10 Ways to Live Normally With a Leaky Bladder
By Paula Spencer Scott, Caring.com senior editor
Nervous about going out because your bladder sometimes leaks? Or constantly worried about getting to a bathroom on time? About one in five adults over age 40 has problems with urinary urgency and frequency, according to the National Association for Continence. But an overactive bladder (OAB), also called urge incontinence or irritable bladder, doesn’t have to cramp your lifestyle.
Overactive bladder is often caused by a disruption in nerve signals from the brain to the muscles involved in urination. Symptoms include the need to go often or suddenly. It’s the second-leading kind of incontinence, as well as part of the most common kind, "mixed incontinence" — having both OAB and stress incontinence, a muscle weakness causing leaks when you cough or sneeze.
Here are ten ways to live a normal life despite bladder worries:
Too much liquid, of course, will send you running to the bathroom too often, no matter what the condition of your nerves and muscles. A smart rule of thumb from ob-gyn Jill Rabin, coauthor of Mind Over Bladder, or I Never Met a Bathroom I Didn’t Like and chief of ambulatory care and urogynecology at the Albert Einstein College of Medicine in Hyde Park, New York: Divide your body weight in half, and that’s roughly the number of ounces of liquid a day that should be your maximum. So if you weigh 150 pounds, aim for 60 to 80 ounces of liquid a day. (That’s about 10 cups total, including water, tea, juices, milk, soup, and so on.)
Drinking too little, on the other hand, sets you up for constipation, which can lead to urinary tract infections. UTIs irritate the bladder, triggering the need to go. Not drinking enough also creates concentrated urine, which is itself a bladder irritant and smells even worse if there’s an accident.
The very best beverage for the bladder: plain water. Try drinking it flavored with a slice of lemon or lime, or drop an herbal tea bag into a sport bottle, glass, or thermos of cool water
For most people with overactive bladder, one or two kinds of food exacerbate the problem. Ob-gyn Jill Rabin’s list of the top offenders: artificial sweeteners (especially Nutrasweet), coffee (and caffeine generally, including tea), alcohol, chocolate, tomatoes, red peppers, and spicy foods. Energy supplements can also contain ingredients that annoy the bladder. Other triggers in some people: acidic foods (citrus) or high-sugar foods.
Eliminate one food for two weeks and see if there’s any difference, Rabin suggests. If not, pick a different substance to eliminate. Most people have just one primary trigger, not all of these.
3. Get the knack.
The muscles that help hold back urine until it’s convenient to go are both involuntary and voluntary. There’s a moment before coughing, sneezing, lifting a box, swinging a tennis racquet, or dealing with other physical stressors when you can consciously tighten the urethra to help hold back the urine. Doctors call this maneuver "the knack."
Because the knack maneuver is a voluntary movement, with practice you can teach yourself to do it at the moment you’ll need it. Right before you cough or lift something (or whatever move you know creates your urinary leakage), consciously contract your pelvic floor.
Do this often enough, and the habit will become a reflex, Rabin says. The extra contracting of the knack movement can be enough to prevent any leaks.
4. Keep on Kegeling.
A therapy used to treat overactive bladder should be an everyday feature, doctors say. Most women know pelvic-floor exercises by the name "Kegel," after Arnold Kegel, the physician who popularized them. Kegels build the muscles used to control urine flow.
Because their effect is cumulative, the more you do them, the better you can resist an ill-timed urge to urinate. To remember to do the exercises often, build associations: Do them every time you’re sitting at a red light, for example. Or leave yourself reminder notes in front of the bathroom mirror or on the dashboard of your car.
You can identify the muscles involved by stopping urine flow midstream. Do regular Kegel exercises when you’re not urinating, however, to avoid the risk of urinary tract infections or other damage. Rabin recommends holding the contraction for a slow count of five ("one Mississippi, two Mississippi . . . "), then relaxing for a count of ten. Repeat five times for one set. Gradually work up to ten sets per day. "It takes up to six weeks to see results," she says.
Since OAB is partly a signaling problem between the brain and the body, try using your mind to forestall an urgent need to urinate. Decide on a powerful mental image that you can turn to whenever you desire a distraction from urinating. Some people imagine a dam at a rushing river, or a drain plug, although for others the water in these images is too tempting. If that’s the case, picture another form of blockage: a fence, a railroad gate, a stop sign on a desert highway. A picture that simply makes you calm and happy might also work, such as a child’s or lover’s face, a sunset, flowers.
When the urge strikes, return to your mental image and take deep breaths.
6. Quit smoking.
Reason number 5,999,999 to drop a cigarette habit once and for all: The chronic cough it causes isn’t doing your bladder any favors. Nicotine irritates the bladder lining. Even worse, smoking produces chronic coughing, which triggers leakage.
7. Treat your bladder the same, seven days a week.
Doctors often see a phenomenon called "schoolteacher’s bladder," ob-gyn Jill Rabin says. Overactive bladder symptoms worsen at night because during the day, the person simply doesn’t use the restroom often enough, sometimes because of work constraints. The result: up all night with what seems like an overactive bladder.
Ideally, aim for using the bathroom every two to four hours (under age 50) or every two to three hours (over age 50).
More than 300 different medications can cause incontinence symptoms, ob-gyn Jill Rabin says. A drug can either be the cause of your overactive bladder, or it can exacerbate the problem. Often a related alternative medication proves less irritating. Be sure that the doctor treating your urinary symptoms knows about any new drugs you’re given by a physician for an unrelated issue.
9. Wear tampons or pads for extra security.
Reducing the odds of leaking in the first place (by changing diet, medications, muscle strength, and so on) provides the best freedom. In the meantime, given the range of discreet, absorbent personal products out there, it’s easier to live your usual life wearing added protection than to hide at home.
Some women swear by a tampon worn during heavy exercise. (Many female athletes with stress incontinence know this trick.) Be sure to change them out often. Disposable underwear is another solution. Forget the "adult diapers" imagery of the past; current products, styled for either men or women, look more like classic undergarments.
Carry a change of clothing in your car, as well as a dark plastic bag to transport soiled clothes until you can wash them.
10. Get the right diagnosis.
The best way to live normally with an overactive bladder is to be sure of the source of the problem, so you get to the right treatment. Only 17 percent of baby-boomer women say they’re likely to immediately contact their doctor when they experience an embarrassing health condition or symptom, such as incontinence, according to a 2011 Harris Poll. And more than half (55 percent) wouldn’t contact their doctor at all, even if the symptoms got worse!
This is changing, doctors say, as more people become aware of the options surrounding incontinence. "Thank goodness, in 2011 overactive bladder is finally coming out of the water closet," Rabin says.