How to Stop Female Urine Leakage: 5 Super Effective Strategies
Understanding Urine Leakage & How to Stop Female Urine Leakage
What is Female Urinary Incontinence?
Urinary incontinence is the involuntary leakage of urine. It is very common among women, and though many people believe this happens after childbirth, it can happen to females of any age. Prevalence ranges depending on studies and age range. Urinary leakage keeps many women from participating in hobbies and activities they love, greatly affecting their quality of life.
Common Causes of Urine Leakage in Women
There are two primary issues that I see for urinary leakage. The first is bladder neck hypermobility, and the second is pelvic floor dysfunction.
Of the group with pelvic floor dysfunction there’s three types of dysfunction:
Pelvic floor muscle overactivity
Pelvic floor muscle weakness
Pelvic floor coordination deficits
The good news: both groups are able to be treated conservatively with pelvic floor PT and/or a pessary depending on the mobility of the urethra.
As you can imagine, a thorough assessment and diagnosis is required to accurately treat urine leakage.
Types of Urinary Incontinence: Stress, Urge, Overflow, & Functional
Stress incontinence usually occurs with things like laughing, coughing, jumping or sneezing. Generally things that put more pressure on the pelvic floor or force generated in the abdomen. This doesn’t necessarily mean the pelvic floor muscles are weak, as I have found that in general, it is usually more of a coordination issue. Your diaphragm, deep core muscles, and pelvic floor should all fire together, and if they are not, this can lead to urinary stress incontinence. Things like overconsumption of bladder irritants (fluids that irritate the lining of the bladder), and dehydration can exacerbate this.
Urge incontinence is when people experience urinary leakage walking to the bathroom, pulling in the driveway of their home, walking through the door into their home, or hear running water. With patients, I often find that the pelvic floor muscles are more tense, affecting the pudendal nerve— a nerve that courses through the pelvic floor muscles. Similar to stress incontinence, and dehydration and bladder irritants can exacerbate this too.
Overflow incontinence occurs when the bladder simply becomes too full and urine overflows from within the bladder. Individuals with overflow incontinence can feel the need to urinate, but can often only release a small amount of urine. This can be from neurological causes or an enlarged prostate.
Lastly, functional incontinence occurs when an individual is unable to make it to the toilet to urinate due to functional reasons, like an inability to walk to the bathroom or unable to remove their clothing to urinate. Helping people improve their functional independence can help treat functional incontinence.
The Impact of Pregnancy and Childbirth on Urine Leakage
It’s no secret that more women have urinary leakage following childbirth. But why?
There can be many reasons for increased leakage – depending on the birth.
For patients who give birth vaginally, we see more stress incontinence (likely due to the trauma to the pelvic floor), but for patients who give birth via cesarean we see more urinary urge incontinence (likely due to scar tissue).
Not every woman that experiences birth will have leakage, but it is quite common. Don’t forget - there is help if this is something you are experiencing. You don’t have to live with urinary leakage because you’ve had a baby!
Hormonal Changes and Urinary Incontinence
Hormonal changes that occur postpartum and postmenopause certainly play a role in urinary leakage. If breastfeeding, estrogen levels are lower similar to the postmenopausal period. Lower estrogen levels means less plump pelvic floor muscles (which help support the bladder and close the urethra).
If hormonal changes are a contributing factor to urinary incontinence, you are not doomed but would probably benefit from topical estrogen to help get those muscles functioning properly.
Diagnosis and Evaluation
When to Seek Medical Help for Urinary Leakage
Unfortunately, this is something a lot of women are told is normal – especially after childbirth. Though incredibly common, it is not normal and there is help for this. If this is something you’re struggling with or ever encounter, I recommend seeking medical help as soon as you can. If you are told this is just normal, ask for a referral to a pelvic floor PT.
Physical Examination for Urine Leakage Issues
If you are trying pelvic floor PT for treatment for urine leakage, a physical examination (with consent of course) assessing the pelvic floor muscles is what you can typically expect at your first visit.
This examination is similar to but different than an exam by your OBGYN. They (OBGYNs) are typically accessing your reproductive organs, while we (PTs) are assessing your muscles, nerves, pain and coordination of the muscles, along with the muscles surrounding to pelvis.
There are three layers of pelvic floor muscles, and typically all are assessed during the initial evaluation with consent. The first layer pelvic floor muscles help close the holes (urethra, vagina, and anus), while the third layer muscles support the organs. The second layer muscles, sandwiched between the first and second layer, surround the urethra.
After a comprehensive pelvic floor muscle examination, your therapist should give you an assessment of what’s going on and why followed by a plan to address the root issues of your incontinence.
Identifying Underlying Conditions Affecting Bladder Control
In addition to a thorough examination, your therapist should take a deep dive into your health history and medication list if applicable to find other contributing factors relevant to your incontinence.
Common medical diagnoses we see that contribute to urine leakage that might surprise you includes:
Anxiety
Diabetes
Ehler’s danlos
Congestive heart failure
Treatment Options
Lifestyle Changes to Reduce Urine Leakage
I have seen so many people resolve their urinary leakage without surgical intervention through lifestyle modifications such as:
Strategic exercise/movement
Managing constipation
Increasing water intake
Decreasing bladder irritants
Core/glute strengthening
Of course, the effectiveness of all of these recommendations depends on the reason for and type of urine leakage you might be experiencing.
