A Weak Bladder

Bladder weakness is a common malady affecting women of all ages, but more commonly with ageing and being postmenopausal. Referring to a weak bladder means urinary leakage occurs – this is called urinary incontinence.

What causes urinary incontinence?

The major causes of what many women refer to as a weak bladder are pelvic floor injury leading to muscular weakness. This leads to a loss of control over urine during times when there is a rise in intra-abdominal pressure. Coughing, lifting, sneezing, laughing, straining and vomiting will all create sudden stress on the opening of the bladder, leading to leakage. These moments of bladder weakness are also called “stress incontinence.”

Common causes of pelvic floor weakness are:

  • damage caused during childbirth,
  • chronic coughing (e.g. smoking, asthma, untreated chest infections),
  • ignoring chronic constipation and the associated straining,
  • excessive physical exercise and lifting of weights
  • Obesity will tend to worsen the problem of bladder weakness.

Ageing is another important factor, combined with a slow development of a habit of rushing to the toilet the moment you feel a need to go. The bladder muscle becomes overactive and bladder capacity shrinks slowly over time. There is urgency to get to the toilet, and often leaking of urine prior to getting there. This is referred to using the term “urge incontinence”.

If you’re currently in perimenopause or menopause, you can make an appointment to discuss your health and wellness as part of our Menopause Clinic

But isn’t it normal to leak a few drops occasionally?

Yes, to some extent this is true. For example, when you are in late pregnancy and have a full bladder, you will find leaking a few drops of urine when coughing, sneezing or laughing is not unusual. In the years following childbirth, many women might again report occasional mild incontinence with sneezing or similar. For many women, if it is mild and occasional, the problem may not overly concern them.

It is wise for all women to do regular pelvic floor exercises to prevent the occasional episode becoming more of a problem.

When should I see a gynaecologist about a weak bladder?

If you begin experiencing regular incontinence or episodes where it’s more than a few drops and you wet yourself more, then you need to make an appointment to have this assessed. A history of how often you leak, what you are doing when leakage occurs, when it happens (e.g. 3-4 times getting up at night is not acceptable, once a night is ok), any accidents, limitations on exercise, work or walking will guide your doctor in:

  1. how much toll the problem is taking, and
  2. what the causes might be

Examination of the pelvic floor and vagina may reveal prolapse, a weakness of the vaginal walls and uterus.

How is a weak bladder assessed?

First, I want to see if there are any correctable factors. For example: addressing the causes of chronic coughing, constipation, or modifying particular exercise routines or work practices.

When the symptoms are a mixed picture of stress and urgency, a special test called urodynamics helps guide us to the underlying cause.

What treatments are available to strengthen a weak pelvic floor?

Lifestyle factors:
First, we will look for solutions to the correctable factors mentioned above.

Pelvic Floor Exercises:
Sometimes called Kegel exercises. A trial of rigorous pelvic floor exercises under the guidance of a qualified physiotherapist. These exercises will usually help significantly and definitely worth trying to strengthen your pelvic floor to help with a weak bladder.
If excessive frequency and urgency has become the main problem the bladder retraining using a bladder diary may help.

Drug therapy
Medication that relaxes the muscular wall of the bladder, preventing overactivity of the bladder can be very helpful. More time to hold on, less visits and leakage en route to the toilet and reduction getting up at night to the bathroom is the aim here. This group of medicines are called anticholinergics and have been refined and improved over the last twenty years.

If the symptoms have worsened around menopause, hormone replacement therapy can be considered. HRT can be either topically using vaginal cream or tablets, or systemic treatment is often helpful.

Surgery can be required to assist with bladder weakness. It is sometimes the only effective treatment. Particularly if there is vaginal prolapse or the weakness of the bladder neck does not respond to the options suggested above. Surgery can greatly improve or fix the problem altogether. Surgery for a weak bladder can be via a vaginal approach, or laparoscopic abdominal surgery.

First steps:

You do not have to live with a weak bladder. Help is available to allow you to continue to do the things you enjoy without leakage. Speak with your family doctor or specialist physiotherapist.

If you need additional help, seek a referral to a gynaecologist. For more assistance, call the rooms to chat with our team, or message us.

Author: Dr Peter England, Obstetrician and Gynaecologist.
Read more about Dr Peter England

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