Women’s Guide on How to Manage an Overactive Bladder

Disclaimer: The information presented here by LL Medico has been collated and published for general information purposes only. Meticulous research was done, and the references used come from authoritative, reputable health websites and organizations.

Nevertheless, this content and the information herein should not be used as substitutes for professional advice or a presentation in a particular field of expertise. Consulting with the appropriate health-care professionals is still the best recourse.

Content:

• How a Healthy Bladder Works
• The Causes of Urinary Incontinence
• The Symptoms of Urinary Incontinence
• The Common Types of Incontinence Affecting Women
• How Does Urinary Incontinence Affect Women of All Ages?
• What to Do with an Overactive Bladder
• Nonsurgical Treatments for Urinary Incontinence
• You Don’t Have to Do This Alone

Urinary incontinence (UI) is a condition in which a person involuntarily leaks urine. It needs to be discussed openly and in depth, especially because it is a common disorder among older people, though people are often hesitant to talk about it.

In addition to urinary incontinence being a sensitive topic, its very nature as a health condition may also be the reason it is inadvertently glossed over during consultations with doctors.

According to Dr. Elaine Waetjen, a gynecologist working at the UC Davis Medical Center, “Because [urinary incontinence is] considered more of a quality of life thing than a life threatening thing, it’s probably not raised as much as it should be with general practitioners.”

Dr. Waetjen has over sixteen years’ worth of research on urinary incontinence, and in her recent study, she discovered that 68 percent of women between the ages of 42 and 64 have urinary incontinence at least once every month.

Her findings were culled from a survey by the National Institutes of Health, called the Study of Women’s Health across the Nation. The study covered nine years’ worth of information and involved three thousand racially diverse women from the aforementioned age-group in six US cities.

This implies how UI is a common occurrence, yet women have trouble opening up about this problem because they are afraid of the stigmatizing effect of such an action.

Bladder leakage and overactive bladders (OABs) are among the causes of urinary incontinence, and to ensure these conditions do not hamper everyday living, it is important that women are thoroughly informed. After all, women have a shorter urethra than men do (4 centimeters versus 11 centimeters, respectively), making them more susceptible to incontinence.

If you are one of those women having problems with frequent urination, take a look at the discussion below to know more about what you can do with an overactive bladder.

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How a Healthy Bladder Works

The kidneys are a pair of bean-shaped organs located at the back of the abdomen. They clean the waste found in the blood, and this waste is discharged from the body as urine. The ureters are a pair of thin tubes through which urine passes until it reaches the bladder, a sac that holds the urine.

When the bladder is full, the brain signals the bladder muscles to squeeze, expelling the urine through the urethra. Lastly, the sphincter in the urethra opens, allowing the urine to flow out.

Normally, the bladder relaxes when it’s not full, and you can hold in your urine or wait before you pass urine. When you have an overactive bladder, however, there may be a problem with the nerve signals between your bladder and your brain.

It may also be because the bladder muscles contract even if the bladder isn’t full yet. Either way, you will feel an urgent, sudden need to urinate, and you may lose control over when you urinate, hence resulting in urinary incontinence.

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The Causes of Urinary Incontinence

The 2018 edition of Current Medical Diagnosis and Treatment (CMDT) identifies two categories for the causes of urinary incontinence: transient causes and established causes. Transient causes refer to temporary causes of urinary incontinence, and CMDT uses the following mnemonic device (DIAPPERS) to easily summarize such causes:

• Delirium—the patient fails to recognize the need to urinate and where to urinate; this may be because of a clouded sensorium, which is marked by the inability to concentrate or to think.

• Infection—symptomatic urinary tract infection (UTI) commonly causes or contributes to urgency and incontinence.

• Atrophic urethritis and vaginitis—urethral inflammation, if symptomatic, may contribute to incontinence in some women.

• Pharmaceuticals—medications such as potent diuretics, anticholinergics, psychotropics, opioid analgesics, alpha-blockers (in women), and calcium channel blockers are another common cause of transient incontinence.

• Psychological factors—severe depression with psychomotor retardation may impede the ability or motivation to reach a toilet. Anxiety and stress may trigger the fight-or-flight response, thus potentially exacerbating urinary incontinence.

• Excess urinary output—an older person may find it difficult to reach the bathroom quickly if there is too much urine. This may be caused by too much fluid intake or by specific metabolic problems (e.g., diabetes insipidus and hypercalcemia).

