Five Myths about Urinary Incontinence

Giggle nervously if you’ve ever peed a little when you laughed really hard. Or went for a run. Or even during sex. Thought you were the only one? 

Actually urinary incontinence (UI)— involuntarily leaking urine— is not at all uncommon. In fact, almost half of ALL women experience urinary incontinence of one kind or another, yet as few as a quarter of women will seek any help. Sadly, like so many of our health issues, urinary incontinence is something that we feel we just can’t bring up in polite conversation. 

So, many women slip into feelings of embarrassment or shame surrounding UI, fearing that they are the only one going through it. This couldn’t be further from the truth. To help us get some perspective, let’s address some of the myths about urinary incontinence.

 

Myth 1: There’s only one type of UI- the one where I pee on myself.

Well, kind of. Yes, while the end result may be the same, there are several reasons why a person pees involuntarily. The two main types:  stress UI and urge UI. 

With stress UI, you may leak when you laugh, cough or sneeze. Rising abdominal pressure can overwhelm the pelvic floor muscles, the hammock-like support muscles that compress the urethra and help to keep the urine safely inside your bladder. 

On the other hand, urge UI is that “oh,oh, gotta go” feeling when you suddenly get an undeniable urge to pee but just can’t get to the bathroom in time. And, of course some people will have both stress and urge UI, or even other types of UI. The reason one person has UI may not be the same as someone else, and that affects why you get UI as well as how you treat or prevent it.

Myth 2: UI is an inevitable part of getting older, having children, (insert any other life situation you can think of)

We are not doomed to get UI because we live to a certain age or we become mothers. While  these life situations may increase the chance of getting UI, one does not cause the other. Let’s tackle age first. Getting older does come with some health problems that increase our risk for UI. For example after menopause, a drop in the female hormone estrogen (which also happens after giving birth) thins the lining of both the urethra and vagina, which can cause urine to leak and vaginal dryness. 

Yet not all mature women over a certain age have UI. Strengthening our muscles (we’ll get back to kegels later), supplementing with vaginal estrogen (if needed) and numerous other healthful endeavors can stave off incontinence. 

Pregnancy (especially during the 3rd trimester) and giving birth, definitely changes our bodies. As we literally grow another human within us, the pressure on the bladder increases, and as we birth these new beings into the world, our pelvic floor muscles must relax. These two facts are natural and necessary. Yet, while over 10% of women still have UI at their child’s first birthday, there is a lot we can do to prepare our bodies for the changes of pregnancy and delivery so that we can prevent UI.  

Myth 3: Kegels are the only option for treating UI

Ever since Samantha confessed to doing her kegel exercises, many women have considered that the end all and be all to treating UI. While kegel exercises— active contraction of the pelvic floor muscles— are a great tool in the armamentarium of managing UI (and some sexual concerns) they are not the only answer. 

First, medical professionals (I must admit I have been guilty of it in the past) don’t always do a great job of educating women about these exercises. That “drawing up feeling” should be centered in the perineum— the area between the genitals and the anus, and not focused on the anus, buttocks or abdominal muscles. Your breathing matters. Your body position, how often you do the exercises, how long you hold the contractions, can all be critical in how well kegels work for you. 

Providing a pamphlet on kegel exercises to women without fully educating them can lead to a sense of frustration and even shame when it doesn’t work. Additionally, not all women can (or should) do kegels— certain neurological conditions or even past traumas might make kegels a poor option. Finally kegels don’t always work for every woman even when done perfectly and they don’t work for all types of UI.

Myth 4: Incontinence pads are the only option for treating UI

This is a very personal choice. While some women may choose incontinence products— and the options available have vastly improved over the past few years— other women will not feel comfortable with this choice. Typically incontinence products are best for women with milder symptoms and can be inadequate in a more active woman. They also are not the best option for certain activities like swimming or sex. Each woman will need to make the decision for herself whether she wants to use them now, in the future, or with other treatment options.

Myth 5: Surgery is the only option for treating UI

Obviously, the last few myths are mutually exclusive; no one treatment is the only or even the best option for UI. For example, there are several surgeries to treat UI that vary based on access (robotics! open! vaginal! endoscopic!), tissues used (your own! synthetic! biological!) and location (behind the pubis! middle of the urethra! abdominal suspension!). 

That means that the success of a surgery really depends on your unique situation and requires a close working relationship with your surgeon. Of course, surgery can come with side effects or it just might not work as well as you hoped. Women need to go into these surgeries with their eyes wide open and ask as many questions as possible (from as many surgeons as needed) to make the right decision. While that may be surgery for one woman, it may be non-surgical options for another.  

The greatest myth of all

Personally, I think that the greatest myth women have believed about UI is that we are alone in it. Let's change the statistic that the majority of women won’t reach out to get help for their UI. Our bodies shouldn’t be shrouded in shame, especially when that shame leaves us stuck and affects our health. Let’s normalize healing ourselves first. 

What about you? What’s the greatest myth you’ve heard about UI?

By Ore Ogunyemi MD oreomd.com