The Kaiser South San Francisco Continence Clinic

Jennifer Normoyle, MD
William Zuber, MD
Kathryn Kurtzman, MD
Gavin Jacobson, MD

Women of all ages have bladder control (incontinence) problems. Some younger women find they can't hold their urine after having a baby. Others have problems when they stop having periods. Many women over the age of 75 also have bladder control problems.

You may feel ashamed about your bladder control problem. Remember that it's a medical problem and it's not your fault. Millions of women have the same problem.

Don't believe people who tell you that urine leakage is normal. It isn't. Most of the time it can be cured or, at least, improved.

You can do many things to improve your bladder control. Your Kaiser South San Francisco Continence Clinic team is here to help you. To start, we designed this information pamphlet to help educate you about the bladder control system and what causes bladder control problems. We have also included a brief summary of evaluation and treatment of these problems as well as resources for further information.

Frequently Asked Questions

What does the bladder control system look like?
Most of your bladder control system lies inside your pelvis. Stand with your hands on your hips. The bones under your hands are the pelvic bones. Your pelvis is shaped like a big bowl. The bottom of this ''bowl'' is the area between your legs. The muscles across this area are the pelvic floor muscles.

Your bladder is another muscle. It is a balloon-shaped organ within your pelvis, just below your belly button.

Your pelvic floor muscles should be strong and tight to hold up your bladder in its proper place. Your bladder should stay relaxed when it is full of urine. But, when you go to the bathroom, the bladder muscle should tighten. This squeezes urine out of the bladder.

The sphincter (SFINK-tur) muscles are muscles that surround the tube that carries urine from your bladder down to an opening in front of the vagina. The tube is called the urethra (yoo-REE-thrah). Urine leaves your body through this tube.

The sphincters keep the urethra closed by squeezing like tight rubber bands.

The pelvic floor muscles also keep the urethra closed. Urine stays inside your body when the pelvic floor and sphincter muscles are tight and the bladder is relaxed.

When the bladder is full, nerves in your bladder signal the brain. That's when you get the urge to go to the bathroom. Once you reach the toilet, your brain sends a message down to the sphincter and pelvic floor muscles. It tells them to relax. The brain signal also tells the bladder muscles to tighten up. That squeezes urine out of the bladder.

Bladder control means your urinate only when you want to. For good bladder control, all parts of your system must work together. Pelvic muscles must hold up the bladder and urethra. Sphincter muscles must open and shut the urethra. Nerves must control the muscles of the bladder and pelvic floor.

What causes bladder control problems?
Most bladder control problems happen when muscles are weak or too active. Problems may also happen when nerve signals don't work properly.

If the muscles that keep your bladder closed are weak, you may have accidents when you sneeze, laugh, or lift a heavy object. This is called stress incontinence. It is the most common type of bladder control problem.

Stress incontinence often occurs when women are pregnant or after childbirth. The pelvic floor muscles stretch and weaken in pregnancy or during the delivery of a baby. The same muscles can become weak after a woman goes through the menopause (stops having periods) because they no longer get female hormones.

Sometimes, the bladder muscles become too active. Then you have a different problem. You may feel strong, sudden urges to go to the bathroom, even if your bladder has little urine. This kind of bladder problem is called urge incontinence.

Several things can cause your bladder to be too active. Examples include:

• a bladder infection
• nerve damage (sometimes from childbirth or surgery on the bladder)
• drinking alcohol (beer, wine etc.) or caffeine (coffee, tea, colas etc.)
• some medicines

Some women have a combination of both stress and urge incontinence. This is called mixed incontinence.

Overflow incontinence results when the bladder muscle is weak and won't squeeze out urine effectively or when the passage of urine out of the urethra is slowed by a partial blockage. People with overflow incontinence may feel that they never completely empty their bladder. If you have overflow incontinence, you may:

• often lose small amounts of urine during the day and night
• often feel as if you have to empty your bladder but can't
• pass only a small amount of urine but feel as if your bladder is still partly full
• spend a long time at the toilet, but produce only a weak, dribbling stream

Finally, people with functional incontinence may have problems thinking, moving or communicating that prevent them from reaching a toilet. A person in a wheelchair, for example, may be blocked from getting to a toilet in time. A person with mental confusion may not think well enough to plan a timely trip to the bathroom.

What is the treatment for bladder control problems?
Your treatment will depend on the type(s) of bladder control problems you have. In order to determine this, you will be asked to fill out a questionnaire about your health history and urinary habits. You will also be asked to keep a record (for a day or so) of when you go to the bathroom and when you have accidents. This record is called a bladder control diary. Diaries help us to understand the cause of your problem.

You will have a physical examination, urine tests and, possibly special testing to see how well the muscles of the bladder and urethra are doing their jobs. Occasionally, it is also necessary to look directly inside the bladder using a special instrument called a cystoscope.

After a complete evaluation, the reasons for your bladder control problems will be discussed with you and a treatment program begun. This may include:

• Pelvic Floor Exercises. These are simple exercises that can strengthen the muscles near the urethra and that take only a few minutes a day.
• Pelvic Floor Muscle Stimulation. Using electrical stimulation and/or biofeedback can also help strengthen the pelvic floor muscles.
• Bladder training. You can train your bladder to hold urine better by following a timetable to store and release urine. You can also learn to suppress the urge to urinate using simple behavioral techniques.
• Weight loss. Sometimes extra weight causes bladder control problems.
• Food and drink. Some drinks and foods may make urine control harder. These include alcohol and caffeine. We can suggest how to change your diet for better bladder control.
• Medicines. Certain drugs and tighten or strengthen urethral and pelvic floor muscles. Other medicines can calm overactive bladder muscles.
• Devices such as pessaries can be placed in the vagina to hold up the bladder to prevent leakage. Other devices that can be considered include urethral plugs and urine seals.
• Surgery. Some bladder control problems can be solved or improved with surgery.

Points to Remember:
1) Many women have bladder control problems.
2) Bladder control problems do not have to be a normal part of aging. Many medical conditions can cause bladder problems.
3) Try not to let embarrassment about bladder control problems keep you from seeking help.
4) Most cases of poor bladder control can be improved greatly.

For More Information:

Agency for Health Care Policy and Research (AHCPR)
(800) 358-9295 or (410) 381-3150

American Foundation for Urologic Disease

The Simon Foundation for Continence
(800) 23-SIMON or (847) 864-3913

National Association for Continence