Bladder Control Basics
Following is helpful information about:
- The urinary process
- Kegel exercises to strengthen your bladder muscles
- Common causes of bladder leaks
- Types of bladder leakage
- Voiding diary - instructions and printable form
We'll start out with a snap shot of how your system processes urine - Urinary Tract 101, if you will! Then we'll identify some of Knowing the basics will help you understand your needs and how best to talk with your doctor. In many cases, little bladder leaks can be cured and in all cases it can be managed.
The Urinary Process
Your urinary tract is a system for collecting, storing and expelling liquid waste (urine) from your body. The bladder stores the urine. When the bladder is full, it triggers the urge to expel the stored urine through the urethra. Special muscles called sphincter muscles hold the urethral tube closed so that you can control the release of urine. Another muscle group called the pubococcygeus (PCG), also helps in the process. It encircles the urethra, vagina and rectum. Many women with incontinence, or loss of bladder control, have weakened or damaged muscles, and may not be able to sense when their bladders are full, which leads to difficulty in controlling urination. Many women are able to gain back some strength in these muscles and minimize lack of bladder control by learning and practicing Kegel exercises.
Kegel Excersizes - to strengthen bladder muscles
If your symptoms of urine leakage usually happen after coughing, sneezing, laughing, or lifting heavy objects, your physician may ask you to perform Kegel exercises. Kegel exercises are designed to strengthen the muscles located around the bladder opening. By exercising these muscles, you may improve your symptoms. In order to realize the maximum benefit from these exercises, it is very important that you perform them correctly.
You can identify the muscles located around the bladder opening by starting and stopping your urine stream. These are the same muscles used for Kegel exercises.
Stopping your urine stream is only a way to identify the muscles used for this exercise. It is not advisable to perform Kegel exercises while urinating.
Another way to identify the muscles used for Kegel exercises is to tighten the rectal muscles (as when holding back gas or completing a bowel movement). Because they are part of the same muscle group, the rectal muscles always work with the muscles located around the bladder opening.
It may take several tries to locate these muscles. Try not to use your stomach, buttock, or leg muscles. See your health care provider if you have difficulty identifying these muscles.
Once you have identified these muscles, there are different types of Kegel exercises: the quick Kegel and the slow Kegel. In performing the quick Kegel, these muscles are rapidly tightened and relaxed. During the slow Kegel, the muscles are tightened for 5 to 10 seconds and then relaxed.
Most people start by completing a set of ten Kegels four times a day. Each week, the number of contractions and relaxations, and the length of time the contractions are held, are gradually increased. Kegel exercises may be done with other activities, such as watching television, ironing, or relaxing. Because it may take several weeks to notice an improvement, it is important that you continue doing these exercises. Regular periodic follow-ups with your physician will assess the benefits of these exercises as well as provide the opportunity to review your Kegel exercise technique.
If your symptoms do not improve, ask your physician, nurse, or therapist to help you. Many individuals need a health care provider's help to identify the correct muscles to use.
Common Causes of Bladder Leaks
Little bladder leaks are not an inevitable part of getting older. And it's not something you just have to "live with" after bearing a child. Little bladder leaks are not a disease—it is a symptom of another medical condition or the side effect of a medication. You may be surprised to learn that there are a number of things that can cause bladder control loss. It's helpful to recognize what kind of bladder control loss you might have so you understand it and can better explain it to your health care provider.
Short Term Bladder Control Loss
Urinary tract and bladder infections, constipation and medication side effects are some of the most readily treated causes of short-term bladder control loss. Following a visit to your physician, relief is usually quick.
Long Term Bladder Control Loss
Childbirth, auto accidents or surgical procedures can sometimes cause longer-term conditions. Recovery from these causes may affect the rate at which little bladder leaks can improve.
- Types of Bladder Leakage
- Stress incontinence
- Urge incontinence
- Overflow incontinence
- Functional incontinence
- Mixed incontinence
- Anatomic or developmental abnormalities
- Temporary incontinence
Most common type with women. People with stress incontinence involuntarily leak urine while exercising, coughing, sneezing, laughing or lifting because pressure on the bladder causes leaking. Think of a balloon which leaks air (or water) because the knot is loose.
