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The down & dirty on women's wellness
Those WHOOPS! Moments...
Those WHOOPS! Moments...
May 1, 2021
Picture this: you are running a race you have been training for over the last few months. You are closing in on the finish line & you really want to give it all you've got. You pick up your pace & drive forward, stronger than ever before. With that extra effort, you lose your entire bladder. The whole thing. Your pants are suddenly soaked in urine, your legs are dripping wet, your shoes are filling, pee is flying. You also won the race. You are now completely drenched with your own involuntary urinary release, however, that you do not even want to claim your medal. You smell like pee & don't want to be around others. You hope you have a towel in your car to protect your seat as you drive shamefully home to shower. You vow to never run with a group or race hard in public again.
This is a true story. We won't name names, but it happened to one of us.
On a lesser level, it happens to women throughout their days. They laugh & lose some pee. They sneeze & squirt a little. They cough & hope they've remembered to wear a pad. They jump & find they're damp. When we talk to women about their bladder control & continence, we are rarely told that they have incontinence, because the general perception is that incontinence is a term used to refer to complete loss of bladder control--the visual representation of which is an older woman in a wheelchair & a diaper.
While that is incontinence, the full loss of bladder control does not comprise all (or even most) of the manifestations of incontinence, many of which we think are normal occurrences or minor irritations that we wish would stop happening but for which we have no known solution. We think this is what happens because we're women, because we are getting older, because we've had so much sex, because we made some babies.
There are three general forms of incontinence that begin to plague women earlier in their lives than you might think. They are functions of gravity & all things that can bother our nerves. They happen for a variety of reasons, some of which are preventable & some of which are not. The best thing is that they are generally quite treatable & are not things we have to just let progress until we are grandmothers wearing diapers or have to learn to simply endure with grace.
You do not have to pee your pants when you run. Or cough. Or laugh. Or jump. Or sneeze.
Among the three general forms of incontinence is the most common: stress urinary incontinence. This form of incontinence occurs when there is weakness that is intrinsic or has been acquired (for instance, from extreme weight gain, power-lifting, or baby-carrying) in the urethral sphincter, which is the group of muscles that keeps urine in our bladders. This kind of incontinence allows urine to accidentally escape when anything that increases the pressure on that sphincter, causes it to give way & release varying amounts of urine before we can catch & control it. This can be very disruptive & can dramatically limit women's physical activities because it is the kind of incontinence described above: the loss of bladder control while running. This affects women's abilities to engage in such things as aerobics, dancing, trampoline play, kickboxing, running, and anything else that requires up & down motion. It can sometimes even affect a woman's ability to do anything that might engage her core. Additionally, women can feel inhibited with their laughter because it can induce stress urinary incontinence, or they can avoid work when they have a respiratory cold, as they don't want to smell like pee when they cough throughout the day.
Another form of urinary incontinence that often affects women is urge urinary incontinence, which occurs when urine is involuntarily released as soon as or shortly after a woman realizes she needs to pee. Sometimes, this can occur because a bladder is overfilled, but it more often occurs because the nerves that control the bladder are irritated or have been damaged & are both hypersensitive & not properly communicating with the brain. This often looks like a woman realizing she needs to urinate & standing up from her desk to walk to the bathroom, then losing the contents of her bladder before she can get to the bathroom. It also often looks like waking in the night to use the bathroom & beginning to urinate before one has made it to the toilet. It can cause women to feel the need to constantly be near a bathroom, & it can cause them to frequently void in a manner that is disruptive to their lives, just to prevent urine from collecting inside their bladders. Additionally, many women affected by urge incontinence will deliberately withhold liquids & dehydrate themselves in order to not produce so much urine & prevent themselves from accidental leakage by reducing the amount of urine they make.
A third form of incontinence is a combination of the two, called mixed incontinence, which can be the worst of the bunch. Mixed incontinence involves muscular & nerve damage, weakness or irritability, & is the most disruptive & bothersome form of incontinence, as it makes women fixate on their bladders & structure their lives around the likelihood of leakage, which can be incredibly limiting.
Urinary incontinence can occur because of genetics, which affect the strength & integrity of our muscles & tissues. It can occur in women who have not had children & who have no identifiable risk factors. It can occur among young girls & can occur among older women. It can be a matter of time or it can be a situation that someone was simply born with. Often, women will tell us: I don't know why this is happening--I haven't even had kids! This highlights the misconception that childbearing causes incontinence. Urinary leakage occurs because the nerves or muscles aren't working properly, which can occur as a consequence of simple bad luck.
Urinary incontinence can also be induced by anything that increases the pressure repeatedly or continuously on the urethral sphincter. These events are often things that occur only in women (e.g., pregnancy) & do not affect men as a result, but urinary incontinence also affects women more frequently than men because of simple differences in anatomy: the male urethra is quite long, while the female urethra is a quicker route from the bladder out. Pregnancy of any kind can result in stress urinary incontinence, whether women push out their babies or deliver them via cesarean section. Certainly, a difficult vaginal delivery, often accompanied by catheterization with the placement of epidural anesthesia, with long periods of downward pushing, can increase the likelihood of later urinary incontinence, & having a vacuum or forceps-assisted delivery can do direct damage to both nerves & muscles, but many women who have simple, scheduled cesarean deliveries can go on to have dramatic changes in their bladder function. Weight gain, especially abdominal weight gain, can also impair sphincter integrity. When we gain visceral fat, in particular, we carry continuous excess weight in our pelvic regions, which can create undue constant stress on those muscles & weaken them over time. Gravity also plays a role, & it is largely inescapable. However, anything that increases the force of downward gravity on the pelvic floor can exacerbate this effect. For that reason, women who Cross Fit, kickbox, or engage in heavy weight lifting or another activity that requires them to jump up & down, engage in high impact physical activity or bear down are more likely to experience urinary incontinence.
Urinary leakage is a definite drag. It is disruptive. It is mortifying. It has a number of downstream effects on our lives, none of which is positive. The reassuring thing, however, is that it needn't be an inevitability, as there are things we can do to prevent it, & it needn't be something we have to learn to live with. There are things that we can do regularly to protect our nerves & muscles, & there are things that we can do to rehab them when they've been injured. Often, women avoid evaluation or a discussion of their bladder-related symptoms because they fear that the only treatment options are invasive, dangerous, or surgical in nature. The options are many & varied---there are all kinds of ways we can help you maintain your function or give you back your life!
We, too, have accidentally peed in our pants. We know the humiliation of the whoops moments. We also know that they don't have to happen. Boldly bring us your bladder concerns! There is no shame in your urination game, & it is both incredibly more common than you might think & an absolutely unnecessary misfortune.