by guest blogger, Michelle Herbst, MPT, DPT
In my last blog, Schooling Up On Pelvic Floor Dysfunction, the characteristics of a healthy pelvic floor were presented: “…a healthy pelvic floor includes the normal placement of pelvic structures and normal functioning of the pelvic muscles, bladder and bowel.” Bladder 101 covers normal functioning of the bladder, diagnoses that may be positively impacted by pelvic floor rehabilitation, and how bladder function may change across a woman’s lifespan. Knowledge is power. So, let’s get started!
Normal Adult Bladder Habits
It is normal to urinate up to 7 to 9 times during the day or every 2 hours. Waking up to urinate is considered normal only after the completion of menopause. Urinary Incontinence regardless of the amount is not considered normal.
Urinary Incontinence Diagnoses Related to Pelvic Floor Dysfunctions
There are several different types of incontinence:
Stress Incontinence: The loss of urine when an increase in intra-abdominal pressure exceeds the closing pressure of the urethra, which is the tube that empties the bladder. Leakage typically occurs when the individual changes position or when laughing, coughing, sneezing, jumping, or running. The likelihood of leakage increases as the bladder volume increases and when weak pelvic basket muscles are fatigued. Bladder habits may be varied with stress incontinence.
Urge Incontinence: The loss of urine in the presence of a strong urge to urinate. Leakage usually occurs during moments of increased anxiety, stress, or the presence of temperature changes. Urge incontinence is sometimes referred to as ‘Overactive Bladder’ which describes an increased activity of the detrusor muscle which causes the bladder to empty. Those who have urge incontinence may urinate more frequently than every 2 hours.
Mixed Incontinence: The presence of both stress and urge incontinence.
How pregnancy may affect the bladder
Hormonal changes during the first trimester may prompt an uptick in the urge and frequency of urination. As the baby grows and the uterus expands there is more pressure on the bladder and decreased bladder capacity. Loosening of ligaments may predispose a woman to changes in her pelvic alignment which may negatively impact how the pelvic basket works resulting in leakage with quick movements and sneezes.
Post-partum changes to bladder function
After a vaginal delivery, the bladder and pelvic basket muscles may seem sluggish to respond and simply very weak. This may be caused by swelling at the perineum and overstretching or compression of the pelvic nerves and muscles during delivery.
But, do not fear! The body is wonderful at healing itself after injury. As the swelling decreases and the muscles and nerves begin to heal, normal bladder function should return in a few weeks. Bladder control will further improve as the sphincter muscles of the pelvic basket heal and become stronger, allowing for initiation, control and completion of urination.
Menopause and bladder function
Hormonal changes during peri-menopause cause thinning of the mucosal lining of the urethra, which is the tube that empties the bladder. Normally when the bladder is filling the urethra is kept closed by the adhering or sticking together of the walls of the urethra and the external compression force from the pelvic sphincter muscles. However, as the mucosal lining of the urethra thins, the walls of this tube do not stick together as well leaving the tube partially or fully open. The result is an increased reliance on sphincters to close or ‘shut off’ the urethra during bladder filling. In the presence of weak sphincter muscles, the leakage will be further be compounded with increased urge and during position changes such as lifting, sneezing, pushing, pulling, or jumping.
When to seek help for incontinence? And, what type of help?
Please do not delay getting help for incontinence. All too often patients suffer with incontinence because they think nothing can be done or that it is normal. This simply isn’t the case. In fact, there are many things that can be done!
My recommendation is to contact a primary care provider to determine the origin of the onset of incontinence or worsening of symptoms. The source may be due to urinary tract infection, underlying medical, psychological issues, or the symptoms might even have a pharmaceutical origin.
Prior to making an appointment with a primary care provider, you should consider recording/journaling bladder habits and how incontinence is negatively impacting your life. Examples may be avoiding physical activities/exercise or socialization due to fears of leakage or avoiding intercourse with your significant other. This subjective information may help the primary care provider in recommending viable treatment options such as dietary changes, pelvic rehabilitation, and medication or prompt a referral to a specialist.
I hope Bladder 101 helps you describe your leakage problem to others so you can seek out appropriate resources and support. But most importantly, I hope you may begin realize that some phases in a women’s lifespan are simplys a phase. Most bladder control issues during pregnancy, post-partum and menopausal periods can be positively impacted by lifestyle changes. Pelvic floor rehabilitation/strengthening may be just the lifestyle change you need.
Please, make Hab-it your HABIT!