I Really Have to Go
Are we there yet? Do you ask this question on a trip or plan stops according to bathroom breaks? Do you know exactly where the bathrooms are in each retail shop? Have you stopped enjoying social activities because of urinary incontinence?
Urinary incontinence, the loss of bladder control, is a common and often embarrassing problem among both men and women. One in four women over the age of 18 experience urinary leakage. Bladder control issues can be embarrassing and cause people to avoid their normal activities, but incontinence can often be stopped or controlled.
There are several types of incontinence:
Stress incontinence occurs when urine leaks as pressure is put on the bladder, such as during exercise, coughing, sneezing, laughing, or lifting heavy objects.
Urge incontinence happens when people have a sudden need to urinate and cannot hold their urine long enough to get to the toilet. It may be a problem for people who have diabetes, Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, or stroke.
Overflow incontinence happens when small amounts of urine leak from a bladder that is always full. A man can have trouble emptying his bladder if an enlarged prostate is blocking the urethra. Diabetes and spinal cord injuries can also cause this type of incontinence.
Functional incontinence occurs in many older people who have normal bladder control. They just have a problem getting to the toilet because of arthritis or other disorders that make it hard to move quickly.
Mixed incontinence. You experience more than one type of urinary incontinence — most often this refers to a combination of stress incontinence and urge incontinence.
Urinary incontinence can happen for many reasons, including urinary tract infections, vaginal infection or irritation, or constipation. Some medications can cause bladder control problems that last a short time. Certain life events in women and health problems can lead to stress incontinence in women weakening the pelvic floor muscles such as pregnancy and childbirth, trauma or injury, pelvic organ prolapse or menopause. Weak pelvic floor muscles can make it hard for the bladder to hold urine during stress incontinence. Individuals may have overactive bladder muscles or a diagnosis such as arthritis that may make it difficult to get to the bathroom in time. Damage to nerves that control the bladder from diseases such as multiple sclerosis, diabetes, or Parkinson’s disease, may also increase incontinence. Most incontinence in men is related to the prostate gland including prostatitis, a painful inflammation of the prostate gland, injury or damage to nerves or muscles that control the bladder, or an enlarged prostate gland.
Treating and managing urinary incontinence
The choice of treatment for urinary incontinence depends on the type of bladder control problem you have, how serious it is, and what best fits your lifestyle. As a general rule, the simplest and safest treatments should be tried first.
A combination of treatments may help you get better control of your bladder. Your doctor may suggest you try the following:
Physical Therapy to strengthen pelvic muscles to help support the bladder, which can help you hold urine in your bladder and avoid leaks.
Urgency suppression helps control strong urges to urinate so you can make it to a toilet on time. For example, you can try distracting yourself to help keep your mind off needing to urinate, taking long relaxing breaths, holding still, and squeezing the pelvic floor muscles.
Timed voiding is used to help control your bladder through scheduling time to urinate. For example, you can set a plan to urinate every hour. As time goes on, you can slowly extend the time between toilet breaks.
If the above does not help with bladder control, your doctor may discuss medications, biofeedback, electrical nerve stimulation, and possibly surgery.
What are hypotonic pelvic floor muscles versus hypertonic pelvic floor muscles?
There is a difference. Hypotonic pelvic floor is basically muscles that are too weak. They struggle to fulfill their responsibilities in your body relating to your lower back, core muscles and pelvic organs. In contrast, hypertonic pelvic floor muscles are too tight or too tense (while still generally being weak). As with basically all your muscles, full range of motion is critical for your pelvic floor. Pelvic floor muscles need to be able to contract or squeeze to maintain bladder control but they also need to remain flexible and relaxed much of the time to avoid pelvic and low back pain and allow use of the bladder and bowel movements when you actually want that.
Pelvic floor exercise is often a good tool to address a hypotonic pelvic floor. But it can be useless or even counterproductive for hypertonic pelvic floor dysfunction, so it’s very important to understand what is going on with your body specifically. There are ways to practice relaxing or down training your pelvic floor muscles if they are hypertonic. Both hypo- and hypertonic pelvic floors can generally be improved or fixed, often using nothing more than conservative therapies like exercise or lifestyle changes. Physical therapy can help you regain the strength necessary to control your symptoms. Just make sure you choose a physical therapist who has experience in treating pelvic floor dysfunctions. Pelvic floor dysfunction is NOT inevitable, so don’t just accept it if you have it!