Women and bladder control
Bladder control problems are common, with many women experiencing some degree of urinary incontinence. Contributing factors include pregnancy and childbirth, constipation, obesity, some medical conditions and ageing. In ‘stress incontinence’ leakage can occur, eg, when exercising or coughing, while in ‘urge incontinence’ a sudden urgent need to urinate can result in leakage. Depending on the cause, treatments may include pelvic floor muscle exercises, bladder training, and in some cases medications or surgery.
How many people are affected?
Approximately 600,000 adult New Zealanders (men and women) do not have full bladder control and experience leakage of urine, in amounts that vary from a few drops to large volumes, twice or more a month.
Improvement possible for many
Urinary incontinence is more common in women than men (ratio of 4:1). Two out three women who suffer from 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.
Incontinence is a symptom that one of the mechanisms which keeps us dry is not working correctly. How incontinence presents itself varies according to the cause.
Types of incontinence
The two types of incontinence most common in women are:
Stress incontinence
The involuntary leakage of small amounts of urine with exertion - such as coughing, sneezing, laughing, straining, lifting or playing sport (in the absence of any desire to go to the toilet) - is called stress incontinence.
Urge incontinence
Urgency is a sudden, overwhelming urge to pass urine. 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".
NB: Many women suffer from a combination of urge and stress incontinence.
Factors that contribute to bladder control problems
How do I get good bladder control?
Boss your bladder
Do not allow yourself to become controlled by your bladder - you should be controlling it. Adults usually pass urine 4 - 6 times during the daytime, and sometimes get up once during the night.
Fluids
Drink an adequate amount of fluid (this includes tea, coffee, milo, soup, etc). Assuming there are no other medical problems, 6-8 glasses (1500-2000 ml) per day is the amount to aim for. This amount ensures urine does not become concentrated and that there is enough available fluid to keep bowel motions moist and soft, therefore avoiding constipation. It is advisable to limit intake of bladder irritants such as tea, coffee, cola drinks and alcohol.
Diet
Pay attention to your diet. Make sure it contains fibre roughage every day in the form of wholemeal bread, whole grain cereals, fruit and vegetables. Fibre adds bulk and attracts fluid to the waste matter in the bowel motion.
Bowels/laxatives
Avoid straining while opening your bowels as this can overstretch the muscles of the pelvic floor and may eventually result in weakness occurring. Do not take laxatives unless advised by your doctor. The bowel becomes reliant on laxatives if they are taken over a long period of time and eventually will not function without them.
Medications
Some medications prescribed for other medical conditions can affect bladder control. Check with your doctor.
Weight
Avoid becoming overweight as this puts extra strain on the pelvic floor muscles.
Pelvic floor muscles
The pelvic floor muscles support all pelvic organs, especially in standing. All women, men and children should be taught how to do these exercises.
For instruction in the correct way of doing these, see Pelvic floor muscle training in women. If not satisfied with your progress in doing these exercises, you should consult your GP, a physiotherapist (with training in continence) or a continence advisor.
What is normal bladder control?
The production of urine is not under our voluntary control, but as adults we have acquired the ability to recognise when our bladder is full, and to be able to hold on to urine until we reach a toilet. We therefore have control over when and where we will pass urine. This control is possible because of messages passing between the brain and the bladder, and our ability to interpret these messages. We can learn to use this mechanism to delay passing urine.
What should I do about my incontinence?
The good news is that seven out of 10 women with stress incontinence can become dry, or significantly improved doing pelvic floor exercises. Only a small number of women require surgery. Most urge incontinence can be corrected by bladder training, which is sometimes combined with medication.
How to seek help
There are health professionals qualified to help you with bladder control problems. Ask your GP for advice or contact the New Zealand Continence Association (details below under 'Further Information and Support').
Original material provided by the New Zealand Continence Association, and edited by everybody, July 2005. Reviewed by everybody, September 2011.
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