Retrain Your Bladder

Retrain Your Bladder

Don’t let urinary incontinence dampen your life

If you’ve experienced some form of urinary incontinence — the accidental release of urine — you are not alone. It’s an issue that affects 25 million people in the U.S., according to the National Association for Continence. And if you’re a woman, it’s twice as likely to be an issue, according to the U.S. Department of Health and Human Services.

“This is a huge women’s health concern,” says Kimberly Kenton, MD, chief of urogynecology at Northwestern Medicine and director of the Women’s Integrated Pelvic Health Program at Northwestern Medicine. “Urinary incontinence typically starts for women in the reproductive years. After pregnancy and a vaginal delivery, there’s a 30 percent increase in urinary incontinence for women.”

The increase in urinary incontinence after pregnancy makes sense given the pressure the uterus puts on the bladder, Kenton says. Then, when giving birth, pelvic muscles can become stretched and weakened, and nerves can be damaged.

Got to go

Even if you’ve sailed through childbirth without an issue, urinary incontinence can creep up on you with age. By 40, urinary incontinence affects 30 to 50 percent of childbearing women, according to the National Association for Continence. By the time women are in their 60s, about two-thirds suffer some form of incontinence, Kenton says.

There are two main types of incontinence: stress and urge. Stress incontinence occurs when a physical movement — like coughing, lifting or running — exerts force on your bladder, causing urine leakage.

Urge incontinence — also called over- active bladder — is the strong, sudden urge to pee at inappropriate times, such as when you hear the sound of water, experience a temperature change or even turn the keys to unlock your front door.

“When it comes to urinary inconti- nence, severity is truly personal — it’s all about how much the leaking is bothering the individual woman,” Kenton says. “No amount of incontinence is normal, but it’s also not life-threatening. And there are plenty of solutions.”

Addressing incontinence

Pelvic floor exercises (or Kegel exercises), which involve repeatedly contracting and relaxing the pelvic floor muscles, can help. But, Kenton says, seeking the guidance of a physical therapist can be even more advantageous. After all, some muscles may need lengthening, some stretching and some tightening.

A physical therapist assesses what’s going on with your pelvic floor muscles and shows you the exercises needed to help the muscles support the bladder and help the body regain control of leakage, spasms and urine stream.

If your leakage is persistent, the tried-and-true pessary — a removable plastic device — can be placed in the vagina like a tampon during the day or during a strenuous activity and taken out at night. Its purpose is to support the neck of the bladder and help prevent leakage.

If you aren’t planning any future pregnancies and are living with stress incontinence, bladder sling surgery has a 90 percent success rate. In this 10-minute, minimally invasive outpatient procedure, mesh is inserted under the urethra for support. Patients can return to full activities the next day, Kenton says.

A slew of bladder medications address urinary incontinence. The largest class, anticholinergic drugs, work to counter overactive bladder. The drugs block the chemical messenger — acetylcholine — that sends signals to the brain to trigger abnormal bladder contractions. Popping these pills can come with side effects including dry mouth, dry eyes and constipation.

For urge incontinence, there’s Botox for the bladder, which results in few side effects and no leakage for six to 12 months. There’s also the option to surgically implant a small device into the sacral nerves that emits electrical pulses that communicate with the brain and bladder. This FDA-approved “pacemaker for bladder” can reduce urinary leaking and urgency, Kenton says.

Bladder training

And then there is bladder training, a form of behavior modification.

“Thankfully, any bladder that has some form of dysfunction — whether it’s not emptying enough or it’s emptying too much — can be retrained,” says Alan Y. Sadah, MD, urogynecologist at West Suburban Medical Center. “Bladders are malleable, like a thermostat. They sometimes need to be recalibrated or retrained.”

In some cases, such as when an individual is experiencing urge inconti- nence, has dementia or when the impulse to empty isn’t received, timed voiding can help. Timed voiding means that the bladder is emptied on a regular basis, like every hour on the hour — not only when the urge to void is felt.

“Now instead of the bladder being in control, the individual is,” Sadah says. “Bladders can be retrained. It just takes a plan and some time.”

“By 40, urinary incontinence affects 30 to 50 percent of childbearing women. By the time women are in their 60s, about two-thirds suffer some form of incontinence.”

Retraining her bladder was necessary for Katy Groves, 41, of Oak Park. After delivering her baby one year ago, her bladder was temporarily paralyzed, possibly due to an epidural during childbirth. Sadah describes this as the bladder going into hibernation, or sleep mode, and says this can happen when anesthetized, such as with an epidural or hysterectomy.

Over the next few months, Groves learned to use a variety of catheters, went to physical therapy and acupuncture and used timed voiding to help get her bladder out of sleep mode and back in working order.

“After a vaginal delivery, you need to learn to reuse your pelvic floor muscles,” says Margaret G. Mueller, MD, urogynecologist at Northwestern Medicine. Pelvic floor symptoms, such as urinary difficulties, perineal pain and pelvic pain, can be common post-delivery. Seeing a physical therapist can help, she says.

Mueller and Kenton are part of Northwestern Medicine’s PEAPOD (Peripartum Evaluation and Assessment of the Pelvic Floor around Delivery) clinic, a program for new mothers who experience pelvic floor symptoms.

Urinary incontinence doesn’t have to be a thing that just happens to you. You should be able to run, sneeze and unlock your front door without fear

of leakage. On average, women wait over six years from the first time they experience symptoms until they obtain a diagnosis for their bladder control problems, according to National Association for Continence.

Instead, think like a bladder and act with urgency. Make it your number one priority — pun intended. There are revolutionary solutions and techniques to help your bladder now.

Originally Published in the Spring/Summer 2018 issue