All about light bladder leakage

You might have started noticing that you pee a little bit when you sneeze, exercise, or lift something heavy. Or maybe you feel sudden urges to go to the bathroom and all of a sudden can’t quite make it in time. Regardless of how it manifests itself, what you’re experiencing is light bladder leakage, which is a mild form of urinary incontinence—and one in three women experience it. It’s so common that next time you hang out with a group of women, more than one of you has probably had light bladder leakage.

There’s no single answer to what causes light bladder leakage, but the good news is that there are ways to mitigate it, whether that’s changing some habits or using products specially up for the job.

How do you know if you have light bladder leakage?

The telltale signs of light bladder leakage are when you notice little leaks of pee when doing ordinary things like sneezing or running. You may also feel an urgent need to pee more often than you’re used to and often at night. An onset of light bladder leakage might seem like a urinary tract infection at first, but while a UTI may increase how often you feel the urge, it usually doesn’t lead to leaks. Light bladder leakage is usually just that—light. So if you’re experiencing particularly heavy leaks or any pain, your situation might be slightly different, and you should consult your doctor.

What causes light bladder leakage?

There are basically two types of light bladder leakage: stress urinary incontinence (SUI) and urge urinary incontinence (UUI).

SUI occurs when the muscles of the pelvic floor and surrounding the urethra weaken a little; as a result, they have trouble keeping your pee where it belongs whenever any type of physical stress is placed on the bladder. Some of the most common stressors leading to SUI and light bladder leakage are:

Coughing and sneezing
Smoking (especially if it causes coughing)
Weight gain or pregnancy
Aging, both because muscles will naturally weaken with age and because estrogen keeps the pelvic floor muscles strong, which decreases at menopause
Childbirth, which stretches the muscles
Exercise or heavy lifting
Excessive caffeine or alcohol intake

UUI, on the other hand, isn’t exacerbated by any specific factors, and its causes are less well understood. In a nutshell, UUI sends strong signals from your brain to your bladder that you need to pee, even when the bladder isn’t full. This can lead to light bladder leakage because you feel like you need to pee more often and sometimes so badly that you can’t make it to the bathroom. Sometimes, this type of light bladder leakage is brought on by caffeine or spicy or acidic food that can lead to bladder spasms.

What can you do about light bladder leakage?

Sometimes light bladder leakage goes away on its own, but other times managing it becomes part of your routine. But whether it’s temporary or here to stay, there are a few things you can do to mitigate the issue:

Watch what you eat. Cut back on caffeine, alcohol, and cigarettes. If you’re experiencing light bladder leakage due to UUI, try decreasing spicy and acidic foods in your diet.
Plan bathroom breaks. Plan to go to the bathroom every hour or so, especially when exercising, so you’re not caught off guard
Do Kegels Do a few sets of Kegel exercises every day to strengthen your pelvic floor muscles
Stay hydrated! Although it might be tempting to decrease your fluid intake, that doesn’t really help and may only lead to dehydration
Find incontinence products that work for you. From pads and liners of all thicknesses to bladder supports to absorbent underwear, there’s an abundance of useful products out there. Just make sure to use incontinence-specific items, and not period pads, which aren’t designed for urine flow.
Talk to your doctor. It might not always be easy to bring up an issue that seems shameful or somewhat insignificant, but because UI has so many roots and causes, a doctor can help you narrow down your specific causes of light bladder leakage and find the course of action that’s right for you

We’ll be the first to admit that light bladder leakage certainly isn’t fun, but it doesn’t have to be a life-altering problem, either. Once you know why it’s happening and what you can do about it, you can exercise, laugh, and go about your day without worrying about what’s going on in your pants.

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Urinary incontinence 101

Real talk: Call it what you will—incontinence, light bladder leakage, involuntary peeing—but it affects most women at some point in their lives.

We don’t really have an accurate number because so many people are afraid to talk about it. We hope that’s changing: After all, as a society, we’ve made great strides in talking about periods and poop, so what’s one more bodily function to add to the mix? The National Association for Continence estimates that one in four women experience some sort of involuntary bladder leak, and of the 25 million adults who experience incontinence, about 80 percent of them are women. And often, that means young women.

Incontinence has the stigma of being associated with the elderly and the sick (and to date, the products to treat it tend to be in that dreaded diaper aisle), but the numbers show that’s simply not true. According to the National Institutes of Health, about a quarter of American women are affected by pelvic floor disorders, which can lead to incontinence manifested by involuntary peeing when you laugh, sneeze, or exercise. More than a quarter of female high school and college athletes experienced some incontinence too, but a whopping 90 percent of those girls were too embarrassed to seek help. And incontinence particularly affects women after they give birth. One study found that half of mothers experienced urinary incontinence in the first year after giving birth. As if new moms aren’t already dealing with enough.

