Your Pelvic Floor and Bladder Leaking

Problems with the bladder are related to its two functions: 

1. Storage problems: when your bladder is filling with liquid, you might feel an abnormal urgency to go to the bathroom or be unable to hold urine. When your bladder leaks urine, it is known as urinary incontinence.

2. Emptying problems: when you have difficulty emptying your bladder. This might mean it is difficult to empty your bladder completely when you go to the bathroom, or it might mean that it difficult to empty your bladder at all.

The pelvic floor is like a gatekeeper for your bladder. It helps keep it closed when you don’t want to pee.

Your bladder might leak urine when you put pressure on your bladder – this can happen when you cough, sneeze, laugh, or run around. This is called stress incontinence and it is the most common type of bladder leaking. Usually, this type of pressure or leakage doesn’t happen at night unless it is very severe. 

Your bladder might also leak urine if you have a strong urge or if you are trying to reach the bathroom. This might cause your whole bladder could empty suddenly and without your control. This is called urge incontinence. It can happen at night and can keep you from sleeping well. 

When you pee, your bladder sends urine out through an open gate, called the “urethra”. When you hold your urine, your bladder muscle relaxes, the gate is closed, and the urine stays in the bladder. Unless you are drinking lots of fluids, the bladder normally empties about 5-7 times a day. As you age, your bladder may also ask to be emptied once to twice at night. 

Your doctor needs to know the whole story of your symptoms and examine you carefully before making a diagnosis. A diary of your daily drinks and pees can help with this. You will be asked to cough during a pelvic examination, and you may need to pee in a cup to check your urine for other problems such as an infection. Sometimes, further tests are needed to decide which treatments are best for you.

If you are having problems with leaking urine, there are a few things that might help. First, it is important to avoid straining or bearing down, which sometimes happens when you are constipated or lifting something heavy. If you cough a lot, speak to your doctor about ways to treat your cough. Weight loss can decrease the overall squeeze on your bladder, and may improve your stress leaks. Finally, a morning cup of coffee may wake you up, but may also send you running to the bathroom – it might be time to switch to decaf or avoid caffeine altogether.

Your pelvic floor muscles also need to be working well to keep your urethra closed and your bladder relaxed. Many things can weaken these muscles: pregnancy, childbirth, repetitive straining, your body’s weight, your genes, or just the passage of time. Sometimes you need to send your bladder to a bootcamp and do some bladder drills where you try to wait a little longer in between two pees. Pelvic floor muscle exercises can work wonders for your bladder and pelvic health physiotherapists can help you do them correctly. Please watch our videos for more information about these exercises.  

Your doctor may also suggest a pessary, which is  a support device for your bladder. It fits in the vagina and a pelvic health physiotherapist, nurse, or doctor needs to pick the right size and shape for you. If it’s the right fit, you won’t feel that it’s there, and it will stop you from leaking urine. You can learn to put it in and take it out, and you may only want to use it during exercise.

If these first steps don’t work, and you still leak, medications or surgery could help you. Medications may help to relax twitchy bladders and help you hold your pee much longer. They also may help you sleep through the night without the need to pee. Surgery is usually the last resort because it is more risky. That said, it is generally more durable and can cure your stress incontinence once and for all. You need to talk to a surgeon about all the different options available.

Watch our video!