My friends and I talk about pee in much the same way we talk about the latest episode of a must-watch TV show—albeit if said show had episodes like The Case of the Bathroom We Couldn’t Find in Time or We Jumped on a Trampoline and Deeply Regretted It. But unlike so many other previously taboo topics like menstruation and childbirth, urinary incontinence is the one subject that women still only whisper about. And it’s true even though the Canadian Continence Foundation estimates that one in four women will experience it, and not only in our Golden Girls years—the Canadian Urinary Bladder Survey found that 33 percent of women ages 40 and up are on this tinkle train. Many family doctors don’t bring it up, either. I’ve had the same doctor for 15 years, and despite the fact that she’s gazed into the abyss of my vagina as many times as an accountant opens an Excel doc and we’ve spoken at length about everything from uterine fibroids to sexual pleasure, she’s never once asked me if I suddenly peed all over myself when my cat launched a surprise attack on my head. (I have.)
Thanks to a laundry list of factors that can include genetics, hormonal shifts, pregnancy, childbirth and the effects of aging on our tissues and muscles, the Leak Ness Monster will eventually come for many of us. The good news is that there are lots of ways to treat it.
“Incontinence really affects women’s lives on an everyday basis,” says Nathalie Leroux, an obstetrician/gynecologist with a sub-specialty in urogynecology and a professor at the University of Montreal. “When I treat patients for abnormal menstruation, I’m fixing one week a month. When I treat patients for incontinence, they’ll come back and say, ‘You’ve changed my life.’ ”
What is urinary incontinence?
The two most common types of urinary incontinence are stress urinary incontinence (SUI) and urge incontinence (UI), though many women will experience a mix of both.
Stress incontinence, explains Sinéad Dufour, a pelvic health physiotherapist and associate professor at McMaster University, is more mechanical, while urge incontinence is more physiological. If you pee when you laugh, cough, jump or, say, get assaulted by a cat, that’s stress incontinence. If you have to urinate all the time, or you only get about a half-second warning between thinking “Gee, I think I have to pee” and actually peeing, that’s urge incontinence.
One reason you can experience SUI is from damage to your pelvic floor, a group of muscles that sit like a bouncy trampoline at the base of your pelvis and support your bladder, rectum and reproductive organs. While vaginal birth is a common way to injure your pelvic floor, doing lots of high-impact sports or constant straining when you’re trying to poo will also do the trick. The pelvic floor controls the sphincter around your urethra, and when your floor is working it responds automatically to increases in intra-abdominal pressure.
“Sneeze, move suddenly—even if you’re yelling at your kid—these are all things that can increase intra-abdominal pressure,” says Dufour. “The pelvic floor is supposed to say, ‘Okay, sphincters, it’s time to come together, lift up and close!’ But if the pelvic floor isn’t working properly, that pressure comes down instead and urine leaks out.”
UI happens when the detrusor muscle, which is in the lining of your bladder, becomes overly active or spastic and squeezes out pee before you can make it to the bathroom. There isn’t one specific reason that the detrusor starts to throw a temper tantrum (especially as we age), but it can seriously cramp your style. “I hear horror stories of women standing in line in the grocery store, getting that urge and looking around, going ‘Shoot, is there a washroom?’ then boom! The next thing they know, it’s like Niagara Falls,” says Dufour.
So what can I do?
First, says Leroux, your doctor should rule out more serious possibilities like an infection, stones in the bladder or cancer. But after that, depending on which type of incontinence you’re experiencing, conservative treatments like exercises to strengthen your pelvic floor and bladder training (where you practise holding your pee) should always be your first line of defence. More serious cases may need to level up to things like medications, injections, lasers and surgery.
A healthy pelvic floor helps fix SUI and UI. Rehabbing a damaged one—and maintaining your bouncy, refreshed pelvic floor from that point forward—usually involves a regime of Kegel exercises (squeezing your pelvic floor to strengthen it). Ideally you should book at least one session with a pelvic physiotherapist for an assessment and to ensure you’re doing your Kegels properly, but a good way to figure out where your pelvic floor muscles are is to try to stop your pee midstream—those are the muscles you want to use. How often you need to do Kegels depends on your circumstances—a doctor or pelvic physio can recommend an individualized regime for you—but according to Leroux, a good general rule is about 30 to 50 squeezes a day.
“I want it to be for my patients like brushing their teeth,” says Leroux. “Maybe they do them every time they’re at a stoplight or every day in the shower, but they have to keep them up. If you only go to the gym once a week, you won’t see results.”
If you have urge incontinence, Dufour also recommends limiting common bladder irritants like coffee, alcohol, tomatoes, vinegar and fizzy drinks. You will also need to retrain your bladder to go longer between toilet sessions. While how often you pee obviously depends on how much liquid you take in, a healthy average is between five to eight times a day—about every two to four hours—and not at night, unless you’re postmenopausal, in which case once at night is normal. Dufour says that you should be peeing for at least eight seconds each time—less than that and your bladder probably wasn’t full.
The most counterintuitive part of treating UI is that the things you’re probably doing to protect yourself from being that Niagara Falls-in-the-grocery-line lady will only make things worse: By always keeping your bladder as empty as possible, you essentially teach it that every time you feel a little tickle you need to go to the bathroom. This results in a hyperactive bladder that will eventually just start to go without you.
Dufour says that using an incontinence product can help build confidence when you’re starting a pelvic floor or bladder-training regime, but they shouldn’t be your long-term plan. And don’t just reach for a period pad, either.
“That’s a big no-no,” she says. “Menstrual products aren’t designed to collect urine and pull it away from your skin, and you’ll get all sorts of abrasions on your vulva if you use them for that.”
Instead, there’s now a wide range of stylish incontinence underwear on the market that look and feel just like regular underwear—which means even if you have taken an unexpected detour to Niagara Falls, you can keep calm and Kegel on.