• Restricted mobility—limits to motion may also hinder a person from quickly getting to the toilet to pass urine.

• Stool impaction—this is common among patients in hospitals or those who can’t move.

Meanwhile, established causes refer to deeper bladder-control problems, and they should be addressed or treated after the transient causes have been identified and controlled. The following are established causes of urinary incontinence:

• Detrusor muscle overactivity—the detrusor muscle is a smooth muscle surrounding the bladder walls. When its contraction is uncontrolled, it causes urine leakage.

• Detrusor muscle underactivity—the least common among the established causes, this usually happens for some reason that is specific to an individual or because of damage to or dysfunction in the sacral motor nerve. This nerve is found in the lower part of the spinal cord and is responsible for voiding functions.

• Urethral obstruction—this rarely happens among older women, and it may manifest as three different kinds of urinary incontinence, which will be discussed further below: overflow incontinence, urge incontinence, or dribbling incontinence. Kidney stones, tumors, and cancer can cause obstructions and make urination difficult.

• Urethral incompetence—in older women, this is the second most common established cause of incontinence. This happens when urine leaks after a woman does certain physical activities, like carrying bulky items or laughing. If there is no detrusor overactivity, the leakage happens only during the daytime.

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The Symptoms of Urinary Incontinence

The resource page of the Urology Care Foundation lists some of the indicators of urinary incontinence:

• How often you urinate—it is consensus among a lot of experts that urinating more than eight times within a 24-hour period qualifies as frequent urination.

• When urine leaks—when you do certain activities and you suddenly feel a strong need to go, urine leaks.

• When you have nocturia—you wake up at night and need to go to the toilet at least twice.

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The Common Types of Incontinence Affecting Women

• Urge incontinence—you have a strong compulsion to urinate, but the urine leaks even before you make it to the toilet.

• Stress incontinence—movements from activities like carrying heavy objects, laughing, coughing, and sneezing may cause your urine to leak because they exert pressure on your bladder.

• Overflow incontinence—your bladder is unable to void completely, so there is some urine left, causing your bladder to eventually become too full.

• Functional incontinence—this doesn’t necessarily mean your bladder is the problem. Other factors or illnesses may be preventing you from getting to the bathroom in time to urinate. For example, there is a physical barrier (e.g., when you’re bound to a wheelchair) or a communication barrier (e.g., cognitive impairment resulting from Alzheimer’s).

• Reflex incontinence—urine leaks because the bladder doesn’t contract at the right time. There may be some kind of nerve damage (e.g., spinal cord injury, multiple sclerosis) hampering the communication between your brain and your bladder nerve.

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How Does Urinary Incontinence Affect Women of All Ages?

• Young adults—according to Professor Kate Moore, the head of the Department of Urogynecology at the University of New South Wales in Australia, incontinence, in the form of bed-wetting, “affects about 4 percent of children between five and twelve.” She also points out in her 2016 article on Newsroom that this happens as a result of having an overactive bladder. It is usually older children and teenage girls who experience this.

• Mothers and pregnant women—pregnancy may cause stress incontinence, which may last for a few weeks after the child is born. This is because of the pressure exerted by the weight of the baby on the pelvic organs (which are the vagina, cervix, uterus, bladder, and rectum). The stretching of pelvic muscles may result in pelvic organ prolapse, a condition in which the pelvic organs drop or are dislodged, pushing against the vaginal wall. When this happens, the pelvic muscles become weak, increasing the chances of having urinary incontinence.

  If the bladder function doesn’t return to normal after six weeks, consult a doctor for diagnosis and possible forms of treatment.

  Pushing for too long or having a long vaginal delivery may cause injuries to the pelvic nerves and, in turn, affect bladder control. Using forceps during delivery may also injure the sphincter muscles and the pelvic floor.

• Menopausal women—menopause refers to the process in which the ovaries no longer produce the hormones regulating your period. You are considered menopausal when you haven’t had your period for twelve months straight. During this time, the production of estrogen stops.

  Estrogen is a hormone that aids in the strengthening of the pelvic muscles. When the ovaries no longer produce estrogen, menopausal women are likely to have a uterine prolapse, or the weakening of uterine muscles.

