That’s because extra weight increases the pressure on the pelvic floor muscles, making it harder for them to hold the bladder in place and control urine flow.
This can be more gradual than other causes of bladder weakness, and happen over a long time. Many of us may not connect our weight changes with leaking – but the good news is that even a modest weight loss can significantly reduce the pressure on the bladder and improve your symptoms.
High-Impact Exercise
Conversely, if you are super fit you should also be cautious when it comes to your pelvic floor and bladder health. For some of us, leaks are triggered by high-impact activities like running, jumping, or intense workouts. This is a type of stress incontinence that happens due to the physical strain on our body. This impact increases abdominal pressure, and our pelvic floor muscles can’t keep up.
It’s important to maintain a healthy lifestyle and exercise is, of course, an important facet of that. It’s important that we listen to our body and if we start to notice leaks, switch up our routine to consider low-impact, gentle exercises support our pelvic floor.
Other conditions, including surgery
There are a number of medical conditions that can have an impact on our bladder health. Diabetes, neurological disorders, chronic urinary tract infections, endometriosis and adenomyosis can all increase the likelihood of leaks occuring.
Similarly, surgeries involving the pelvic area such as C-sections and hysterectomies, can weaken the muscles or nerves that support the bladder, leading to incontinence. These operations also carry a high risk for bladder injury, and of course catheterisation can cause urine retention although this is rarely more than a temporary issue.
If you experience any symptoms of incontinence or bladder weakness, speak to your GP. You may be able to request a referral to a women’s health physiotherapist if available in your area. If not, you can find one via the Squeezy App or POGP.
Taking Steps to Strengthen Our Bladder Health
If leaks are affecting us, there are plenty of practical steps we can take:
- Pelvic Floor Exercises: Also known as Kegels, these exercises can help strengthen the muscles that support our bladder. They’re simple, but consistency is key.
- Bladder Training: This involves gradually increasing the time between trips to the loo, helping our bladder hold more urine and reducing urgency.
- Lifestyle Changes: Cutting back on caffeine, alcohol, and fizzy drinks can help, as these can irritate the bladder. Spicy foods, chocolate or citrus can also trigger leaks and urgency. Staying hydrated is important because it keeps the urine diluted, preventing infection and irritation of the urethra.
- Seeking Medical Advice: If lifestyle changes aren’t enough, a GP can offer further advice and options, from physiotherapy to medication or even surgery in some cases.
Let’s normalise the conversation (and tackle the taboos!)
Knowing how frequent bladder leaks are for so many of us can help to reassure you that you aren’t alone – but that doesn’t mean it’s easy to talk about. Fortunately, there are many resources out there that support the conversation and help us to find help when we need it. Sharing our experiences, seeking support, and learning about the options available, helps us to tackle this issue together.