So all that is to say: If you’re experiencing bladder leaks, welcome to a pretty non-exclusive club! We know it can suck. But it’s important to know that incontinence is caused by a number of different factors that can be effectively treated and managed. But the truth is that many people who experience incontinence are too embarrassed or even ashamed to seek help. I mean, nobody wants to admit that they’re peeing their pants, right?

Odds are, though, that if you’re in a group of women, someone else is doing just that. And talking about it might mean that you can really help someone who’s struggling with incontinence, too. So let’s talk.

What is incontinence anyway?

The most common kind of incontinence is urinary incontinence, which is simply the loss of bladder control. It means that you pee—a little or perhaps a lot—when you don’t mean to. (The other type of incontinence is fecal incontinence, but this is less common, especially in younger people.) Under normal circumstances, the pelvic and bladder muscles keep the urethra closed until it receives a message from the brain that you’re ready to urinate. Then the muscles contract, the urethra opens, and pee is released. However, weakened muscles—which can occur for a lot of reasons not necessarily in your control—or crossed brain-bladder signals are often to blame for incontinence.

There are four types of urinary incontinence. Stress urinary incontinence (SUI) is the most common, especially in women. It occurs when pelvic muscles—which form a “sling” that holds the bladder, uterus, bowel, and rectum in place—have been stretched and weakened. Stress on the bladder then causes it to leak, and those weakened muscles can’t do much to stop it. In this case, “stress” doesn’t refer to anxiety, being overworked, or worries about personal problems, but rather to pressures exerted by exercise, lifting heavy things, sneezing, coughing, or laughing. Pelvic muscles can weaken for a variety of reasons, but childbirth is a major one, which is why so many women experience postpartum SUI. In addition to all the other challenges that come with having a baby and suddenly taking care of a new human, lifting the baby or trying to get back into a workout routine can often come with the gift of unexpected spurts of pee. But luckily, SUI can be managed by anything from Kegel exercises to surgery, if necessary.

The second type of urinary incontinence is overactive bladder (OAB), which occurs when the brain tells the bladder to empty too often, and often before it’s full. According to the American Urological Association, 40 percent of women experience OAB, often after menopause.

The other types of urinary incontinence are mixed incontinence, which combines aspects of SUI and OAB, and overflow incontinence, a rare type in which the bladder makes more urine than it can hold.

What can be done about incontinence?

As weird as it is to say, there is good news about incontinence: Treatments for it work really well! Depending on your situation—the type of incontinence, its cause, its severity, your lifestyle—a doctor might prescribe drugs, surgery to restore or replace the pelvic muscles, physical therapy or exercises such as Kegels to strengthen the pelvic floor, or neuromuscular electrostimulation.

The key thing is that incontinence doesn’t need to be some shameful secret. I mean, the secret is already out: One in four women deal with it, so it’s really no secret at all! Whether you talk about it with your doctor or with your friends, the key is to talk about it, normalize it, and find a way to make it easier for you. And as if leakage itself weren’t bad enough, incontinence is also associated with a slew of other problems. For instance, one study found that women who experience incontinence after getting birth are nearly twice as likely to develop postpartum depression. Another study reports that 25 percent of women experience incontinence so severe that it noticeably impacts their quality of life. It can also lead to mental repercussions such as deep-seated feelings of shame and lower self-esteem and to some sexual dysfunctions and disorders.

So the bottom line here is that incontinence is a real issue that can lead to significant (preventable and fixable!) problems. The good news—there’s good news!—is that you’re definitely not alone, and incontinence affects way, way more people than you realize. Talking about it can really make a difference, and that’s what Motherfigure is for.

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Pelvic floor therapy: an explainer

I’m all too familiar with the challenges of living with a bladder condition; since 2005 I’ve had interstitial cystitis (IC), a chronic, inflammatory condition marked with urinary urgency, frequency, and continuous pain. When I first sought answers and treatment options for IC, I was amazed at how few resources there were for people struggling with all types of pelvic floor dysfunction, including urinary incontinence.

As an occupational therapist, I became motivated to help people get back to living life in spite of whatever medical condition they were enduring. I began training in pelvic biofeedback, one of the many treatment options offered by a pelvic floor therapist.

Whether you’re new to managing incontinence or you’ve been dealing with it for many years, pelvic floor therapy might be one solution to consider. Here, we take a closer look at it and how it can help you heal.

