When Your Bladder Doesn't Hold Up
Sage advice from a female urologist.
It’s our best-kept secret, only it’s not exactly a secret.
We women have an issue with peeing.
It’s not that we can’t go. It’s that we can’t stop going. In the middle of the night. After we’ve already gone. While going for a jaunt around the block…
One in three women in the U.S. deal with bladder leaks (and that’s likely universal). After all, bladders are bladders, right?
I first realized that my bladder was not up to snuff when I returned to my aerobics class as soon as I was cleared by my ob-gyn, following the birth of my first son. My body felt fine, but just as I was getting my dance moves back, my bladder decided to remind me that it was not fine. Even though it didn’t feel full, it was yearning to be set free.
Yes, leakage. At the time I was not prepared for this, but of course, now I know that our pelvic floor muscles stretch during pregnancy and remain that way for some time.
Incontinence…let us count the ways.
There’s stress incontinence (when urine leaks if we cough, sneeze, laugh, etc.)
There’s urge incontinence; sometimes called “overactive bladder” (when we have a sudden and overwhelming urge to urinate, even if our bladders are not all that full, and can’t make it to the bathroom in time).
And then there’s urinary frequency - the need to pee …and pee…and pee – a lot.
Kegels, kegels – if and when I remembered to do them – helped.
The problem disappeared over time. But then, ta-da! Perimenopause hit, and my bladder nudged me once again to acknowledge it.
So many women – especially after menopause – suffer some sort of incontinence. Yay.
The culprit this time? Lower levels of estrogen during causing problems like nocturia (having to pee in the middle of the night), incontinence, urgency or frequency. Estrogen causes thinning of our urethral and vaginal tissues and the pelvic floor muscles to relax, both leading to urinary problems. A sneeze or cough, laughing too hard, jogging, or sometimes not much at all can set the pee free.
Lisa, can you relate?
Yes, sadly I can relate, Sheryl. Although I have no problem with getting older (most of the time, I think of it as a challenge or opportunity rather than a problem), the physical issues that crop up can be depressing and debilitating at times. And, in the last year or so, I too have been dealing with many of the bladder-related issues that you detail above. Sigh…
And so, when I had the opportunity to interview a female urologist, Dr. Alex Rogers, I jumped at it. I stress the word female here, because female urologists are a rare breed, comprising a very small percentage of urologists. Below is an edited version of our recent Zoom conversation:
SK. It’s so refreshing to speak with a female urologist. Why is it so rare to find one?
AR. First, thank you for writing about incontinence. It’s such an important topic because incontinence impacts millions of people, and so many wait years before seeking treatment due to the stigma often attached to the condition. By writing about this, you’re helping de-stigmatize this condition and empower patients to open up to their healthcare providers.
Second, many people don’t realize that urologists treat many conditions - such as overactive bladder - that disproportionately affect women, so it’s important for them to be represented in the field. Thankfully, we’re starting to see these gender disparities decrease.
SK. A woman comes to you with these problems (which is a miracle of sorts, since so many feel stigmatized and ignore the problem). So, what’s next?
AR. When patients go to their doctors to discuss overactive bladder, we typically begin by implementing lifestyle or behavioral changes like dietary adjustments, the use of absorbent products and bladder or pelvic floor training to see if they may help alleviate symptoms.
Attention, ladies! I found this next comment to be one of the most helpful things I’ve read/heard.
AR. It’s also important to control the intake of liquids. While you may think drinking less water can reduce symptoms, it can actually worsen symptoms by making urine more concentrated, which can irritate the bladder.
[Lisa: Wow, that is interesting indeed! An insider’s tip for sure; thank you.]
Instead, drink water when you’re thirsty, or sip it throughout the day to keep from drinking too much liquid at once, which puts pressure on the bladder. If you’re waking up to go to the bathroom throughout the night, limit how much you drink before bedtime.
SK. Once you’ve established the problem(s), what are our options beyond lifestyle and behavioral changes?
AR. There are treatment options and medications that healthcare providers can prescribe to help manage the condition, which can include oral medications such as beta-3 agonists like GEMTESA (vibegron)* and anticholinergics. These work by inhibiting involuntary contractions of the bladder muscle, or relaxing the bladder muscle so it can hold more urine. *Note: Product names may be different in other countries.
For a Pause…
2. We often say men are lucky to have exterior plumbing, enabling them to pee just about anywhere. Here’s something to kinda make up for our lack of freedom-to-pee. Would you use this portable, funnel-shaped device? (I’m still trying to figure out exactly how to use it if you’re caught in something like, say, a traffic jam…)
3. Do you know what the color of “healthy” and “hydrated” urine should be? The color of urine can tell you a lot about your body, say the experts at Cleveland Clinic.
4. Feeling nostalgic? Here’s a potty training song to lighten the mood.
Some helpful links if you have the urge (#pun) to read more bladder blather: