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Hello Ladies, can we talk?March 1, 2017

Written By Dr. Sharon Ransom
OB/GYN of Taos Health Systems

In my line of work as an OB/GYN, I meet women every day who have been told that their embarrassing leaky bladder is a symptom of getting older and “it’s just the way things are”. For all of you ladies out there who cruise the aisle for “products” to deal with your bladder and who think they may need to buy stock in the companies that make their pads, absorbent panties, and laundry detergent, we need to talk.

A Matter of Understanding

If you have experienced unexpected loss of urine you may feel as though your body has betrayed you. You are not alone. It is estimated that between 23 to 35% of women have urinary incontinence. Urinary incontinence (that’s science for peeing your pants) affects many women and seems to peak in occurrence around the age of 50 years. Women who experience the inability to control their bladder report loss of self-confidence, sexual difficulties, a decrease in social activities, and loss of self-esteem.

Do you leak when engaging in activities such as sneezing, coughing, or even vigorous exercise? If you answered ‘yes’, your symptoms are referred to as “stress” incontinence. If you are standing in the checkout lane with your cart of groceries and your bladder tells you it is time to go find the restroom, can you ignore the urge or will you have to go? This is called urge incontinence. If both of these types of incontinence occur, you have ‘mixed’ incontinence. Is your bladder an over-achiever? If your bladder sends messages to your brain that you need to pee multiple times a day (more than 7), you may have an overactive bladder.

Some women with stress incontinence may notice a bulge which has developed ‘down there’ and over time, the bulge makes it necessary to change positions while seated on the toilet in order to fully empty the bladder. The bulge may become more noticeable as the day progresses and is less of a problem at night. The bulge may be another situation referred to as pelvic organ prolapse (the pelvic organs include the bladder, the uterus, vagina, and rectum).

Did you know that overactive bladder, pelvic organ prolapse, and urinary incontinence affect more women than diabetes, heart disease, or arthritis? Did you also know that certain substances and medications can worsen your symptoms? Caffeine, one of my favorite beverages, can irritate your bladder and result in symptoms of overactive bladder.

Why We Leak

There are many reasons women develop incontinence and certain risk factors such as childbirth, chronic diseases, racial differences, age, menopause, family history, and body composition have been researched. Your age can be a huge factor in the chance of developing incontinence because of the association of age with pelvic organ prolapse. Childbirth is associated with the development of a leaky bladder and can be unrelated to age. If you have pushed a human being out of your vagina, you may recall how much effort that took, right? So pushing affects the part of our body called the pelvic floor (more about that in another blog) and some women will notice loss of urine immediately after delivering a baby, or even during pregnancy. The relationship between obesity and incontinence has been studied extensively. The way carrying extra weight impacts your bladder is much the same as pregnancy increase in abdominal girth increases intra-abdominal pressure which causes stress and strain on, you guessed it, the pelvic floor.

Do you smoke? If so, despite all the other nasty things smoking can cause, just know this- smokers have double the risk of developing stress incontinence.

Your genes can also play a role in determining a risk of developing bladder problems and/or pelvic organ prolapse. Women with prolapse may have collagen which lacks the appropriate component related to durability and strength. Our pelvic organs are designed to function best when suspended properly by structures that attach to the uterus and vagina. Our bladder works properly when important attachments to the vagina are intact. We lose skeletal muscle mass as we age and this impacts the ligaments and connective tissue supporting the pelvic organs. In effect, the loss of resilience may be more pronounced among women with genetically susceptible connective tissue which is made of collagen.

As Above, So Below

What does the brain have to do with the bladder, you might ask? Urinary incontinence is often caused by problems with the bladder during the filling and storage phase. The job of the bladder is to store urine and empty in socially acceptable circumstances. In order for our bladder to work properly, our brain, nervous system, and tissues that support the bladder must function well. The bladder sends messages, carried by nerves, to our brain which translates the message as a sensation of fullness, the brain then sends the message to contract and empty or to relax and fill.

The Bottom Line

So, how can we live in harmony with processes that seem to be inevitable? Stay healthy, avoid substances that create a negative impact on our bodies, and stay informed. There are means to achieve the end result of the quality of life, in regard to the bladder ranging from lifestyle changes to medication, and even surgery. When you are ready to pursue options to make peace with your bladder, simply make an appointment and we can continue this conversation!