• Elderly women—pregnancy and menopause may lead to the development of incontinence in old age, but as mentioned previously, other factors can also contribute to this. Medications, certain diseases (e.g., arthritis), nerve damage, and weak bladder muscles may cause one form of incontinence or another in elderly women.

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What to Do with an Overactive Bladder

Go to a urologist or a urogynecologist who specializes in and can treat overactive bladders. It is crucial to ask lots of questions and to be able to discuss your condition as candidly as possible. You can expect the following things to come up during your doctor’s appointment:

• Your medical history—your symptoms, your previous and current health problems, your diet and fluid intake, your medications (both OTC and prescription), and experiences and life changes brought about by said symptoms.

• Physical exam—the doctor will palpate the following areas: abdomen, pelvic organs, and rectum. This helps your doctor determine the possible causes of the symptoms.

• Laboratory tests—the doctor may order these tests to supplement the findings in the physical exam: urinalysis, bladder scan, cystoscopy, and urodynamic tests.

It is best to keep a bladder diary so you can monitor your condition. This also allows your doctor to understand more about your bladder activity and determine the best course of action. This diary should contain the following information:

• When and how often you go to the toilet

• When and how often you leak urine

• How much urine you leak

• How much urine you pass

• How much and how often you drink fluids

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Nonsurgical Treatments for Urinary Incontinence

Lab results and other pertinent information help identify the appropriate treatment for incontinence. Surgery may be recommended for more extreme or delicate cases. Otherwise, noninvasive, nonsurgical options are available, according to the Cleveland Clinic:

• Lifestyle modification—avoiding caffeine, alcohol, and other diuretics. Your doctor may recommend adjustments to the amount and frequency of your fluid intake, but those depend on the climate in your area, your health condition, and how active you are. The normal daily urine output is around 800 to 2,000 milliliters if your daily fluid intake is at 2 liters.

  Keeping a healthy weight is also important because excess weight increases the pressure on pelvic organs. Quitting smoking is advised because smoking may trigger coughing, which, in turn, may trigger stress incontinence. Maintain healthy and regular bowel movement as well.

• Behavior modification—try bladder training, which involves sticking to a regular schedule when voiding. You may gradually make the intervals between bathroom visits longer to increase your bladder’s capacity to hold more urine.

• Exercise and physical therapy—Kegel exercises aid in strengthening your pelvic floor muscles.

• Medications—antimuscarinic agents, beta-3-agonists, injectables that thicken and tighten the urethral lining to avoid leaks, Botox for relaxing bladder muscles (repeat dose needed once or twice yearly).

• Pessaries or vaginal cones—these vaginal inserts help support the urethral walls to avoid bladder leakage. These soft rings are made of plastic and are removable.

• Electrical nerve stimulation—electric impulses help modify the bladder’s reflexes.

• Biofeedback—computer graphs and sounds show muscle movement and strength.

The following products may be used in conjunction with the forms of treatment mentioned above:

• Adult diapers—wearing these is a discreet way of managing your incontinence. Such diapers may come in a variety of sizes, brands, and styles (e.g., pull-up briefs and tab-style briefs), and they are designed to maximize the absorption of urine

• Disposable pads—you may wear a pad that will absorb the urine in your underwear, or you can put large pads on beds, chairs, and other surfaces where you recline or sit.

• Special underwear—waterproof underwear prevents your clothes from getting wet, while highly absorbent types can be washed and used repeatedly.

• Specially formulated skin creams and cleaners—these anti-irritants can help protect the skin around the urethra or even keep urine away from the skin.

• Urine-deodorizing tablets—ask your doctor about this. These oral tablets will make the scent of your urine less pronounced.

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You Don’t Have to Do This Alone

Removing the stigma of incontinence means treating this disorder as one would any other medical condition. Do not suffer in silence and shame.

Barbara Grufferman, an advocate of positive and healthy aging, says, “Body changes are a natural part of being a woman, and bladder leaks shouldn’t hold anyone back from the activities they love. Women who may be experiencing bladder leaks should talk to their doctors about their symptoms and how to manage leaks with the right protection.”

At the same time, incontinence doesn’t also have to be a normal part of aging or of being a woman. When you take care of your physical health, you are proactively doing something to ensure you live your life to the fullest and with dignity, regardless of your age.

Empower yourself through reading and participating in support groups so you can help yourself and enlighten others about this distressing health condition. Talk to your loved ones about it so you can all figure out a way to deal with incontinence in the most efficient and least stressful way.