You meet up with some friends for an early-morning run. Your stride is strong, your lungs are powerful and you’re feeling positively euphoric—until a familiar feeling stops you in your tracks. No matter that you just used the restroom right before heading out, when your bladder decides it’s time to go, there’s no stopping it. Suddenly, your blissful run has turned into a major embarrassment.
It’s a topic no one wants to talk about, but it’s all too common. According to the National Institute of Diabetes and Digestive and Kidney Diseases, research shows that 25 to 45 percent of women have some degree of urinary incontinence (UI), which is a loss of bladder control that results in the accidental leakage that can leave you blushing during boot camp. Although men can also experience UI, it happens twice as often for women.
What Causes Loss of Bladder Control?
According to Dr. Alyssa Dweck, a practicing OB-GYN in Westchester County, New York who has been voted "top doctor" in New York Magazine, one out of every three women in the United States struggles with the frustration of occasional bladder control issues. Aging is a common cause of loss of bladder control, but as Dr. Dweck points out, there are other factors that can trigger potty problems.
"Carrying excess weight can also contribute to occasional bladder control issues," says Dr. Dweck. "The heavier you are, the more weight presses on the bladder and the more likely you’ll have trouble controlling your urine flow. A healthy BMI (body mass index) can help prevent occasional urgency."
In addition to how much you eat, your choice of foods and beverages can impact your bladder. "Some foods can be bladder irritants and worsen bladder control; be mindful of typical culprits including chocolate, spicy and acidic foods," suggests Dr. Dweck. You might want to cut back on coffee and sodas, too: The doctor points out that if you suffer from occasional urinary urgency, caffeine can act as a diuretic and aggravate your symptoms.
"Many medications can also influence bladder health and urinary habits," she adds. "Speak to your healthcare provider about modifying dosage or changing medications to improve bladder complaints."
4 Types of Incontinence
Although the end results may be just as embarrassing, there are different types of incontinence. It’s important to identify which type you have so that you can get the right treatment. Dr. Jaime Knopman, Director of Fertility Preservation at CCRM New York, breaks down four common types of incontinence:<pagebreak>
- Stress incontinence: This type of incontinence is triggered by certain movements that put physical pressure on the bladder. "Much like the pressure it causes in our daily lives, stress incontinence results from increases in intra-abdominal pressure," says Dr. Knopman. "Think cough, sneeze, laugh, push—all of these actions increase pressure in your abdomen and can lead to the leakage of urine." She says stress generally occurs because the urethra changes position, sometimes becoming hypermobile (or uber-flexible), thereby weakening those muscles. This can occur when there is poor support in the pelvic floor, which is a common side effect of pregnancy, deliveries, obesity, chronic coughing and high-impact activity.
- Urge incontinence: When you get that panicky feeling that you’ve got to go right now—whether your bladder is full or empty—that’s urge incontinence. This is typically due to abnormal bladder contractions, and usually happens along with age and certain medical conditions.
- Overflow incontinence: "In an overflow situation, the urine is always flowing; whether it is a stream or a dribble, it never stops coming," says Dr. Knopman. "In general, this results from a physical inability to completely empty the bladder."
- Mixed incontinence: When you suffer from multiple types of bladder control issues at the same time, you have what’s called mixed incontinence. As Dr. Knopman points out, the combination effect makes diagnosis a bit more clouded and treatment slightly more difficult. You will likely need a specialist to help you pinpoint and solve the issue. When Dr. Knopman’s patients come to her with mixed incontinence, she starts by performing a thorough history and exam focused on the pelvis and pelvic organs, then checks their urine for infection.
Incontinence and Exercise
Dr. Anup A. Vora, a urologist with Chesapeake Urology, treats many women who experience loss of urinary control while working out. "During exercise, especially when the abdominal muscles are tightened, the pressure in the abdomen increases, which can transmit pressure to the bladder, which can cause urine to leak out," says Dr. Vora. "While women of all ages can be affected, those women who have had childbirth are especially prone, as the muscles in the pelvis to prevent this type of leakage have lost their tone over time."
Don’t let embarrassing leakage keep you from sticking to your fitness goals. Try these tips for staying active in spite of an overactive bladder:
- Use yoga to stop the flow. In addition to Kegels, Dr. Dweck suggests trying certain yoga poses that can help to maintain pelvic floor muscles and reduce occasional urgency to urinate.
- Stick with water during workouts. Caffeinated liquids, including energy drinks, teas and coffees, can act as diuretics, causing you to lose bladder control. Resist the temptation to avoid drinking altogether, as this can actually increase urine concentration and lead to leakage, while also increasing your risk of dehydration.
- Wear protection. Use a thin pad to absorb unwanted leaks. If it makes you more comfortable, stick to looser-fitting, dark-colored clothing.
- Switch up your activities. If your regular running routine or boot camp classes are causing embarrassing bladder flare-ups, it may be time to add some lower-impact exercises to the mix. In an Everyday Health article on stress incontinence, physical therapist Tasha Mulligan suggests trying activities that lengthen the spine and reduce pressure on the bladder, such as yoga, Pilates, swimming and bicycling.
- Don’t be afraid to take breaks. Always empty your bladder right before exercising, and take bathroom breaks as often as necessary during your workout. It’s better to miss a couple of minutes of class than to risk an embarrassing incident that could cut your session short.
Treatment for Incontinence
Before beginning any medical treatment for incontinence, Dr. Knopman asks her patients to examine their lives and see if any changes need to happen. "If you are smoking, you need to quit," she says. "If you are overweight, you need to lose weight. If you are suffering from constipation, you need to take a stool softener and eat more fiber, and if you are drinking tons of caffeine, you need to cut back. While basic, these can be the biggest beasts to tackle."
She The doctor also recommends learning and implementing daily Kegel exercises as a means of strengthening the pelvic floor muscles, which support the bladder. In a way, you may have to go back in time to the days of potty training and focus on retraining your bladder to void frequently and keep urine volumes low.
Traditional Kegels aren’t always the answer, though. Some women have hypertonic pelvic floor muscles, which is when those muscles are too tight and don’t relax enough to completely empty the bladder. This can result in an increase of urinary urgency and frequency, as well as painful urination. In that case, a doctor may recommend doing a combination of regular Kegels and reverse Kegels to help relax tension in the pelvic muscles.
Dr. Dweck suggests urinating on a timed schedule, regardless of whether or not you feel the urge, to help lessen the chance of losing bladder control.
If your bladder issues become severe or persist over time regardless of your best efforts to control them, it may be time to talk with your doctor about exploring other options.
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