How to Stop Bladder Leaks From Dictating Your Social Calendar

The truth is, roughly 33 percent of women over 40 experience pee leaks on the regular. Welcome to the club, ladies!

It was the middle of the night, two years ago in January, when Rebecca Clive woke up confused and disoriented. She felt damp around her bum and legs and, at first, couldn’t figure out exactly what was wrong. But then the realization hit her—hard. “I had wet the bed,” says the now 48-year-old.

“It only happened that one time, but it was mortifying,” says Clive. She had to nudge her husband awake, clean herself up, change the sheets and, perhaps worst of all, recon with this unsettling event. “My husband understood and didn’t make an issue out of it, but I was so embarrassed,” she says. “I was thinking, ‘God, am I going to be arbitrarily wetting my pants now?’ I was quite panicked.”

What causes pee leaks?

According to Dr. Magali Robert, a urogynecologist and head of the Pelvic Floor Clinic in Calgary, pee leaks are probably more common than you think, and they can happen for a few different reasons.

Overactive bladder (also called urge incontinence) is the second most common type of incontinence and happens when you have a sudden, strong need to urinate. This can mean night-time mishaps or daytime leaks on the way to the toilet. Some women have little warning before they need to pee, while others spontaneously leak at the mere suggestion of peeing (the sound of running water can set some women off). Big triggers are: aging, caffeine and bladder irritants such as spicy or acidic foods.

Overflow incontinence happens when your bladder doesn’t empty fully when you go to the washroom. The most common causes of overflow incontinence are medications and frequently holding which stretches the bladder over time.

Stress incontinence is the most common type and accounts for about 50 percent of women who experience pee leaks. (Some of these women also have overactive bladder, a condition dubbed “mixed incontinence.”) These types of leaks are caused by an inability to fully close the urethra, the muscle that opens and closes off the bladder. This is typically due to weak or damaged pelvic floor muscles, which hold the bladder up like a sling. (Women who carry extra pounds, have chronic constipation or cough constantly due to smoking or respiratory issues like asthma are more likely to experience this type of incontinence.) “There’s a wear and tear that happens over the years, and all of this starts to accumulate to the point where our bodies can’t compensate for it any longer and we start to leak,” says Dr. Robert. Although most women with stress incontinence are in their 50s or older, it’s not uncommon for younger women to experience it temporarily after having babies.

Brittany Roland started noticing small pee leaks during her second trimester of pregnancy when she would laugh or cough or sometimes just out of the blue, especially at the end of the day. “Luckily, I was at home most of the time,” she says, “but if I was running errands, I would wear pantyliners whenever I was out of the house.”

Little leaks can feel like a big deal

“It was many months postpartum before I could trust my sneezes,” says Roland. Her baby is now a two-year-old, and she still doesn’t have complete confidence in her ability to hold it. “If I am in Starbucks and don’t know when my next opportunity to go to the washroom will be, I’ll go, just to be safe,” she says. Clive can relate: “I wear a pantyliner every day because I’m just so worried that something might happen,” she says.

The concern about having a leak in a meeting, at the gym or on a coffee date with a friend is real, but what about in bed with your partner? “We talk about jogging, jumping on trampolines and making jokes about laughing so hard that you pee your pants, but we never talk about intimacy,” says Dr. Robert. Pee leaks during sex are possible and may be just as common as wetting yourself during a run or yoga class. “I’ll have patients cry, and it’s the real reason they come to see me—they don’t care about jogging,” she says. Pee leaks should not be getting in the way of your sex life or dictating your social calendar. (Keep in mind that these exercise moves can give your sex life a boost.)

Managing bladder mishaps

Wearing an incontinence product or absorbent underwear (either a disposable option available at the drugstore or a washable option, like Canadian brand Knix) is one way to deal with smaller leaks. “But I don’t consider this to be a treatment,” says Dr. Robert. “It’s a management option. It won’t make things better, but you’ll feel more confident.” Solving incontinence issues involves getting to the root of the problem.

Women with an overactive bladder can often stop their pee leaks by simply regulating their fluid intake and nixing coffee and tea, says Dr. Robert. Others can use urge suppression training, which involves retraining your bladder reflex so that you’ll be able to delay the urge to go long enough to make it to the washroom.

For women with stress incontinence, weight loss, smoking cessation and even dietary changes to deal with constipation can do the trick, says Dr. Robert. Some women have success with pessaries, rings fitted by a specialist that are inserted into the vagina to provide support. “Think of them as scaffolding for your vagina,” says Dr. Robert. Pelvic floor muscle training can also play a key role in managing stress incontinence. A pelvic floor physiotherapist can assess the condition of your muscles and prescribe a range of therapies, from biofeedback training to exercises with weighted vaginal cones to Kegels coaching. Roughly one in three women has difficulty identifying their pelvic floor muscles, so some professional help to target the right spot for strengthening—or muscle relaxation—can make a big difference. (Roland noticed an improvement in her postpartum pee leaks with some pelvic floor coaching from her Pilates instructor.)

There are surgical options for those who need it

Some women opt for the laser vaginal skin-tightening treatments offered at many medispas across the country, but Dr. Robert cautions against them. “The guidelines from the Society of Obstetricians and Gynaecologists of Canada don’t recognize these treatments for incontinence because there’s no evidence that they actually make a difference,” she says. But that doesn’t mean you shouldn’t consider them, as many women have reported success. Also, a number of brands are approved by Health Canada for this, including Viveve, DiVa Vaginal and MonaLisa Touch.

Whatever you do, be sure to talk to your doctor first and do something about it, says Dr. Robert. Too many women make the mistake of thinking they have to live with pee leaks, but for about 90 percent of them, the problem can be managed one way or another. “I get really sad when I hear women tell stories of how their bladders dictate what they are going to do,” says Dr. Robert. “I’ve had women who are afraid to visit friends because they might leak on their couches or don’t go to the movies because they don’t think they can sit through them,” she says.

“It’s not at the stage where it’s driving decisions around how social I can be, thank goodness,” says Clive. But she is not taking her pee leaks lightly either. After her bed-wetting experience, Clive promptly made an appointment with her doctor, who, after some testing, concluded that the onset of perimenopause and extra anxiety that Clive was working through at the time were likely to blame for her overactive bladder. Her pee leaks have been less frequent in recent months, but if that changes, she is open to pursuing more aggressive treatment. “When there’s a problem, whether it’s physical, medical or psychological, if I can remedy it so that I can live a full life, I want to pursue that treatment,” she says. “I don’t want anything to hold me back.”

Originally Published in Best Health Canada