“I laughed so hard I almost wet myself.”
How many times have we heard a woman we know say this? How many times have you said it yourself? What about those light-hearted comments and jokes related to ‘peezing’, i.e. when you sneeze and pee at the same time.
This is Stress Urinary Incontinence, which is an involuntary leakage of urine when there are increases in intra-abdominal pressure, such as coughing, sneezing, laughing, jumping, running, squatting, and lifting.
Yes, it is VERY common. In fact, 1 in 4 women over the age of 18 will experience episodes of stress urinary incontinence. Is it normal? No. Is it something we just have to live with? Definitely not.
Stress Urinary Incontinence is just one kind of bladder problem we may experience. Others include:
- Urge Incontinence (an involuntary leak of urine with a strong and sudden urge to go, often associated with triggers like running water, seeing a toilet, putting a key in the door)
- Urinary Frequency (excessive voiding of the bladder)
- Urinary Hesitancy and Incomplete Emptying
- Nocturnia (getting up once or more at night to urinate)
- Nocturnal Enuresis (bedwetting);
- Recurrent UTI’s
What is normal bladder function?
- Based on the consumption of 2 litres of liquids, we should be emptying our bladder about 6-7 times a day
- Each time we empty our bladder there should be “enough” that you can count to 7 or 8 Mississipis from start to finish (this would be 300ml-500ml).
- You should be able to wait at least 2-3 hours between each emptying of the bladder. Remember Alfred Hitchcock’s advice “the length of a film should be directly related to the endurance of the human bladder”
- We shouldn’t have to get up at night to empty our bladder (considering that we empty our bladder and do not drink too many liquids right before bed)
Some bad habits that can lead to dysfunction:
- Just in case-ing
How many of us are guilty of this? We’re leaving the house, and we don’t have an urge to go. BUT we go anyway, ‘just in case’.
Why is this dysfunctional? This habit teaches the bladder to contract and empty when it is not really time ‘to go’. Over time, we can lose some of the sensitivity in our bladder or also reduce the capacity of our bladder to hold on when we really need to.
- Hovering or semi-squatting
Sit down fully on the toilet. Do not hover.
Why is this dysfunctional? When we empty our bladder, our pelvic floor muscles must relax, and the detrusor muscle in the bladder must contract. Our pelvic floor muscles also play a role in postural stabilisation, so if we are in this ‘squat’ position, they cannot fully relax, as necessary. This means that the detrusor must work twice as hard to empty the bladder. This can potentially trigger some prolapse issues from extra straining. This can also lead to incomplete emptying.
- Stopping and starting the flow of urine as a pelvic floor exercise
It is important not to stop and start mid-stream, not even as a pelvic floor exercise!
Why is it dysfunctional? As already explained, to empty our bladder, the pelvic floor muscles must relax. This allows the detrusor muscles to contract. So, when you contract your pelvic floor muscles (to stop the flow), you are sending the signal to your bladder muscle (detrusor) to stop contracting. This means you will not empty completely, which can lead to a UTI. It can also potentially lead to urinary hesitancy
- Pushing or Straining
Many women do this because they try to pee faster, because they are too busy. We should not push or strain when emptying our bladder. Relax your tummy and pelvic floor muscles.
Why is it dysfunctional? Pushing and straining means increasing intra-abdominal pressure and it means you are ‘bearing down’. This weakens the pelvic floor and pushes pelvic organs downwards. This can lead to or worsen a prolapse.
What can we do to improve our bladder function?
The good news is that in the majority of cases bladder function can be improved and function restored naturally. It will take some work and effort, and education about your body.
Here are some important habits and tips for better bladder function:
- Aim to drink 2 litres of water per day to keep optimally hydrated – but spread the consumption throughout the day rather than a lot at once. Try to avoid too much water before bed, especially if you experience nocturnal enuresis (bedwetting) or nocturnia (getting up often at night to urinate).
- Avoid alcohol – it is contribution to bladder dysfunction is 3-fold: it is a bladder irritant, a diuretic, and a muscle relaxant. This means it will make urinary frequency and urgency worse.
- Improve your bowel function, as constipation and straining can also impact bladder function and urinary incontinence.
- If you are prone to recurrent UTI’s related to sexual activity, remember to empty your bladder before and after sex
- Avoid other potential bladder irritants such as caffeine, carbonated drinks, spicy food, and acidic fruit and juices.
- Improve your pelvic floor function – the pelvic floor is directly related to bladder function. The pelvic floor muscles contract when the bladder fills and relax when emptying. So, you can see how a weak pelvic floor could cause problems with continence. However, often overlooked is a ‘too tight’ or overactive pelvic floor, which can also cause leaks and incontinence problems. Getting properly assessed by a woman’s healthy physiotherapist is very important.
Francesca Sant qualified as a personal trainer in 2009, and after experiencing her own struggles with c-section recovery, diastasis, incontinence and a mild prolapse, went on to further her studies with specialisation in women’s wellness – including post-natal recovery, hysterectomy recovery, incontinence, pelvic floor and core dysfunction and peri-menopause.
