Hey, it’s your Aunt Julie, ready to bust some myths and talk about incontinence throughout life. No, it doesn’t mean that someone is incapable of reading emails correctly or of putting the milk in the tea before the water; that’s incompetence. I am talking about female urinary incontinence.
The Science Behind Urinary Incontinence
By definition, urinary incontinence is the unintentional passing of urine. While it is not often discussed, it is extremely common, with a European study finding up to 42% of women in the UK experience UI.
The science behind UI is relatively simple in theory. Urine is made by the kidneys and stored in the bladder. When you need to urinate, your bladder muscles tighten, and you pass urine through your urethra. Simultaneously, your sphincter muscles relax, allowing urine to pass.
Think about jumping on a trampoline, laughing, or being startled — your body naturally tenses and your muscles contract. If your bladder muscles or your pelvic floor suddenly tighten and your sphincter isn’t strong enough to close the urethra, you may pass a small amount of urine.
UI can be a result of nerve damage or pelvic floor stress and muscle stretching.
The two most common types of urinary incontinence in women are:
Urge Incontinence
Urge incontinence arises after a sudden, strong urge to urinate before you get to the bathroom. Sometimes you might get there in time, other times, perhaps not. Urge incontinence is often associated with ‘overactive bladder’ and people with overactive bladder may feel the need to urinate frequently, sometimes more than eight times a day, often not passing very much urine.
This affects millions of women in the UK.
Stress incontinence
Stress incontinence is particularly common among younger and middle-aged women. Pressure on a bladder that isn’t fully supported due to a damaged or weakened pelvis puts more strain on the bladder and urethra, which work to prevent urine leakage. Because of this, everyday things like coughing, laughing, and exercising can cause urine leakage.
Seasons Of Life - When You Might Be Affected
Around 4/10 women in the UK over the age of 18 reported incontinence in a European study shared by the National Library of Medicine, and it is no surprise when we consider the common life events of the average woman - pregnancy, childbirth (around 1 in 3 females experience urinary incontinence after having a baby), and menopause, which can all affect the surrounding muscles of our bladder.
During menopause, our estrogen levels plummet, resulting in thinning of the urethra, bladder, and vaginal wall strength, which can cause bladder leaks along with other vaginal symptoms such as vaginal atrophy.
Hormonal changes can make intimate skin more delicate and sensitive. For women managing bladder leaks, this can sometimes lead to irritation or discomfort, especially when wearing synthetic fabrics or liners for long periods.Choosing breathable organic cotton underwear to help reduce moisture build-up and irritation.
Other causes of urinary incontinence include:
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Overweight - Having more weight pressing on your abdominal wall can put pressure on your bladder.
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Constipation - Long-term constipation and straining can put stress on the pelvic floor muscles and weaken them.
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Nerve Damage - Vaginal childbirth and chronic health problems such as diabetes or multiple sclerosis can cause incorrect or even no signals to be sent to the brain, encouraging urination and your pelvic muscles to tighten, causing leakage.
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Surgery - Any surgery around the pelvis such as a hysterectomy or c-section, can damage the pelvic floor muscles, especially if the uterus is removed.
Sometimes urinary incontinence lasts only for a short time due to side effects of caffeine, medications, or infection of the urinary tract.
Expectations and Stigma
Incontinence is often reserved in the mind for those living their winter years, but in truth, it affects people of all ages for lots of different reasons. Many cases can be significantly improved through pelvic floor exercises, lifestyle changes, medication, or medical treatment.
We are constantly taught that feces and urine are ‘yucky’ and should be avoided at all costs - whether that is touching, talking about, or even acknowledging that we all do it, especially here in the UK. As such, there has been such a stigma built around ‘lavatorial activities’, that it is no wonder that anyone who fits outside that very closed box of what is perceived as ‘normal’ or ‘socially acceptable table talk’ feels alienated.
Because of the taboo around UI, many people experiencing it don’t feel comfortable talking about it, and the stress of an incident occurring can be so oppressive that it worsens anxiety around the situation, often leading to people excluding themselves from situations where UI incidents may occur, such as social events, gatherings, exercising, or travel. This can have a major impact on a person's self-confidence and social life, both of which are critical to maintaining good mental health.
How to Manage Urinary Incontinence
Step One - Breath
Try to remind yourself that UI is very common. You are not any of the things that you may choose to say about yourself; your body just needs a little TLC to get back on track. Sharing your experience with those closest to you, alongside support groups, might help reinforce that it isn’t as scary as it might feel and that there is help at hand.
Step Two - Learn
Learn about the causes of UI and which version you may be experiencing. This will help you understand how to start implementing tactics to improve your pelvic floor strength, lifestyle changes, and to prepare for those occasional times when you might need a spare pair of knickers in your bag, with a bit more confidence.
Step Three - Try pelvic floor exercises
Here’s how:
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Relax your muscles.
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Pull the muscles around your vagina and anus up and in, as though you are trying to stop yourself from urinating.
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Hold the squeeze for 8 seconds, or as long as you can manage, while breathing normally.
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Relax your muscles and wait 8 seconds.
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Repeat the squeeze and release. Try to do this 8 to 12 times.
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Do this exercise 3 times a day.
If you can’t do all of the reps, remember that you are at the start of the strength-building journey, and you can gradually increase as your muscles repair and strengthen.
The beauty of pelvic floor exercises is that you can do them almost anywhere with no one being any the wiser, on the bus, in a waiting room, while you're cooking.
Remember where you can, try not to go to the toilet ‘just in case’.
Step Four - Talk to a professional
If you are having trouble improving your control, talk to your GP. They will be able to offer advice, personalised treatment, and help you get on track with the progress you need.
Remember, it can take time, patience, and support to manage urinary incontinence, but many people see significant improvement with the right treatment and lifestyle changes. The more openly we talk about urinary incontinence, the easier it becomes for people to seek support without shame.
With bountiful boldness, Aunt Julie x
This article is for general information and breaking stigma around women's health and should not replace medical advice from your GP or healthcare professional.
