Why I can't hold my urine

Urinary incontinence(UI)  is the involuntary leakage of urine.  It is a condition often suffered in silence as many shy from speaking of such matters. It is mostly always accompanied with fear and anxiety during daily activities, always needing to be near a washroom, and it can prevent one from enjoying life.

Incontinence affects twice as many women as men, due to their unique health events, such as pregnancy, childbirth, and menopause, that may affect the urinary tract and the surrounding muscles.

 The pelvic floor muscles that support the bladder, urethra, uterus (womb), and bowels may become weaker or damaged. When the muscles that support the urinary tract are weak, the muscles in the urinary tract must work harder to hold urine until you are ready to urinate. This extra stress or pressure on the bladder and urethra can cause urinary incontinence or leakage.

 Urinary incontinence is not a disease by itself. Urinary incontinence is a symptom of another health problem, usually weak pelvic floor muscles. In addition to urinary incontinence, some women have other urinary symptoms.

There are different causes, characteristics and triggers for urine leakage. Knowing the type of incontinence is often an important part of the diagnosis and treatment plan for incontinence.

The types of incontinence include:

Urge incontinence:

This type of incontinence is characterized by an intense need to urinate right away. Often, this happens too quickly for you to make it to a toilet and you end up leaking urine. Urge incontinence can be caused by a condition called overactive bladder (OAB). You could have OAB for a variety of reasons like having weak pelvic muscles, nerve damage, an infection, low levels of estrogen after menopause or a heavier body weight. Some medications and beverages like alcohol and caffeine can also cause OAB.

Stress incontinence:

When you leak urine during activities, this is often stress incontinence. In this type of incontinence, your pelvic floor muscles are weak and no longer support your pelvic organs as they should. This muscle weakness means that you’re more likely to accidentally leak urine when you move around. For many people, leakage issues happen when they laugh, cough, sneeze, run, jump or lift things. These actions all place pressure on your bladder. Without the support of strong pelvic muscles, you’re more likely to leak urine. Women who have given birth are at a higher risk of having stress

incontinence. Men who have had prostate surgery may develop stress incontinence. 

Overflow incontinence:

If your bladder doesn’t empty completely each time you urinate, you could have overflow incontinence. Think of the bladder as a juice jug. If you only pour some of the juice out of the jug, but not all of it, there’s still a risk that you could spill when you move around. People with overflow incontinence never completely empty the bladder — placing them at risk for a spill. Usually, this results in small amounts of urine dripping out over time instead of one big gush of urine. This type of incontinence is more common in people with chronic conditions like multiple sclerosis (MS), stroke or diabetes. This may also occur in men with a large prostate.

Mixed incontinence:

This type of incontinence is a combination of several problems that all lead to leakage issues. When you have mixed incontinence, you might be dealing with stress incontinence and an overactive bladder. It’s often important to pay attention to what you’re doing when you have leakage issues with this type of incontinence. Identifying what triggers mixed incontinence is usually the best way to manage it.

Management.

Be physically active.

Although you may not feel like being physically active when you have incontinence but even something like walking can improve your health. If you’re concerned about not having a bathroom nearby during physical activity, find a place with nearby restrooms, such as a shopping mall, community park, or local gym.

Avoid constipation.

Constipation, can make urinary tract health worse and can lead to UI. Make sure to drinking more liquids and eat enough fiber to help avoid constipation.

Bladder training

is when you urinate on a schedule to help reduce leaking. Use the bathroom on a regular schedule, this is called timed voiding. Gradually lengthening the time between trips to the bathroom can help stretch your bladder so it can hold more urine.

Control your urge to urinate.

You may be able to suppress, or control, the strong urge to urinate, called urge or urgency suppression. With this type of bladder training, you can worry less about finding a bathroom in a hurry. Some people distract themselves to take their mind off needing to urinate. Other people find that long, relaxing breaths or holding still can help. Doing pelvic floor exercises to strengthen your pelvic floor also can help control the urge to urinate. Quick, strong squeezes of the pelvic floor muscles can help suppress urgency when it occurs, which may help you get to the toilet before you leak.

Do pelvic floor muscle exercises.

Strong pelvic floor muscles hold in urine better than weak muscles. You can make your pelvic floor muscles stronger by doing Kegel exercises. These exercises involve tightening and relaxing the muscles that control urine flow.

Men can also benefit from pelvic floor muscle exercises. Strengthening these muscles may help a man leak urine less often, especially dribbling after urination.

 A physical therapist can help you get the most out of your Kegel exercises by helping you improve your core muscle strength. Your core includes your torso muscles, especially the lower back, pelvic floor muscles, and abdomen. These muscles all keep your pelvis lined up with your spine, which helps with good posture and balance. Your physical therapist can show you how to do some exercises during daily activities, such as riding in a car or sitting at a desk.

In some cases the doctors will give medication, devices and surgery if necessary according to the cause and severity.

References

  1. Angelini K. Pelvic floor muscle training to manage overactive bladder and urinary incontinence. Nursing for Women’s Health. 2017;21(1):51–57.
  2. Womenshealth.gov
  3. Urologyhealth.org

Written By:

Joy Waihenya,
Physical Therapist
Chiropractic & Physiotherapy Health Centre

Why Can’t I Hold My Urine?

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