What is the pelvic floor?

The pelvic floor is known as a “sling” or “hammock,” and it’s a complex network of muscles, ligaments, connective tissues, and nerves that support the organs of the pelvis, including the bladder, the uterus, the vagina, and the colon. When the pelvic floor is healthy, the supportive network of tissues allows these organs to function correctly. But when there’s injury, trauma, illness, or muscle weakness in the pelvic floor, the organs can’t perform optimally, and dysfunction, like urinary incontinence, can arise.

What is pelvic floor therapy?

In most cases, a pelvic floor therapist is a physical therapist with an advanced degree and specialized training to rehabilitate the pelvic floor using a variety of treatment modalities.

If you have stress or urge incontinence or an overactive bladder, studies have shown that pelvic floor therapy is an effective tool to manage and potentially alleviate all types of urinary incontinence. If you’re dealing with UI while pregnant, pelvic floor therapy is a reasonable option for you to try; there are many, safe exercises and treatment options to address your concerns.

Kegel exercises are one type of activity used to strengthen the pelvic floor—and one you’ve probably heard of if not already tried. But a PT with expertise in pelvic floor dysfunction and urinary incontinence may implement a wider range of ideas to create a treatment plan for you. Some of the other techniques a pelvic floor therapist uses include:

An internal and external assessment of the pelvic floor muscles
Stretching, strengthening exercises, relaxation, and release work (such as myofascial release and trigger point therapy) of both the internal and external musculature
Biofeedback (an electrical way to monitor the strength of muscle contractions and relaxation, in this case, of the pelvis muscles)
Correction of your postural alignment
Education and training so you can manage the condition on your own
Recommendations for lifestyle modifications

What should I expect at a pelvic floor physical therapy appointment?

Each pelvic floor physical therapist likely has a particular way they approach a visit, but an initial session may look something like this.

When you first arrive at your appointment, you’ll be evaluated by the PT to create a treatment plan. During the evaluation, the therapist will interview you to gather a detailed account of your medical history, list of symptoms, and what you hope to accomplish throughout your treatment. Following the interview, a therapist will typically conduct a physical examination. She’ll examine the alignment of your spine, core strength, pelvis, hips, and more.

Next, she’ll assess the pelvic floor. The therapist can do this is a couple of ways. The first is to insert a gloved finger intra-vaginally to palpate the muscles and tissues that might be causing UI. If you’re uncomfortable with the idea of an intra-vaginal examination, some therapists may be able to use external biofeedback to determine how the pelvic floor is functioning.

On a personal note, I’ve seen three pelvic floor physical therapists, and they each slowly walked me through the steps of their internal examination, making sure I was aware of what they were doing and asking me to let them know if I was uncomfortable in any way.

If you’re nervous about your appointment, talk with the therapist about your concerns; she’ll help you feel more at ease. Each person’s circumstance is unique, so it’s important to keep the lines of communication open between you and your therapist, so she can tailor the treatment plans to meet your specific needs.

How often should I see a pelvic floor therapist?

After you’ve had your initial evaluation, your therapist will talk to you about the how often you’ll need to see her. If you have a severe case of UI, you may need to schedule appointments three times a week at first, reducing the frequency of the visits as symptoms improve. If your symptoms are minor, you might see a breakthrough in symptoms in one to two visits. The frequency of visits differs from person to person, but the goal is to resolve UI or reach a manageable level.

Keep in mind, your insurance may only allow for a certain number of physical therapy visits in a given year. When this occurs, the therapist will determine the best course of treatment for you within the allotted timeframe. It’s important to note that no matter how many sessions your insurance covers, you can still experience benefits from pelvic floor therapy.

How do I find a pelvic floor therapist?

First, you’ll need to talk with your doctor about obtaining a referral for pelvic floor physical therapy, and it’s possible your physician may be able to provide you with recommendations. Although any physician can write a referral for physical therapy, you’ll want the doctor who’s treating for UI (like an OB-GYN or a urogynecologist) to do it, so they can receive updates regarding your progress. If your doctor can’t recommend anyone, check out the PT Locator on the American Physical Therapy Association’s Section on Women’s Health to locate a pelvic floor physical therapist in your area.

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The unexpected side effect of motherhood

There were a lot of things I knew to expect after I had my second baby: the sleepless nights, the hormonal mood swings, the time it would take to lose the baby weight, the huge adjustment to my life. But while my baby was sleeping through the night by eight weeks and my life had found a new rhythm that included a 21-month-old toddler and a newborn, my body wasn’t doing its part in getting back to normal.

