Leaky Bladder Causes and Treatments

Deborah Howell
MemorialCare Health system excellence in health care presents Weekly Dose of Wellness. Here's your host, Deborah Howell. Hello and welcome to the show. I'm Deborah Howell, and today we'll learn about leaky bladder causes and treatments with a leading expert in the field. Our guest today is Dr. Jennifer Gruenenfelder, a urologist at MemorialCare Saddleback Medical Center. She's also a subspecialty boarded in female pelvic medicine. Welcome, Dr. Gruenenfelder.

Dr. Jennifer Gruenenfelder
Thank you.

Deborah Howell
Lovely to have you. So, what is urinary incontinence?

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Dr. Jennifer Gruenenfelder
Urinary incontinence is leakage of urine. Or essentially, if the urine is coming out of your bladder any time that you don't want to be urinating.

Deborah Howell
And what are some common symptoms of urinary incontinence disorders?

Dr. Jennifer Gruenenfelder
Well, in broad terms, we divide urinary incontinence into two different kinds. There's overactive bladder. And the symptoms of overactive bladder include urgency, which is the feeling that you have to get to the bathroom urgently. Frequency, meaning that you go into the bathroom more often than other people, and then urge incontinence, which is where you get an urge to go. And before you can get to the bathroom, you leak or urine comes out. This is different from stress incontinence. Stress incontinence is where you have leaking with things that are like coughing, sneezing, jumping, anything that requires physical exertion. There's another kind of incontinence called overflow incontinence where people really aren’t emptying their bladder, and so they continuously drip urine. But mostly if urge incontinence or stress incontinence that we treat people for as urologists.

Deborah Howell
And what are some common symptoms of urinary incontinence disorders?

Dr. Jennifer Gruenenfelder
Well, leakage of urine is the major symptom, meaning that you have loss of urine before you get to the toilet and you have to wear a pad. Although you can also, as I said before, have associated frequency and urgency waking up at night to urinate, things like that.

Deborah Howell
What's a normal amount of times to wake up at night?

Dr. Jennifer Gruenenfelder
It depends on your age. Most people below the age of 50 won't wake up at night. As people get older, it becomes more common, so people in their 80s will often wake up 1 to 2 times at night. As you age, your bladder capacity gets to be a little bit lower so you can hold less. But if it becomes more than that, then that's definitely something that you can improve with treatment.

Deborah Howell
And also not drinking after, say, 9:00.

Dr. Jennifer Gruenenfelder
Exactly. We usually start with behavioral treatment when people have these issues. So just being mindful of how much you drink and when you drink it can make a huge difference in terms of how many times you wake up at night. So if you're having a big glass of water before bed, you probably will wake up. And especially if you have water on a bedside table and you're taking sips all night, you'd be more at risk of waking up at night.

Deborah Howell
Or a glass of warm milk like some people like to tell you to do. It works to get you to sleep, but then it wakes you up later. So are there any non-surgical treatment options for urinary incontinence?

Dr. Jennifer Gruenenfelder
Sure. And part of it, as you just said, is fluid restriction or behavioral changes. We know that patients who drink a lot are more likely to have problems with incontinence. So there does seem to be this common idea that you need eight glasses of water a day. But patients, especially with an overactive bladder, will probably be fine on 4 to 6, and they'll find that they have a little bit of better control if they're not drinking all the time. And there are also some drinks that seem to make overactive bladder worse. If you have a diet that's high caffeine or alcohol or spicy foods or citrus foods, those are often bladder irritants and can make people feel like they have more urge incontinence, more urinary urgency or frequency. And then the other treatment that is, I think, very important is to be aware of your pelvic floor health. You can do exercises called Kegel exercises where you are practicing strengthening the muscles to hold the urine in so that you can have better control when you do get the urge. And there's also a lot of evidence that doing core strengthening exercises will be helpful for this problem. A lot of people read about exercises, and you can certainly do them on your own. In the last ten years, our guidelines have evolved in urology that it's been proven that pelvic floor physical therapy can be very helpful to teach people how to do the exercises and really give them the knowledge to do them on their own at home. And so there are quite a few pelvic floor physical therapists across the country who are really able to meet one on one with people who are suffering from this problem and teach them how to have better control.

Deborah Howell
And having good core muscles, you know, is never a bad thing for other reasons as well. So, when is surgery typically necessary?

