Incontinence 101: Why Incontinence Occurs

Peeing your pants, leakage, wetting yourself, urinary incontinence...whatever you call it, it’s a real issue that is a reality for a surprising number of people. Why incontinence occurs is one of the top questions we get! In this post, we’ll explain the ins & outs of this pesky issue, why incontinence occurs, whether it will go away, and what you can do to treat it.

What is Incontinence?

Incontinence is an involuntary loss of control over the bladder, bowels, or gas. It refers to any amount (even just a little bit!) of any type of leakage at any time. You can read that again. Even if you only pee a little when you sneeze, that’s still incontinence. Even if you lost control of your bowels a couple of times on a run, that’s still incontinence. According to the National Association for Continence (NAFC) more than 25 million people in the USA experience leakage daily, and despite being highly treatable only 1 out of 12 people who experience incontinence seek help. There are three most common types of incontinence including: stress incontinence, urge incontinence, and mixed incontinence.

Types of Incontinence

  1. Stress Incontinence. Stress incontinence is leakage caused by an activity that increases pressure or stress on the pelvic floor. These activities might include coughing, sneezing, running, jumping, laughing, heavy lifting, exercise, etc. It has nothing to do with psychological stress. A person experiencing stress incontinence may or may not leak every time they do one of these activities, and they might notice that their incontinence is worse with a full bladder.
  2. Urge Incontinence. Urge incontinence is leakage that occurs following a sudden, random urge to urinate. This type of incontinence happens when the bladder and sphincter muscles are not functioning properly. People with urge incontinence may feel the need to urinate often, including in the middle of the night. The NAFC estimates 12.2 million adults in the United States experience urge incontinence.   
  3. Mixed incontinence. Mixed incontinence is when more than one type of incontinence is present.

Why Incontinence Occurs

The cause of incontinence is different for every person. In fact, for some, there may be multiple factors to consider. Some of the most common explanations for why incontinence occurs are: bladder irritants, dehydration, pelvic floor dysfunction, pregnancy and childbirth, menopause, and poor bladder habits.

1. Bladder irritants

Bladder irritants are foods and beverages that aggravate the bladder. The lining of the bladder is very sensitive, and if an irritating liquid is inside the bladder, it will attempt to get rid of these contents at any chance it gets. Common bladder irritants include: caffeine, alcohol, acidic liquids/foods, some vitamins, some dairy, and items containing artificial sweeteners. Basically, anything that isn’t water has the potential to irritate the bladder. Certain medications can also lead to increased urination, so speak with your medical provider for more information and to see if medications you are taking could be causing more frequent urination.

2. Dehydration

On the topic of liquids, hydration is also key when it comes to leakage. A common myth about water is “if I drink less, I’ll leak less...” FALSE! Hydration is necessary for proper function of the pelvic floor. The pelvic floor muscles need to be hydrated to function at their full capability, just like any muscle in the body. Dehydration can sometimes lead to increased leakage because of decreased muscle function and because the urine is more concentrated, leading to bladder irritation as mentioned above. Realistically, two thirds of the fluids we drink each day should be water, with a total of fluid intake during the day being half your bodyweight in ounces. Breastfeeding, exercise, and altitude can all affect hydration as well. Dehydration can also lead to constipation, and constipation (regardless of the cause) can cause stress to the pelvic floor leading to leakage.

3. Pelvic Floor Dysfunction

Pelvic floor dysfunction is an umbrella term that describes issues occurring with the pelvic floor muscles. This dysfunction can include weak muscles, tight muscles, and scar tissue.

  • Weak Muscles: If the pelvic floor muscles are truly weak, it’s understandable that leakage can occur, since the muscles are unable to do their job to stop urine from leaking out. True pelvic floor weakness (and the incontinence/issues that follow) will likely improve with kegels. However, be cautious: many people are misdiagnosed with weak pelvic floor muscles.
  • Tight Muscles: If the pelvic floor muscles are too tight (which is more common than weakness) kegels won’t improve the issue and will likely make things worse. Attempting to strengthen muscles that are already tight is likely to lead to further tightness. When a muscle is already tight and more stress is placed on the muscle, that muscle will be unable to perform its normal functions, such as stopping leakage from happening.  Tight muscles can also prevent the bladder from fully emptying. Check out the video below to do a self assessment of your pelvic floor to help differentiate between a tight or weak pelvic floor.
  • Scar tissue: Scar tissue (usually a result of childbirth) surrounding the pelvic floor muscles can lead to the muscles being unable to contract or relax fully, preventing the bladder muscles from functioning as they should.

4. Pregnancy/Childbirth

While you probably won’t hear about pelvic floor issues in your prepping for baby reading, pelvic floor dysfunction leading to incontinence is very common during and after pregnancy. However, this doesn’t mean that it’s normal to have leakage at either time. While the pelvic floor undergoes increased stress during pregnancy, the pelvic floor should still be able to withstand this extra demand and you should be able to make it through pregnancy without experiencing incontinence. The same goes for post-baby: Once the initial healing phase is completed, there really should be no pelvic floor issues beyond 6-8 weeks postpartum. If you continue to have leakage beyond this point, physical therapy can be beneficial.

5. Menopause

Menopause is a common cause of incontinence many people forget about and brush off. A common thought pattern we hear is, “well I’m just getting older, it’s what I should expect”. FALSE! Did you know that it’s actually not normal to experience leakage as we age? With menopause, the cause can come from two major issues: decreased lubrication inside the urethra and weakness of the pelvic floor muscles. As expected, the drop in estrogen and the shift in hormones are to blame for these issues. The hormone shift leads to decrease lubrication the tissue of the urethra (where urine exits the body), without proper lubrication this tube can’t function normally. This hormone change also leads to a global weakening of strength throughout our body, leading to also pelvic floor weakness and therefore leakage. This makes it important to continue with strength training and exercise as we age.

6. Bladder Habits

Did you know we can train our bladder to do crazy things and empty at certain times and in certain places? Have you ever gone to unlock the door of your house or stepped into the shower and suddenly had a very strong urge to urinate and had to run to the bathroom to hopefully make it in time? It’s possible you’ve trained your bladder to think it needs to empty when you do these activities.

Another bladder habit to be aware of is when you use the bathroom “just in case.” If we consistently don’t allow our bladder to fill fully between urinating then the sensors in the bladder start to think that partially full = completely full. And when this habit is repeated long-term, it will lead to very frequent bathroom trips. You may even notice when you go that it didn’t seem like there was much to empty. It is normal to urinate 6-9 times in a 24 hour period and have 2-4 hours between bathroom breaks. Emptying the bladder more frequently than this may indicate that you have created some bad habits.

The good news is that these poor bladder habits can be reversed. All it takes is some training, just like any other muscle. A pelvic floor physical therapist can help give you tips on how to retrain your bladder.

The Wrap Up

Long story short, the explanation for why incontinence occurs goes deeper than “I just need to do more kegels.”  The causes of incontinence and the steps needed to resolve are unique for every person and are dependent on many different factors. While kegels can improve incontinence for some, this exercise does not resolve everyone’s issues.

National Center for Continence:

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