What I hadn’t expected was that the minor urinary incontinence I’d experienced with my first pregnancy that faded after the baby was born would linger (and linger and linger) after my second baby. I did not expect that six months after having my second son I would still have to cross my legs every time I sneezed. I definitely didn’t expect to still be crossing my legs six years later. What seemed like one of those clichéd jokes about motherhood became a very real, very annoying part of my life. I was embarrassed and frustrated, but I was also angry that my body was betraying me.

Was it the fact that I’d had my babies so close together? Or that my second baby weighed in at nearly 11 pounds at birth? Was it my age—44 when I had my second baby—more than the effects of pregnancy itself? My doctor couldn’t give me a clear answer except to say, “It’s probably a combination of factors,” and to prescribe patience and Kegel exercises. Well, great. That combination of factors had me carrying a change of underwear in my purse at all times. And had me scoping out the nearest bathroom whenever I left the house. Whatever the factors, the number of accidents I had after my baby was born hadn’t seemed to decrease from when I was nine months pregnant and had a good excuse for my weak bladder.

So where patience and Kegels fell short, I used humor to cope with this fun new side effect of being a second-time mom. I wryly told my husband, “I bounced back after one baby, but the second one wrecked me.” The truth is, I can’t imagine life without my little (big) baby—but man, having to change my underwear almost as often as I changed my baby was not something I’d expected to cope with once he was out in the world and off my bladder.

It’s gotten better, thankfully. Of course, the situation is not perfect—I still carry a spare pair of underwear in my purse—but it’s improved enough that an afternoon at a park with nary a bathroom in sight doesn’t strike fear in my heart unless it’s allergy season. It’s still frustrating and potentially embarrassing if I push myself to “hold it” for too long, but my anger has faded. I’ve come to accept that my body will probably never return to its former leak-proof self—and that’s OK, because I have so much more in my life. Much like many other side effects of pregnancy, this is one where the good outweighs the bad. It just took me a while to accept it.

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Growing pains

When most women talk about urinary incontinence, they’re referring to what happens after having a baby or once menopause hits. In many ways, it’s a badge women wear, signifying a time in their lives. But peeing your pants from laughing isn’t something a nine-year-old girl experiences on a regular basis, right? Wrong.

My history with this embarrassing disorder is a long one. When I was very young, it was a source of frustration for my parents, who didn’t understand why I was having so many problems after being toilet trained. I’m sure they tried their best to be patient with me, but my memories are of being punished for having yet another accident that appeared to be for no real reason.

Eventually, I was given a diagnosis and a prescription to reduce the frequency of my accidents, and I was told I would grow out of the problem. In the meantime, though, I lived with the accidents that happened regularly, and as I got older, went to high school, and became part of more complex social hierarchies, the shame of this secret of mine grew.

I truly hated myself at times. I felt like my body was betraying me, embarrassing me, causing me to hide who I was. I refused to share my secret with my friends, unless I found myself in a situation where I had no choice but to reveal it. I became a master at tying a sweater around my waist to hide my shameful accident or being the last person in the room to get up from her chair, so that no one would see me from behind.

As predicted, though, my disorder improved as I grew into adulthood. The accidents were less frequent, though I still had to be careful. It became easier to manage, because I could predict and prevent the scenarios that might lead to an accident.

Then, I had babies.

More specifically, I had my second baby, who was a whopping nine pounds, four ounces, in a three-hour natural labor with only 15 minutes of pushing. While my midwife was measuring him after I had given birth, she exclaimed in surprise when she measured his head circumference. It was the size of a three-month-old’s.

Needless to say, my troubles with urinary incontinence have returned. This time, however, I have found liberation in my challenge, because I know that I’m not alone. Mothers talk about peeing a little when they sneeze or laugh all the time. I’m part of an illustrious little club rather than suffering on my own. I don’t feel ashamed, because I know that there’s finally a measurable reason behind this problem: the fact that my body had to adapt to a large baby and the strain that came with the birth.

It’s not my fault. Logically, I know it was never my fault; my diagnosis at 10 years old confirmed that. Having no real understanding of why I was having accidents before then, however, had a profound impact on how I viewed my role in my accidents. Self-blame is hard to unlearn.

I can’t begin to express how that transformation in my point of view has positively affected my state of mind. I realize this problem is still an inconvenience, but it’s not one I’m afraid to admit to anymore. Sharing my experiences with fellow moms, laughing about them together, has transformed this part of me which used to be a source of so much shame, into something that just is. I am not my problem. And neither are you, if you’re part of the club.

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