About three years ago, Becky Beach let out a loud, head-back guffaw during a work meeting. Full-body laughter is typical for Beach, now 37, but what happened next took her by surprise: She released some urine — enough to leave a wet spot on the front of her pants. “I used my notepad to cover it, then changed into workout pants to wear for the rest of the day,” says Beach.
This wasn’t the first time. After having her first child, Beach noticed that certain movements and activities, like coughing, sneezing and running, caused her to leak a little. But this was the worst accident yet, by far. “I was afraid I could lose respect at the workplace if people knew I wet myself,” she says. “I had to keep it a secret from others.” She made an appointment to see a doctor and started wearing feminine pads.
Many people decades away from an AARP card experience bladder leakage. “The problem is common enough in women in their 20s and 30s that I see it every day,” says Dr. Angel Marie Johnson, a urogynecologist and the director of the Women’s Health Center at Greater Boston Urology.
Even so, bladder leakage isn’t something that younger women discuss openly. When Cora, a brand that makes pads and liners for light bladder leaks, surveyed 1,000 women between 30 and 50 years old, 89 percent said they were more likely to talk with their friends about relationship issues, body image fears and taboo lifestyle habits like drinking or drug use than bladder leakage. Luckily, there are ways to help manage light bladder leakage and reduce feelings of shame and isolation that often accompany the issue.
What is it?
Light bladder leakage is not a medical term. “It’s a term people use to describe their symptoms,” Johnson says; some companies that sell pads use it as well. When people talk about LBL, they usually mean overactive bladder syndrome, stress urinary incontinence or mixed urinary incontinence.
Overactive bladder is defined by frequent urination (meaning eight or more times during the day or more than twice at night) and strong, sudden urges to pee that occasionally make you leak before you reach the bathroom. Stress incontinence is when you pee a little upon coughing, laughing, sneezing or exercising. Mixed incontinence is a combination of the two conditions.
Overactive bladder is a functional problem; spasms in the bladder cause urges to pee even when it’s not full. “The bladder is like a reservoir,” Johnson explains. “It stretches to hold urine, and it has sensors that indicate when the bladder is full. When this happens, it then squeezes to empty.”
Stress incontinence, on the other hand, is a structural problem. That means leakage stems from weakness in the muscles around the urethra (the tube that expels urine), not an improperly functioning bladder. When an action, like laughing, causes an abdominal contraction, the weakened muscles can’t fully hold back the flow of urine.
While the exact causes of these conditions are unknown, several things can increase your risk for them. “The biggest cause of overactive bladder that’s within our control is consuming irritants,” Johnson says, a category that includes artificial sweeteners, caffeinated drinks and alcohol. The more you consume, the worse it is.
As for stress incontinence, smoking weakens the pelvic floor muscles and being overweight increases pressure on the bladder. Beyond that, “childbirth is probably the biggest risk factor,” says Dr. Jonathan Shaw, a urogynecologist at Dartmouth-Hitchcock Medical Center. “A vaginal delivery can put a lot of strain on the pelvic floor.” Complications that require the use of forceps or a vacuum can also cause muscle tears.
The restrictions and stigma of leakage
Living with light bladder leakage isn’t harmful to your health, but it can “decrease your joy and prevent you from living your best life,” Johnson says. Some of her patients say they won’t spend the night at a friend’s house, fearing the possibility of having an accident that they’ll need to explain. Others avoid planes, buses, movie theaters and anywhere else they can’t guarantee easy bathroom access. And since exercise, especially jumping of any kind, puts pressure on the bladder and can lead to leakage, Johnson says many women stop working out.
Beach, who lives in Dallas, used to wake up at 5 a.m. every morning to run, but stopped after the leakage started. “I can’t run without a Depends undergarment, and they are so bulky that they show through my running pants,” she says. “I feel so embarrassed wearing them. I know bladder leakage isn’t an excuse to not exercise, but I let it control me.”
She’s also nervous to laugh, sneeze or cough at work, where she’s stopped taking the stairs, which can also cause leakage.
“It can affect your job if you try to avoid activities where you may leak, or if you feel self-conscious about walking to the bathroom all the time,” Shaw says. “Others are afraid they’ll leak during intercourse, which can cause sexual dysfunction or avoidance of intimacy.”
Simple lifestyle changes can remedy LBL
If you have light bladder leakage at any age, talk to a primary care physician, ob-gyn or urologist. “You are not alone, and there are things a doctor can recommend to help you,” Johnson says.
Lifestyle changes are the first line of defense. For overactive bladder, this usually includes cutting back on excess consumption of fluids (though not to the point of dehydration), especially coffee and alcohol. “Many people are cured by just that,” Johnson says.
Additionally, bladder retraining can help. “We need to teach the bladder to not freak out when it thinks it’s full but it isn’t,” Shaw says. First you note how often you currently use the bathroom. Then you develop a schedule with your doctor that helps you space out those trips. When an urge comes on before it’s time for your next scheduled trip, you can practice deep breathing and other relaxation techniques, as well as engage the pelvic floor muscles, to help you wait it out. Over time, you space out your planned pee breaks until you can hold it for three to four hours at a time.
If someone with stress incontinence smokes, quitting is a priority. Similarly, if someone is overweight, losing 5 to 10 percent of their body weight can cut symptoms in half, Shaw says. But the best-known treatments for stress incontinence are kegels and other pelvic-floor exercises, which target the muscles that support the urethra, rectum and vagina. While you can find kegels guides online, Shaw says many women do them incorrectly and recommends seeing a pelvic-floor physical therapist. They specialize in treating pelvic floor dysfunction and can make sure you’re doing movements that will help you gain control over your pelvic floor muscles — strengthening them if they’re weak and relaxing them if they’re tight.
After three months of doing an online exercise program to strengthen her pelvic floor muscles, Beach is leaking less. But like many women with light bladder leakage, she still wears pads. For others who decide to do the same, Johnson says it’s important to buy incontinence pads and not menstrual pads. “Although menstrual pads are less expensive, they’re not designed to hold as much volume and are not meant to be worn all day. This can lead to irritation,” she explains. The same thing can happen with a product like Thinx, which are also designed for menstruation.
Alternatively, if you don’t want to use pads, you could see an ob-gyn or urogynecologist to get fitted for a pessary, Shaw says. A pessary is a small plastic device — like a diaphragm, but firmer — that’s inserted into the vagina to support the urethra and bladder wall, thereby preventing leakage. You can put it in and take it out as often as you want. Some women also use tampons designed for incontinence, Shaw adds, which support the urethra too.
Medication is typically a secondary treatment option. There are OTC and prescription drugs that help either reduce spasms in the bladder so you don’t leak as much, or that relax the bladder muscle so it can hold more urine. If medication doesn’t work, Botox is another approach to consider. “I recommend it for patients in their 20s or 30s if medicine and more conservative measures have failed,” says Johnson, adding that it is effective and low risk. The same way it relaxes facial muscles to smooth out wrinkles, Botox can also block nerves that tell the bladder muscles to contract. Treatments are typically given every six months. While it’s also possible to treat urinary incontinence with surgery, experts say it’s a last resort that’s mainly recommended for older women.
Between making lifestyle changes, using products like pads or a pessary and, if necessary, taking medication, most women can reduce their bladder leakage. While the first accident might have taken you by surprise, the problem doesn’t need to take over your life.