According to the National Association for Incontinence, over 33 million adult Americans suffer from some form of urinary incontinence (uncontrolled leakage); and 80% of those are women!
The urinary bladder is a muscular organ located toward the front of the pelvic cavity. It continually collects urine from the kidneys via the ureters, filling it up like a balloon until stretch from the special detrusor muscle inside the bladder tell us it needs to empty. Under healthy circumstances, we can choose to hold the urine by maintaining pelvic floor muscle contraction or closure. As long as the pressure of the pelvic floor is greater than the pressure inside the bladder, the urine remains inside.
But if the pelvic floor muscles are weakened or poorly coordinated, pressure and urgency from bladder filling, actions such as sneezing and coughing, and activities like running and jumping can cause urine to leak out. Constipation can increase bladder leakage by adding pressure from the full bowels onto the bladder, causing it to contract. Pelvic Floor Physical Therapy (PFPT) helps bladder leakage by teaching you how to find and contract your muscles correctly so you may improve their strength and coordination with movement over time. PFPT treatments may also include biofeedback, nerve stimulation, nutrition education, bladder retraining, massage therapy, and exercise. In a nutshell: it ain't just Kegals, girl!
Gotta Go RIGHT NOW!
Urinary urgency and frequency are typically issues caused from an overactive or very sensitive bladder. This can happen after surgery, radiation, prolapse, child birth, pelvic scar tissue and/or tight muscles, as a result of chronic infection...(the list can go on and on). Over time, as we cater to a bladder which is very sensitive to internal and external pressures, the neurological connection between brain and bladder can become hyperactive and cause us to feel as though we need to go all the time (or even immediately) when in reality the bladder could probably hold a lot more fluid volume. Bladder re-training helps to “reset” that neurological connection, and when practiced along with PFPT, can be successful in prolonging time between voiding, decreasing the sense of urgency, and decreasing or preventing leakage.
Some foods or liquids can cause the bladder to become irritated when they are consumed. Irritation increases bladder contraction, and therefore, may increase incidence of incontinence or even pain depending on your specific symptoms. You can keep track of what you consume in your bladder diary to determine which items are triggers for you. The list below may be a helpful way to start. (Items are not listed in any particular order):
Caffeine, stimulants, and carbonation: coffee, tea, soda, B12
Natural and artificial sweeteners: sugar, corn syrup, chocolate, and honey
Spicy foods
Acidic foods: vinegar, citrus fruit, tomatoes/sauces
Certain fruits: Apples, Watermelon, Cantaloupes, Cranberries, Grapes, Guava, Peaches, Pineapples, Plums, and Strawberries
Alcohol
Doc, I hear you, but that sounds boring as hell. Abstaining from coffee and alcohol can be very difficult for those who are used to having a morning cup-a-joe and a nightly wind down glass-o-red. Luckily, there are a few alternatives that I can offer you along your road to recovery. Once you have better control over your bladder, you can slowly begin to add back in those old favorites. In the meantime, try these suggestions on for size:
Low tannin wines:
Barbera
Zinfandel
Pinot Noir
Primitivo
Grenache
Merlot
Teeccino Herbal Coffee Alternative
No JICing Allowed!
Just like Pavlov’s dogs, our bodies can be conditioned to have an expectation or reaction relative to something going on in the environment. When we just-in-case (JIC) urinate frequently, we begin to condition our body to expect that we will urinate each time we leave the house, arrive at a destination, arrive home, etc. Some people have a bladder that is so conditioned to urinating when they arrive home that they will leak on their front porch as they try to get through the door! As scary as it may be, we should begin the process of de-programming the body of these responses in order to increase your likelihood of success. This can be a slow process that progresses over time. The best thing to do is ask yourself if you truly need to “go” before you leave or if it can wait until you arrive at your destination. Over time, you will grow more self-aware and gain more control over telling your body when you are ready, rather than it telling you. True, more leaking may occur, but if you are working with your Physical Therapist on strengthening and bladder re-training, the process will be much more successful!
Healthy Bowels, Healthy Bladder
Adequate fiber and water intake are two of the most important parts of maintaining healthy bowels. Constipation causes straining and places added weight onto the bladder, increasing symptoms of urgency, frequency, and leakage. In most cases, constipation can be completely resolved just by addressing diet. A healthy diet consists of fiber and phytonutrients from plant-based sources such as fruit, veggies, whole grains, and legumes. Foods from meat, dairy, and processed sources are known to contribute to constipation, bladder irritation, and irritable bowel.
Water recommendations are based upon a calculation of body weight:
1oz per every 1kg (2.2lbs)
(Divide weight in lbs by 2.2)
As we discussed, carbonated, caffeinated, and sugary beverages such as soda (including sparkling water) and fruit juice can irritate the bladder and bowels. It is best to obtain fluid intake with pure, fresh water. Many people will limit the intake of their fluids when they are afraid of leakage because they feel that an empty bladder will mean dry pants. While this may be true, the long-term effects of chronic dehydration may lead to recurrent bladder infections and worsening of constipation, which then only makes leakage worse!
Mother Earth for the Win!
When bladder leakage is an issue, the obvious answer is to control said leakage by using disposable pads and adult pull ups. While this can be useful, its definitely not cost effective and can often lead to significant irritation of the vulva. This is not only due to the constant contact with moisture, but also from the abrasive textures and chemicals that are used to manufacture traditional incontinence products. Disposable products also pile up in land fills and destroy our beautiful Earth. So, an all-round fantastic alternative is to take a page out of an old book. Many women are going back to cloth diapers for their babies and reusable cotton pads for their monthly cycle. There are NUMEROUS companies popping up which are dedicated to this growing movement, and now there are even more innovative products such as period panties that are starting to make a surface. Touted for menstrual use, they have also been found to be quite beneficial for women with bladder leakage issues and can be customized per amount of protection needed during the day and night. Here are a few of my favorite companies, but do your research! There are many options out there!
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