Bladder Health: Prevalence

13 million Americans are incontinent; of those, 85% are women; 1 in 4 women 18 years or older have some type of incontinence; 1 in 5 adults over 40 years of age have symptoms of OAB (overactive bladder syndrome) and UUI (urinary urge incontinence) and that’s only the amount of women who actually report it! Some women may be embarrassed to discuss it with their doctor so there are many cases of incontinence that go unreported.

In other studies, it is estimated that over 40% of women who have given birth report some type of incontinence (JM PPH4M).

Studies have shown that women who have bladder dysfunction report a lower quality of life and decreased feelings of self worth.

1 in every 12 people that suffer from incontinence seek treatment.

80-90% of women who have treatment for their bladder dysfunction report a significant improvement in their symptoms (Voices for PFD).

Bladder dysfunction, in any shape or form, is NOT normal! Incontinence, or plainly put, any unwanted loss of urine, is a topic that most people tend not to talk openly about. Most women suffer in silence and are told, “it just happens with age” or feel that “it’s just one of those things that happen after you have kids.” Regardless, it is a topic that needs more discussion and should not be swept under the rug. There IS treatment for bladder dysfunction and it involves more than stocking up on pads (or buying stock in pads, for that matter!), avoiding running, trampolines or jumping jacks, limiting your water intake before you go anywhere or knowing where every bathroom is in stores!

So what are the different types of bladder dysfunction?

There is no cookbook recipe to what bladder problems can look like and someone may have one or a few of the below listed symptoms:

  • Stress Urinary Incontinence (SUI): ANY loss of urine occurring with an increase in abdominal pressure, such as coughing, sneezing, laughing, active exercise (walking, running, etc), and/or lifting.
  • Urge Urinary Incontinence (UUI): ANY loss of urine following a strong, sudden urge to urinate.
  • Mixed Urinary Incontinence: combination of both SUI and UUI.
  • Overactive bladder syndrome (OAB)/ Urgency/frequency syndrome: a sudden strong desire to urinate and/or increased number of voids (normal bladder function is 6-8x/day, 0-1x/night) Usually due to detrusor (muscle inside the bladder) over activity; symptoms may also include UUI.
  • Urinary retention: Inability to empty the bladder completely.
  • Interstitial Cystitis (IC)/Painful Bladder Syndrome: Pain in/around the bladder, usually caused by an inflammation in the lining of the bladder. Symptoms can include bladder/pelvic pain, pain during/after urination, urinary frequency and urgency as well as incontinence.
  • Pelvic organ prolapse affecting the bladder (cystocele): over-stretching of the vaginal/pelvic connective tissue (fascia) and muscles that hold up the bladder, causing the bladder to “fall” deeper into the pelvis.
  • Some symptoms may include: a pressure/heavy sensation in the pelvic cavity and/or vaginal vault, (some women report they feel like they’re “sitting on a ball)” urinary urgency/frequency, urine leakage, feelings of incomplete bladder emptying, and/or a visible bulge seen/felt at the vaginal opening.

How does this happen?

Some of the more common causes of bladder dysfunction are pregnancy, vaginal delivery, a history of straining/bearing down, known as “Valsalva” (such as with chronic constipation or activities that involve heavy lifting) or surgery to the abdominal/pelvic region. Other causes can be chronic respiratory problems that alter breathing patterns, causing more pressure in the abdominal cavity, neurological conditions (Multiple Sclerosis, stroke, traumatic brain injuries) that cause the nerves to not work properly that control the bladder, obesity, certain medications, or injury to the abdominal/pelvic region. And other times there is no clear-cut reason for a bladder problem. The first step is to discuss your bladder issue with a medical professional (primary care doctor/NP, OB/GYN, midwife, urogynecologist, physical therapist) to start the return to wellness!

Treatments:

A conservative treatment plan is usually the first line of defense when addressing a bladder problem. Physical therapy is commonly prescribed by doctors to treat neck pain or after knee surgery but who knew that physical therapy could help with bladder problems?? A physical therapist trained in pelvic floor dysfunction (PFD) will assess how the muscles of the pelvic floor are functioning along with investigating other musculoskeletal issues that may be contributing to the bladder problem (weakness in the core muscles and therefore putting more work load on the pelvic floor muscles, causing weakness), diastasis recti (separation of the abdominal muscles, commonly heard of during/after pregnancy but can have other causes) and identifying poor toileting habits (urinating “just in case” or frequently in order to stay dry, pushing when you urinate).

Physical therapy treatment for bladder dysfunction includes pelvic floor and core muscle retraining, behavioral modifications (bladder retraining/timed voiding, managing fluid intake, reducing bladder irritant intake) and lots of education.

Medical Management

Evaluation by a medical doctor (primary care physician, OB/GYN, urogynecologist) to determine if/what course of medical management should be taken is usually the first step to diagnose and treat bladder dysfunction. There are various types of medications used to quiet the over activity of the bladder muscle (detrusor) and they can be very helpful, especially in conjunction with the behavioral modifications listed above. A pessary (a small device that is inserted into the vagina to provide more support to the bladder) is another conservative treatment and is fitted by your doctor. Surgical options are also available to address causes of bladder dysfunction and these will be described in much more detail in our piece tomorrow.

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