Regain Control: Effective Strategies for Managing Urinary Incontinence

1. Why does urine leak increase with ageing?

Urinary incontinence is the inability to control urine. There are various types of incontinence such as- Stress, urgency, overflow, mixed and neurogenic incontinence. This issue leads to decline in the quality of life primarily.

It is predominantly found in elderly women though can be seen across age groups. The pelvic floor and the organs are predominantly supported by the fibro collagenous tissue along with some strong muscles. Given the upright posture of humans, integrity of both of these is essential to support the pelvic organs. Few of the below mentioned points will explain why the probability of incontinence increases with age.

• As age advances, a woman goes through various biological changes due to which the pelvic muscles and the supportive tissues tend to get weak. This can lead to loss of control over urine while doing anything that increases the abdominal pressure.
• Female hormones are essential for maintaining the functioning and caliber of the urethra. After menopause there is complete stoppage of hormonal activity which can make the urethra weak and inefficient to hold urine.
• Pelvic organ prolapse- weak pelvic floor might no longer be capable of supporting the pelvic organs leading to pelvic organ prolapse. In females, vagina is a pouch like opening in the pelvic floor and this acts as a weak area leading to prolapse of bladder (cystocele), rectum and intestinal loops (rectocele and enterocoele) and the cervix and uterus itself (uterovaginal or apical prolapse). When the bladder is not in its proper anatomical place, it will dysfunction which will manifest as urinary incontinence.
• Risk factors contributing to weak pelvic floor - chronic cough and constipation, obesity, prolonged and obstructed labor, precipitate labor, short inter delivery intervals.
• Adding to this, certain chronic illnesses that come with age, especially diabetes mellitus can affect the nerve supply of the urinary bladder which makes it function abnormally and lead to incontinence issues.
• Low immunity leading to repeated urinary tract infections and ill-treated UTI can affect the bladder function which can present as urinary incontinence.
• Arthritis and other similar musculoskeletal issues might make it difficult to reach the bathroom on time and present as incontinence.
• Few drugs and lifestyle habits can also make the bladder irritable leading to urgency incontinence such as - too much intake of caffeine and tannins, cranberry juice, excessive spicy food, anti-psychotic drugs, too much intake of alcohol.

  2) Various measures to strengthen pelvic floor 

Pelvic floor muscles hold the pelvic organs and certain abdominal organs in place especially in upright posture. Females have a natural opening in the pelvic floor in the form of vagina which aids in various biological functions. Due to this, it is important for women to concentrate on improving the pelvic floor health as equal to other parts of the body. Here are few pointers to improve the strength of pelvic floor muscles.

• Focus on losing excess weight. As excess weight puts extra pressure over the pelvic floor, it can weaken the muscles in due course of time.
• Prompt treatment of constipation and cough. Both of these increase the abdominal pressure which in turn can pressurize the pelvic musculature leading to its weakness. Hence, it is of priority that you get yourself treated at the earliest for the same.
• Stop smoking. Smoking breaks down collagen and restricts blood flow to muscles. This doesn’t allow the muscle and tissue elasticity to be rejuvenated.
• Avoid doing unchecked heavy weight lifting. Focus on improving core strengthening and pelvic muscle strengthening exercises. In case you need to lift heavy weights in a day to day scenario, then consciously contract your pelvic floor muscles while lifting. This ensures the pelvic organs are well supported during the times of increased abdominal pressure.

Exercises/measures to strengthen the pelvic floor

• Kegel’s exercises : After ensuring that you have passed urine and have no urge to pass stools, you need to squeeze the pelvic floor muscles (akin to while controlling the urge to pass urine) and hold for 2-5 seconds and then relax. Repeat this maneuver for 10 times twice a day. To start with, the duration of hold and the repetitions can be reduced and gradually increased. Make sure you are contracting the pelvic floor muscles and not the glutes, thighs or abdominal muscles. No need to hold your breath while doing so. It can be done in any posture.
• Pilates and abdomen core strengthening exercises help in strengthening the pelvic muscles
• Diaphragmatic breathing
• Pelvic floor relaxation while passing motion or urine is equally important for the integrity of the pelvic muscles.

Similar squeezing of pelvic floor muscles can be done while lifting heavy weights too.