stress-versus-urge-incontinence

Stress Versus Urge Incontinence: Why the Difference Matters

Maybe you have heard that incontinence is just part of motherhood. Maybe you have already tried everything. Now, you’re resigned to dealing with wet pants as part of life. Do you know there are different types of incontinence, and different treatment approaches are necessary depending on the type? It’s true. If you treat one with the opposite methods, you will never find success. Let’s take a closer look.

Types of urinary incontinence

Research shows that about 1/5 of women experience some kind of incontinence after their first vaginal birth, and over 1/3 of women experience incontinence after a forceps delivery. There are actually several different types of urinary incontinence. But for the sake of this discussion, let’s cover the two types most common in mothers. These two are called stress incontinence and urge incontinence.

Stress incontinence is the leakage of urine during some physical activity. This could include laughing, coughing, sneezing, lifting, or exercising. To resolve stress incontinence, one needs to address the central stabilizing system and the way a woman manages pressure and load. This can mean changes in the strategy used to perform an activity. Or it might involve adopting a different posture to perform the offending task. For some women, it is as simple strengthening, but for others, it becomes more complex.

stress-incontinence-jumping

Urge incontinence is the leakage of urine accompanied by the feeling that you need to empty your bladder but can’t get to the toilet fast enough. Similarly, an overactive bladder (as defined by the International Continence Society) involves the same urgency, but with or without incontinence. It also includes increased frequency of urination both during the day and at night. According to research, an overactive bladder affects 17% of women over the age of 18 in the United States. This is more than the rates of diabetes and asthma.

Lastly, you can have mixed incontinence, where there is a component of both stress and urge. In this case, the treatment approach would need to address both types of causes to find success.

Which type of incontinence do you have?

The gold standard to determine the type of incontinence is an extensive exam. In most cases, this exam includes a detailed history, a voiding diary, a test for urinary tract infection, neurologic and pelvic examination, measurement of residual urine volume after voiding, and a cough stress test. However, all of this can involve a lot of time and expense.

determining-incontinence-type

To simplify, there have been efforts to make this process as quick as possible through a brief questionnaire. Although not as accurate as the extensive exam, the questionnaire is a start for both categorizing and improving understanding. Otherwise, women are left with a lack of information. This might lead them to believe there is nothing that can be done or that surgery is the only option.

You can find the entire questionnaire here. But it really boils down to one key question. Considering the last 3 months of your life, you have to decide what you were doing most often when the incontinence occurred.

  • Stress incontinence is most likely if your leaking occurred most often during physical activity.
  • Urge incontinence is most likely if your leaking occurred most often with an urge. This means you felt like you needed to empty your bladder, but you could not get to the toilet fast enough.
  • Another cause might need investigation if your leaking occurred most often without physical activity or a sense of urgency.
  • Mixed incontinence is most likely if your leaking occurred about equally with physical activity and a sense of urgency. In this case, you are exhibiting components of both stress and urge incontinence.

How do you treat urge incontinence?

Maybe you already have a diagnosis of urge incontinence. Or maybe this article leads you to believe there is at least an element of urge incontinence in your issues. If this is the case, then there are two main ways to address it. The first is changing habits, and the second is adopting new techniques to control symptoms.

Potential habits to change

The answers will look different for different individuals, but there are several habits to consider along with their actual impact on the urge to urinate. Some foods and beverages can irritate the bladder and make it more active or excitable. This commonly occurs with caffeine but can occur with other foods or beverages as well.

Too much fluid or too little fluid can also increase symptoms. Too much fluid will obviously cause an increased need to urinate, but too little fluid can do the same. With fluid restriction, urine concentration increases, and this can irritate the lining of the bladder, creating a subsequent increase in urgency or frequency. General guidelines involve drinking 30 mL/kg of body weight over a 24-hour period.

fluid-restriction-and-incontinence

Another habit to consider is the frequency of bowel movements. Chronic constipation (defined as less than 3 stools/week or straining while passing stool) is linked with both overactive bladder and urge incontinence. Habit changes that may affect this are increasing fiber or fluid intake, addressing pelvic floor muscle function, and participating in regular exercise.

Lastly, there is some evidence that obesity and smoking can increase the likelihood of urge incontinence. With obesity, it seems there is a possibility of increased pressure on the pelvic floor. Along similar lines, there may be increased pressure in smokers due to excessive coughing, or nicotine can have an effect on the bladder muscles, themselves.

Techniques to control symptoms

In addition to changing habits, there are also techniques that can help suppress the urge to urinate. These might include relaxation techniques, pelvic floor muscle contractions, methods of distraction, and positive affirmational statements, such as ‘I can wait’ or ‘I am in control.’ For some women, combining multiple strategies might have the best effect.

Another technique is referred to as bladder training. This involves urinating at timed intervals, while using the suppression techniques described above to make it to the next interval. When success is achieved at one interval, the intervals can be progressively increased over time until the woman is able to hold her urine for 3-4 hours.

walk-to-the-toilet

Finally, behavioral training involves changing the response to the feeling of needing to urinate. Instead of rushing to the toilet, a woman might instead sit down, contract the pelvic floor, and wait for the urge to pass. Once this happens, she can walk calmly to the toilet, while maintaining the decrease in urgency and still reaching the toilet with success.

How do you treat stress incontinence?

Stress incontinence, on the other hand, involves the muscular response throughout the body to different events. These events are the ones that trigger the incontinence, such as sneezing, laughing, coughing, or exercising. Within the abdomen, every individual has to manage internal pressure. This pressure helps to hold us up against gravity and to provide stability to the many mobile joints of the spine and hips.

This deep, internal pressure is largely regulated by a coordination between the diaphragm, the pelvic floor muscles, and the deepest layer of abdominals. This coordination is often disrupted by pregnancy because of its effects on abdominal length and rib cage position. Consequently, lots of women have difficulty with stress incontinence after babies.

pregnancy-changes-deep-core

For some women, simply strengthening the pelvic floor muscles, or performing Kegels, is all that is necessary. But for other women, it’s more complicated and involves addressing the balance between diaphragm, pelvic floor, abs, and even more distant parts of the body. You can read more here about stress incontinence that shows up during pregnancy, postpartum, or even years after babies.

If this sounds like it might be you, the best place to find personalized advice is from a good pelvic floor physical therapist. If for any reason one isn’t available to you, my Mama Made Strong program may also help you to find the right answers. Nonetheless, although incontinence happens to a lot of women after babies, it isn’t something you’re destined to put up with for the rest of your life. Your answers are out there. The important things is to find the ones the address your needs specifically.

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