This is a very common question women ask of their doctors. Unfortunately, some women who have leakage don’t ask the question because they have been led to believe that it is normal, or that nothing can be done. This question is so important because it opens the door for education about your body and an opportunity to improve your wellbeing and quality of life at any age.
What is normal?
Urinary leakage with activity or cough is common but not a normal state of being. I often point out to women when they ask this question that it would be similar to asking “I need reading glasses now to see the small print; is that normal?” It is common for eyesight to change, especially as we get older, but it is NOT something that we consider a normal state or expect you to just “live with.” Similarly, leakage of urine with activity, coughing or laughing is common in women (as many as one in four or more as we age), but it is most certainly not something that is normal that you just have to live with.
Why does this happen?
Urine leakage that is caused by a sudden increase in abdominal pressure, such as occurs with a cough or strenuous exercise, is called ‘stress urinary incontinence.’ Normally urine only leaves the body when you are purposefully emptying your bladder. With stress urinary incontinence, urine leaves the bladder unexpectedly at the time of a cough, sneeze, laugh, jump, etc. This happens because the strength of the bladder outlet – the urethra, is weaker and no longer is able to keep the outlet closed during the increase in pressure on the bladder. This is not normal and it indicates a weakness of the ‘door.’ This weakness can progress over time, making the leakage more and more common.
Weakening of the urethra can be caused by loss of strength of the supporting muscles known as the pelvic floor muscles. These are the same ones that you squeeze when trying to keep urine from passing. Another cause of weakness of the bladder ‘door’ is a loss of strength of the connective tissue which supports the urethra and lower bladder. This connective tissue acts like a strong hammock that keeps the urethra and bladder in the best position. When the pelvic floor muscles become weak or the hammock support loses its strength, stress leakage can occur.
What can be done?
First of all, whether to do something or nothing is up to the woman who is experiencing the leakage. For some women, an infrequent small leak of urine is not bothersome, and does not feel worth the effort of intervening. However, this leakage indicates that the door is weak, and some women may wish to be proactive and try to avoid any worsening of the problem.
Preventative strategies could include strengthening the muscles of the pelvic floor with Kegel exercises. It could also include avoiding unnecessary strain to the pelvic floor support tissues (the hammock). Most women are not aware that certain daily life habits can breakdown supportive tissue to the pelvic organs and the urethra little by little over time. Examples of this are frequent bouts of constipation with straining, a chronic deep cough that puts frequent pressure against the pelvic support system, or heavy or improper lifting techniques. All of these generate stress and strain on the connective tissue and can cause further loss of support. Thus, treating constipation or a chronic cough, avoiding unusually heavy lifting, and learning how to lift correctly are all things that can prevent further loss of support to the urethra.
In some cases, the leakage is bothersome enough that a woman will ask her doctor about it, or even see a healthcare provider just for this purpose. Multiple options exist for treating bothersome leakage, including formal pelvic floor exercises with a trained physical therapist, as well as nonsurgical and surgical support to the urethra to prevent leakage. Before deciding on a treatment, you should feel well-informed about the risks and benefits of all of the options in order to make the best choice for you.
If it is bothering you, talk to your doctor about it. Do not manage the leakage by avoiding healthy activities like running or jumping in order to stay dry. This deprives you of the important vigorous activity that the rest of your body needs and is so important to general health and wellbeing. Just know that while leakage is common, is not a normal state and should be treated if it limits you from being the healthiest you can be.
Make an appointment to talk to a gynecologist about leakage or others issues today! Find a location >
Dr. Susan Hobson is a gynecologist physician and surgeon at the Peterkort location of Northwest Gynecology Center. She received both her MD and PhD degrees from Oregon Health & Science University. She also completed her residency in Obstetrics and Gynecology at OHSU. Dr. Hobson is focused solely on urogynecology, pelvic medicine and reconstructive surgery. Her focus is not only on treating pelvic floor disorders, but on attempting to prevent and better understand pelvic floor injuries. She is a steering committee member in the multidisciplinary Providence Continence Center, and is the Gynecology Section Chair at Providence St. Vincent's Hospital.
Sources: Image of woman sneezing - Trinity College Dublin