Dr. Ruth Maher on What Happens to Your Body When You Leak

Dear Dr. Maher, 

I’ve recently realized that I have stress urinary incontinence and am going to need to deal with it—I just can’t handle the uncertainty of never knowing when (and where!) I will have an accident. I tend to be more driven and able to tackle issues when I understand exactly what’s going on. Can you explain what's going on with my body when it comes to leaking? 

Sincerely,

Ready to Solve These Pee Problems in Santa Fe

 

Dear Ready to Solve These Pee Problems, 

First, I’m glad you’re committed to dealing with your incontinence—and I appreciate you wanting to better understand your body. When it comes to why incontinence happens, there are a number of reasons. You can have pregnancy-induced stress incontinence because of the stretching of the muscles and connective tissue in the pelvic floor that is needed to allow the baby to pass through the birth canal. Computer modeling shows that these muscles can stretch up to three times their normal length during labor, thus affecting their ability to contract. Consequently, the laxity or reduced tone in the pelvic floor muscles, means you have little to no support down there after having a baby. So when you cough, sneeze, or even bend down to pick up your baby, you’ll involuntarily leak. That’s because those activities increase the pressure in the abdominal area and the weakened pelvic floor is unable to provide enough resistance to counteract this pressure and provide support to the sphincter muscle that keeps your urethra (the opening of your bladder) closed.

Also, many women who have stress urinary incontinence will go on to develop mixed incontinence in their late forties or fifties, often associated with depletion of estrogen. Without estrogen, the sphincter muscle that keeps your urethra closed can become compromised. So women may end up not only with stress incontinence but also with urgency urinary incontinence. 

As for what’s going on in your body, stress urinary incontinence is sometimes referred to as bladder weakness, but that’s a misnomer because there’s nothing wrong with the bladder. It’s the connective tissues, muscles, and ligaments in the pelvis that provide support and keep the holes closed to keep us continent.

Strengthening and improving the coordination - the timing of the contraction - of these muscles is key to stopping incontinence. In fact, research has shown that the timing of the reflex contraction that should occur when you cough and exercise is delayed in women with Stress Urinary Incontinence - therefore a coordinated contraction is very important. 

Kegel or pelvic floor exercises are highly recommended as a first-line treatment prior to considering surgical interventions. The problem with pelvic floor exercises is that up to 50 percent of women either can’t do them at all or they can’t do them appropriately. Since the muscles are hidden inside the pelvis and out of sight, it’s difficult to get confirmation of doing them correctly. You’ve no biofeedback. That’s the number one problem. The second problem is compliance. You have to do them several days a week, and for several weeks, to derive the benefits. In fact, pelvic floor exercises should be part of all women’s self-care regimens.

INNOVO is the answer to this problem. It is a non-invasive pair of bike shorts that delivers 180 perfect Kegels per session to strengthen and facilitate coordinated contractions of your pelvic floor from home. Try it for 30 minutes a day, five days a week, 87% of women are dry within 12 weeks. Plus, 80% of women see results in just 4 weeks.