These activities apply sudden pressure to the bladder, causing urine to leak out. Stress incontinence is the most common type of incontinence among women, and may be due to weakened pelvic muscles, weakening in the wall between the bladder and vagina, or from a change in the position of the bladder. In many cases, the condition develops as a result of pregnancy and childbirth. Other causes of stress incontinence include:
- Weakening of muscles that hold the bladder in place, or of the bladder itself
- Weakening of the urethral sphincter muscles
- In men, benign prostatic hyperplasia (a noncancerous overgrowth of the prostate gland) prostate cancer or from prostate surgery
- In women, a hormone imbalance or a decrease in estrogen following menopause, which can weaken the sphincter muscle
- Damage to the nerves controlling the bladder resulting from diseases such as diabetes, stroke, Parkinson's disease and/or multiple sclerosis, or from treatment of gynecologic or pelvic cancers with surgery, radiation or chemotherapy
Most common in the elderly. Urge incontinence is the frequent, sudden urge to urinate with little control of the bladder (especially when sleeping, drinking, or listening to running water). It’s a problem with an over sensitive bladder.
Urge incontinence is also known as spastic bladder, overactive bladder or reflex incontinence. Marked by a need to urinate more than seven times daily or more than twice nightly, urge incontinence is most common in the elderly. It also may be a symptom of a urinary infection in the bladder or kidneys, or may result from injury, illness or surgery, such as:
- Diseases of the nervous system, such as multiple sclerosis, Alzheimer's or Parkinson's
- Tumors or cancer in the uterus, bladder or prostate
- Interstitial cystitis (inflamed bladder wall)
- Prostatitis (inflamed prostate)
- Prostate removal, cesarean section, hysterectomy, or surgery involving the lower intestine or rectum
Caused by weakened bladder muscles. Individuals with overflow incontinence can’t completely empty their bladder, causing either a constantly full bladder requiring frequent urination or a constant dribbling of urine, or both.
This type of incontinence is generally caused by weakened bladder muscles as a result of nerve damage from diabetes or other diseases. It can also result from the urethra being blocked due to kidney or urinary stones, tumors, an enlarged prostate in men, or a birth defect.
Common among elderly with certain conditions. Functional incontinence is the most common type of incontinence among elderly individuals with arthritis, Parkinson's disease or Alzheimer's disease. Frequently, these individuals are unable to control their bladder before reaching the bathroom due to limitations in moving, thinking or communicating.
Some individuals have two types of incontinence simultaneously, typically stress incontinence and urge incontinence. Mixed incontinence is the most common type in women, and what causes the two forms may or may not be related.
Anatomic or developmental abnormalities
Incontinence is sometimes caused by a physical or neurologic abnormality. An abnormal opening between the bladder and another structure (fistula) can cause incontinence, as can a leak in the urinary system.
Some patients lose normal bladder function because of damage to part of the nervous system due to dysfunction, trauma, disease or injury. Called neurogenic bladder, the damage can cause the bladder to be underactive, in which it is unable to contract and empty completely, or overactive, contracting too quickly or frequently.
Temporary incontinence may be caused by:
- Severe constipation
- Infections in the urinary tract or vagina
- Certain medications, such as diuretics (water pills); sleeping pills or muscle relaxants; narcotics, such as morphine; antihistamines; antidepressants; antipsychotic drugs; or calcium channel blocker.
- See Your Doctor
We hope this information has given you a better understanding of the causes and types of little bladder leaks and will make it a little easier to talk with your doctor. You can help your doctor make an accurate assessment by completing a urine voiding diary for seven days before your visit. Also, make a list of any prescription and over-the counter medications you're taking and let him/her know of any family history, accidents and injuries that might be contributing to your little bladder leaks. Keep in mind that many women who seek treatment see an improvement in their situation.
The urine voiding diary gives your physician a picture of your incontinence. Keeping an accurate and thorough diary will allow your doctor to see a clearer picture of your individual situation. Try to keep your diary for at least a week before you see your doctor, then take it with you to your appointment.
- Make at least seven copies of the blank voiding diary form so that you can keep the diary for a week
- Record the time of day when you void in the toilet or have leakage
- Record (yes/no) that you voided in the toilet in the "Toilet" column
- Indicate the degree of leakage (none/damp/wet) in the "Leakage" column
- Indicate if you changed your absorbent product or had to change your clothing
- Note your activity at the time of any leakage
- Measuring the amount you drank or voided may help the doctor or nurse assess your condition. If possible, record these measurements in the "Fluid Intake" and "Fluid Output" columns.