What Is The Best Treatment For Bladder Leakage? A Pelvic Floor Therapist’s Perspective
What Is The Best Treatment For Bladder Leakage?
Many women experience bladder leakage but not many are willing to talk about it. Over half of U.S. women ages 20 and older experience bladder leakage, according to a 2021 study published in JAMA Network Open.
It’s often laughed off as something that “just happens” after you have kids. You’ve heard it before:
“if I laugh too hard”
“if I jump on the trampoline”
“OH! I don’t run/lift weights/do sit ups anymore”
Although it can be common, it doesn’t have to be the norm. So what is the best treatment for bladder leakage? The best treatment isn’t just pads or surgery–it starts with understanding the root cause.
Common Types of Bladder Leakage
There are mainly two types of bladder leakage, also known as incontinence:
Stress Incontinence: Leakage with increased pressure or stress to the bladder including: coughing, sneezing, exercise
And
Urge Incontinence: Sudden, strong urge to urinate and leaking before you get to the toilet
Mixed: Combination of both –many have both!
Why Leakage Happens: Getting to the Root
The pelvic floor muscles play a big role in bladder and bowel function. They contract to keep you dry and they relax when you’re ready to relieve yourself. However, if they are weak or uncoordinated, they may not be able to do their job efficiently.
Other things that can impact your pelvic floor strength and coordination include:
Childbirth: Carrying a baby can put stress on the pelvic floor muscles. Especially if we aren’t taught ways to engage the pelvic floor during pregnancy. We also can lose mind/body connection with the pelvic floor and deep core muscles which can cause issues with coordination postpartum. And NO – a c-section doesn’t prevent this as you still carry a baby!
Menopause: Estrogen levels drop during menopause which can cause thinning and decreased elasticity of bladder and urethral tissue. This can make it harder for them to keep closed when needed. Topical vaginal estrogen (prescribed by an OB/GYN, Uro-gyn or GP) can be so helpful during this stage of life!
Chronic cough: Frequent pressure down on the pelvic floor can decrease pelvic floor strength. Think of it like repeatedly stretching out a rubber band, eventually it loses its “snap back”.
Poor toileting habits: “power peeing” or pushing your pee out, straining when having a bowel movement, hovering over the toilet seat and going “just in case” can all cause increased bladder leaks from decreased strength from repeated pressure down or can cause issues with the brain/bladder loop which can cause increased urgency, frequency or leaks. Also, always waiting until the very last minute (and no--having "the bladder the size of an elephant" is not a flex!) can also cause increased pressure on the bladder ligaments
Chronic Constipation: again–having to strain to poop can decrease muscle strength and put strain on ligaments. Also, if you’re always backed up, it can put pressure on your bladder which can increase urgency and frequency–and potentially cause bladder leaks.
If we understand why you may be having bladder leaks, it will help to guide the best treatment approach. Often, it's a combination of healthy habit changes, corrective exercise and manual therapy to treat the root cause.
Common Approaches That Don't Help Longterm
Pads or liners: Although this can be a quick fix or “band aid”-- it is not a solution!
Reducing fluids: Many think that the trick to reducing urgency is to drink less. However, this can actually backfire as the urine is then more acidic when diluted so it can actually irritate the bladder more —causing more urgency
Ignoring the issue: Many think they can just ignore the problem because it's “just a few drops or dribbles”. Often, the symptoms do worsen over time, especially as you age.
Pelvic Floor Therapy can get to the root cause by addressing several factors:
Personalized assessment: We assess strength and coordination –yes, of the pelvic floor muscles but also the entire body! We are also assessing coordination of the muscles and pressure management when doing activities.
Corrective exercises tailored to the type of incontinence: By identifying which type of incontinence you have, we can better address the cause vs. telling you to “just do kegels” and hope it helps.
Lifestyle and Behavioral Changes Including:
Bladder training/timed voiding.
Fluid management and assessing for bladder irritants
Managing bowel health and constipation support.
Education on proper voiding techniques
Pessaries –Pessaries are an option for managing bladder leaks. These can be fit by a gynecologist or a trained pelvic floor therapist
All of these things are discussed and assessed in depth during the initial evaluation and follow up appointments. It may seem like a lot when reading it, but when its individually tailored to your specific needs-- it reduces the overwhelm into manageable tasks.
Other available options:
Medications (mostly for urge incontinence) – Although there are medications to manage urgency or “overactive bladder” it isn’t getting to the root cause of your symptoms. Many people are not happy with side effects of the medications and are not aware about the possible cognitive effects.
Surgical options – Some people with a significant bladder prolapse may benefit from a bladder sling surgery. It is still important to know of all of your options and potential risks before jumping in to a treatment option.
Although these are other treatment options that are available, pelvic floor therapy is a less invasive, evidence-based approach for treating bladder leaks. It should be used as a first line treatment before trialing other options.
If a patient decides that surgery is their best option, pelvic floor therapy can still be beneficial as “pre-hab” or preventative rehabilitation in order to assess their current pelvic floor muscles, pressure management and everything else listed above. This would not only help to assure their surgery is successful but could prevent the surgery from failing in the future.
Next steps:
Although bladder leakage is often considered something normal that happens to women, it is not something that you should have to suffer with. Pelvic floor therapy is an effective option for getting rid of the leakage and back to the activities you want, whether that is running, jumping or laughing with your girlfriends!
If you are in Lancaster, OH or surrounding areas, you can
Click here to book a discovery call to answer any questions you may have in a one on one free phone consultation
Click here to book a 90 minute evaluation so we can develop a plan that works best for you!
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