Dr. Jennifer Gruenenfelder
Well, necessary is always a difficult word with incontinence because it's really a quality-of-life decision. And so as an incontinence surgeon I would never tell somebody you need surgery. It's really about when you decide that there is such an impact from this condition that it's really negatively affecting your quality of life. Maybe you don't travel or you don't exercise because of this problem. Generally speaking, we try to do conservative measures first, but if you're requiring multiple pads per day and leaking urine, it's something that you may wish to consider. It's not always a surgical problem. Patients with an overactive bladder are initially treated with medication and physical therapy, and then if medication doesn't work, they can be treated with Botox in the bladder, which is an office procedure, or there is a surgery that's like a pacemaker procedure where you stimulate the bladder nerve and that treats overactive bladder. But generally we try patients on medications first. For stress incontinence, which is a leakage with coughing, jumping, sneezing and running. It's a quality of life decision, as I said. But if you're at a point where there's such an impact from your incontinence that you're no longer doing activities that you like to do that involve physical exertion, it may be time to think about surgery. And we have a surgical procedure where you can inject medicine in the urethra to close the urethra better, or we do what is called a sling procedure to kind of tighten up the sphincter muscle, which is the muscle that holds the urine in and provide better scaffolding on the pelvic floor so that you can resume your normal activities without that kind of leakage.

Deborah Howell
So, you mentioned medication. Say somebody has this problem, but really they only want to deal with it when they're traveling. Is there a way to go on and off?

Dr. Jennifer Gruenenfelder
Yes. It's a medicine that's very safe for you can start and stop without any significant side effects.

Deborah Howell
Very interesting. Is it common for women to experience pelvic floor disorders after giving birth, and if so, what do you recommend for people who may experience this?

Dr. Jennifer Gruenenfelder
It's very common because you're passing essentially a bowling ball through something that was the size of a keyhole. So obviously there's going to be some stressors on this system, and a lot of women will experience loss of some of the muscles and straining of all the ligaments. I would recommend Kegel exercises, and also seeing if you can get a referral to a pelvic floor physical therapist to really make sure that you're being taught how to do those exercises. To regain that strength early in the postpartum period.

Deborah Howell
As you are talking about the bowling ball scenario. Our male producer really cringed. Now, is there anything women can do to prevent weakening of the pelvic floor muscles?

Dr. Jennifer Gruenenfelder
Well, you can certainly work on pelvic floor exercises. Obesity has a role, so staying thin or at least normal BMI will really help. If you look at data on overweight and obese women, they are far more likely to suffer from incontinence than women who are of a normal weight. So making sure that you're mindful of what you eat and exercising regularly will help. And I just really would emphasize that it's important to have a fitness regimen and work on core strengthening, and just be aware that this is a part of your body that is muscular like everything else. And if you're not paying attention to it, it's more likely that you'll experience things like atrophy. So trying to make heel exercise as part of your regular regimen, that's a good thing.

Deborah Howell
Absolutely. Do you have any words of encouragement for people who have an issue with incontinence, but are maybe embarrassed to address it?

Dr. Jennifer Gruenenfelder
Go see your doctor is my word of encouragement. Incontinence is extraordinarily common, it affects 15 million Americans. And so I understand the embarrassment. But I also know that there are lots of treatment options, and you certainly don't have to be embarrassed when you see your doctor. This is what we do all day long. So this is something that really can be improved with good medical treatment. It is such a big thing in terms of people's quality of life. If you're having incontinence severe enough that you're not going out when you want to, that you can't sit through a movie, that you're not traveling when you want to. You shouldn't be embarrassed. This is unfortunately, a condition that's associated with aging, but that doesn't mean that there isn't treatment for it. And there are a lot of people who are, like me, trained to really give people options for how to make their quality of life better.

Deborah Howell
Well, thank you so much, Dr. Gruenenfelder. for being on our show today. It's been so good to talk to you.

Dr. Jennifer Gruenenfelder
Thank you for having me. I'm always happy to talk about this topic.

Deborah Howell
Our pleasure. And you're helping so many folks. For more information, visit MemorialCare.org/Saddleback. That's MemorialCare.org/Saddleback. And if you enjoyed this podcast and would like to hear more, just go to a MemorialCare.org/podcasts. Thanks for listening and have yourself a fantastic day.