Many women tend to lose a degree of bladder control after giving birth, but you shouldn't have to memorize every bathroom between your home and your office or wear an extra pad when going out for a run. There may be alternatives to shying away from social situations, carrying around a change of clothing, and making excuses to avoid sex because you’re afraid you’ll leak. After all, the cloak-and-dagger lifestyle of the incontinent woman can get exhausting.
Bladder leakage, or incontinence, affects more than 30 million American women. The most common type of incontinence is stress urinary incontinence (SUI), the sudden, involuntary loss of urine that often happens while laughing, sneezing, coughing, or exercising. Many women are too embarrassed to talk about it, but not Bonnie Blair, the five-time Olympic Gold medalist in speed skating, who broke the ice when she talked about developing SUI after the birth of her child.
Blair has been good enough to step out and speak up to raise awareness and let other women know that help is available. The American Foundation for Urologic Disease (AFUD) just released a national survey that found that only 3 percent of women suffering from symptoms of SUI are actually diagnosed by a health-care professional.
That's a whopping 29 million undiagnosed cases in this country alone!
I realize that most women don't need someone else to tell them if they are incontinent, but the implication of the study is that women are too embarrassed to ask their doctors and consequently unaware of the treatments available for this condition.
The effects of SUI on a woman's sex life can be devastating. AFUD's survey found that one-third of women with SUI avoid sexual intimacy due to fear of leakage during intercourse or orgasm. Those of you who have read this column in the past know a woman has to be able to relax to enjoy sex, and it's difficult to relax in bed when you're worried about wetting it!
Urine leakage related to SUI is typically brought on by any condition that strains or weakens the pelvic muscles. The pelvic-floor muscles support the bladder, vagina, and bowel. They are crucial to the proper function of these organs, not to mention a central part of sexual response — in particular, orgasm. Furthermore, loss of pelvic-floor strength can result in a loss of support for the bladder, uterus, and even the bowel, resulting in them slipping down — known as prolapse — which can make intercourse impossible.
What are the risk factors for SUI? First of all, just being female has actually been identified as a risk factor because of the shape and anatomy of the urethra. Pregnancy, and vaginal delivery in particular, involves significant lengthening and stretching of the pelvic-floor muscles to permit the passage of the baby. It is not uncommon for women to find it difficult to maintain bladder control postdelivery. In fact, a 2001 study in the American Journal of Obstetrics and Gynecology cited that 30 percent of women develop SUI within five years following their first vaginal delivery.
Furthermore, menopause and the depletion of estrogen that goes along with it may contribute to the weakening of the pelvic floor and harm the health of the tissue in the urethra. Other risk factors include pelvic surgeries, smoking, obesity, certain medications, chronic disease, and caffeine. Starting to lose count?
This generation of women does not have to suffer in silence, as their mothers did. There are many steps that can be taken to alleviate the symptoms of SUI:
First, it's crucial to limit the intake of caffeine. In addition, women with SUI should undergo a pelvic-floor evaluation and do rehabilitative exercises — which you can be taught by a good gynecological physical therapist, who can help you isolate and strengthen the muscles that are key to maintaining bladder control and sexual function. Very often good physical therapy and strengthening can prevent the need for surgery.
While pelvic-floor exercises can't repair a prolapse once it has occurred, they can certainly help with bladder control and help prevent symptoms from getting worse. If surgery is ultimately needed (as is often the case with prolapse), physical therapy can assist in post-surgery recovery. Finally, there is an array of prescription medications you can discuss with your doctor that may help with symptoms.
Not all incontinence problems are solved quickly or easily. However, if you have symptoms that are affecting your quality of life and making you less willing to engage in activities you enjoy, there is help available.