Pelvic Floor Exercises: Strengthening for Control and Coordination
A kegel is a voluntary pelvic floor muscle contraction, often recommended for pelvic floor symptoms like incontinence and prolapse.
Unfortunately, per the research, 50% of women report being unsure if they’re even doing kegels correctly.
Additionally, this isn’t exactly how the pelvic floor works. The pelvic floor muscles need to contract AND relax. These muscles are more often more tense than weak, anyways. There’s a lot more information about how the pelvic floor muscles work here. But for the sake of this blog, I’m going to give you five strategies that are more effective at managing urinary incontinence than kegels.
Hip internal rotation: because of muscular attachments in the pelvis and on the femur, when the hips internally rotate the pelvic floor muscles lift and pull forward (the same motion as a kegel). During pregnancy, most women live in an externally rotated position, which can lead to leakage.
Glute strengthening: if the glutes do their job, the pelvic floor muscles don’t have to work overtime doing both jobs. By doing both jobs, these muscles become overworked and typically not able to do their job when needed (like with laughing, coughing, or sneezing).
Pelvic floor coordination training: there’s a lot more on that & why it is important HERE.
Constipation management: a full rectum sits on the pelvic floor muscles like a weight, making it harder to do their job. HERE is a more detailed blog about managing constipation.
Minimizing bladder irritants: and last but not least, the bladder irritants. There are fluids that you might be consuming that are very irritating to the bladder. Consuming less of these and more water helps tremendously with leakage. Read more about bladder irritants HERE.
Medications for Managing Urinary Incontinence
The most common medications prescribed for urinary incontinence include:
Oxybutin
Vesicare
Gemtesa (new, works on muscles so it doesn’t cause all of the dry eyes and dry mouth side effects like oxybutin)
Common side effects of these medications include:
Dry eyes
Dry mouth
Dry everything because that’s how the medication works & unfortunately the receptors that the medication bonds to are not specific to the bladder
Medical Devices and Surgical Options for Treatment
A pessary is a medical device prescribed and fitted to an individual with the goal of supporting the pelvic organs or eliminating stress urinary incontinence. I like to say it’s similar to a sports bra; they come in different shapes and sizes and provide a little extra support. Additionally, like sports bras, each person has a little different preference when it comes to fit and size. The most commonly fitted pessaries include rings and cubes each of which comes in different sizes and variations. Pessaries are similar to a prosthetic, and that they have to be sized and fitted to each person according to the goals of the individual.
Who can fit a pessary? In the United States, OB/GYN’s, Urogyn’s, and pelvic floor physical therapists with further training in pessaries are able to fit pessaries.
The most common surgery for urinary leakage is a bladder sling surgery. This is typically done for a hypermobile urethra – it keeps the urethra from moving so much.
Prevention Strategies
Preventing Urinary Incontinence During Pregnancy
Pregnancy is a season that can definitely increase/exacerbate urinary leakage due to many factors. Some of the common contributing factors include:
Pelvic floor overactivity due to pelvic instability
Constipation
Postural changes to accommodate center of mass changes
Increased pressure on the pelvic floor muscles (hello growing uterus)
While there are many things you cannot control during pregnancy, a few things that can help prevent urinary incontinence during pregnancy include:
Managing constipation
Core strengthening
Paying attention to posture
Eccentric glute strengthening to maintain hip internal rotation range of motion
If you do experience an increase in urinary leakage during pregnancy, the research shows pregnancy is the best time to seek treatment rather than waiting until postpartum.
Healthy Habits to Maintain Bladder Control
If I could give three healthy habits to maintain bladder control they would be:
Daily movement of some type - but incorporating core strengthening is important
Drinking 60-80 ounces of water each day
Aiming for daily bowel movements
The Role of Diet in Preventing Urine Leakage
The primary role of diet in preventing urine leakage (in my opinion) should be aimed at managing constipation. A full rectum sits on top of the pelvic floor muscles, and makes it harder for the pelvic floor to do its job and puts unnecessary pressure on the bladder.
Adequate fiber intake is 25-35 grams per day. My favorite sources of fiber include:
Avocados
Oatmeal
Legumes
Fruits
Vegetables
Dates
Flaxseeds and chia seeds
Fluid Management Techniques for Bladder Health
The interesting thing is that most people will eliminate water when they are experiencing urinary leakage, but continue drinking other things like soda, coffee, and tea.
This means those fluids (bladder irritants) are more concentrated in the bladder. By increasing water intake to 60-80 oz/day, these fluids are diluted in the bladder and the bladder lining can become less irritated or symptomatic.
Recognizing and Avoiding Triggers for Incontinence
Triggers from incontinence can vary based on type of incontinence.
Examples of triggers for urge incontinence:
Driving into the driveway or garage
Hearing running water
Walking to the bathroom
Examples of triggers for stress incontinence:
Laughing
Coughing
Sneezing
Jumping
Other triggers for incontinence:
Fluids including coffee, tea, soda, artificial sweetener, and juice
Constipation
If female urine leakage is something you are experiencing – good news! We are currently taking new patients in Rockwall, Canton, and Sulphur Springs. If you are interested in scheduling an appointment, please request an appointment here and someone from our team will reach out to you to get you scheduled.
