Published July 21, 2022
If a cough, laugh, sneeze or the urge to “go” sends you searching for the nearest restroom, you are not alone. For many women, bladder control problems and other pelvic floor disorders can be as embarrassing as they are common – but they do not have to be accepted as a normal part of aging.
“As we get older, our toileting habits get a little harder,” said Tania Sierra, MD, a urogynecologist with Northeast Medical Group, part of Yale New Haven Health, who specializes in female pelvic medicine and reconstructive surgery at Bridgeport Hospital. “Urinary incontinence – the loss of bladder control – is extremely common, but just because something is common does not mean we have to accept it as it is.”
Stress incontinence and overactive bladder – also known as urge incontinence when it results in “accidents” – are two types of bladder control problems related to pelvic floor disorders. “When we say, ‘stress incontinence,’ we are talking about stress on the bladder and leakage triggered by exertion or movement,” Dr. Sierra explained. “That’s where coughing, laughing, heavy lifting or sneezing can cause you to leak a little bit or a lot.”
Overactive bladder involves the frequent and overwhelming need to urinate.
“The pelvic floor is made up of muscles that support the bladder, the bowels and our reproductive system,” Dr. Sierra explained. “These muscles are commonly stressed and damaged by pregnancy and childbirth.”
Stress incontinence is commonly experienced by women who have had children or have been pregnant, while overactive bladder can also result from neurological issues, such as Parkinson’s disease, multiple sclerosis or stroke.
Women may start to experience stress incontinence in their mid-30s and 40s, usually after they are done having children. Overactive bladder tends to affect older women.
A prolapsed bladder, which is one that juts out through weak vaginal walls, can sometimes cause urinary issues as well. Sometimes, the uterus or the vaginal wall that supports the rectum can also prolapse.
Treatment for overactive bladder may begin with lifestyle changes. Doctors recommend that people avoid drinking too much caffeine or alcohol, lose extra weight and watch fluid intake (especially before bedtime). Kegel exercises, which strengthen the muscles that support the bladder to prevent urine leakage, can also help. “Kegels can be tricky to master, and many patients find significant improvement by participating in pelvic floor physical therapy to strengthen their pelvic floor muscles,” Dr. Sierra noted. (Learn more about Kegel exercises from the American Urogynecologic Society.)
If lifestyle changes are not enough, treatment might include prescription drugs. Women should talk to their doctor to find the right medication for them. “Unfortunately, over-the-counter medications are often not very helpful,” Dr. Sierra said. “If patients fail to improve with medications, there are advanced treatment options, such as bladder Botox® injections or stimulation of bladder nerves.”
Another non-surgical treatment is a pessary, a device that can help women with stress incontinence as well as those with pelvic prolapse. A pessary is a supportive device inserted into the vagina to lift the pelvic floor organs into their proper position.
For some patients, surgery may be the best option for stress incontinence or prolapse. One of Dr. Sierra’s patients, who leaked urine whenever she coughed, laughed or sneezed, had a sling surgery a year-and-a-half ago. The sling, which supports the urethra, resolved her problems.
Dr. Sierra encourages women to seek care, especially with the options available. Talk to your doctor to determine the best treatment option for you.
“If it’s bothering you or limiting what you like to do, that’s not a good way to live,” Dr. Sierra said. “Even in more complex cases, I’d say it is important to know what is happening to your body and why – know what you can do, what to expect and where to go next. Knowledge is power.”
Learn more about Urology and Women’s Health services or pelvic floor therapy at Bridgeport Hospital’s Ahlbin Rehabilitation Center.
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