Women of all ages have bladder control problems. Some younger women find they can't hold their urine after having a baby. Others have problems when they stop having periods. Many women over the age of 75 also have bladder control problems.

You may feel ashamed about bladder control problems. Remember that it's a medical problem and it's not your fault. Millions of women have the same problem.

Don't believe people who tell you that urine leakage is normal. It isn't. Most of the time it can be improved.

Your health care team can help you. Nearly everyone with a bladder control problem can be helped. Call your clinic and find out how.

Where Can You Go for Help?

You can do many things to help improve your bladder control. Talk to your family doctor or nurse.

If you have a more difficult case, you may need to see a urologist. Urologists are experts in bladder and urine problems. Some urologists specialize in the female urinary tract.

A gynecologist is a doctor who treats problems of the female system. Your gynecologist also can help you with bladder control. Your doctor also might want you to see a urogynecologist. Urogynecologists treat women's bladder and urine problems.

You also can get help from a urology or continence nurse. Visiting home nurses can help you learn about bladder control. Some physical therapists help people with pelvic muscle exercise programs.

Check with your insurance plan about payment for these services. You may need a referral from your regular doctor.

If you feel shy about calling a doctor or nurse, maybe a support group can help you. Some groups will talk to you on their toll-free number. Others have free or inexpensive brochures and videos about bladder control. Support groups and patient organizations are listed at the end of this brochure.

What Does the Doctor Need to Know?

You will need to keep a record. Try to write down the times when you go to the bathroom. Write down when you have accidents, too. Do this for a day or more. This record is called a bladder control diary. Diaries help your doctor or nurse learn the cause of your problem.

Print out the form below and answer the questions. Check off the statements that apply to you. Fill in dates and other information. Show this form to your doctor.

What Your Doctor Needs to Know

I take these prescription medicines:
_______________________________________________
_______________________________________________
_______________________________________________
I take these over-the-counter drugs (such as Tylenol, aspirin or Maalox):
_______________________________________________
_______________________________________________
_______________________________________________

If you take more medicines, please list them on a separate paper.

I started having bladder trouble
Recently
1 to 2 years ago
_____ years ago

Number of babies I have had:_____________________
Dates: _________________________________________

My periods have stopped (menopause).
Date: __________________________________________

I recently had an operation.
Date: __________________________________________
Type of operation: ________________________________

I recently hurt myself or have been sick.
Date: _________________________________________
Type of injury or illness: ____________________________

I recently had a bladder (urinary tract) infection.
Date: _________________________________________

I am often constipated.

I have pain or a burning feeling when I go to the toilet.

I often have a really strong urge to go to the toilet right away.

Sometimes my bladder feels full, even after I go to the toilet.

I go to the toilet often, but very little urine comes out.

I don't go out with friends or family because I worry about leaking urine.

The first thing I do at new places is check the bathroom location.

I worry about being put in a nursing home because of bladder control problems.

I have (or had) these medical problems:

Cancer	Constipation
Crippling arthritis	Depression
Diabetes	Diverticulitis
Interstitial cystitis	Multiple sclerosis
Spinal cord injury	Stroke
Urinary infection

I smoke cigarettes.

Will the Doctor Do Tests?

You will probably have a physical exam. The exam can show the reasons for your bladder control problem. First, your health care team will look for a simple cause. It could be an infection in the urinary tract. This can be treated easily.

The reason for your problem may be harder to find. Then the doctor or nurse may want to do some tests:

• Check to see how well the bladder muscles are doing their jobs.
• Take samples of urine and blood for tests.
• Look for something blocking the urine flow-like a stone, a growth, or hard bowel movement or stool.
• Take pictures of your bladder, using special machines.

Most of your bladder control system lies inside your pelvis. Stand with your hands on your hips. The bones under your hands are the pelvic bones. Your pelvis is shaped like a big bowl.

The bottom of this "bowl" is the area between your legs. The muscles across this area are the pelvic floor muscles.

Your bladder is another muscle. It is a balloon-shaped organ inside your pelvis, just below your belly button.

Your pelvic floor muscles should be strong and tight to hold up your bladder in its proper place.

Your bladder should stay relaxed when it is full of urine. But when you go to the bathroom, the bladder muscle should tighten. This squeezes urine out of the bladder.

The sphincter muscles are two muscles that surround the tube that carries urine from your bladder down to an opening in front of the vagina. The tube is called the urethra. Urine leaves your body through this tube.

The sphincters keep the urethra closed by squeezing like tight rubber bands. The pelvic floor muscles also help keep the urethra closed.

Urine stays inside your body when the pelvic floor and sphincter muscles are tight and the bladder is relaxed.

When the bladder is full, nerves in your bladder signal the brain. That's when you get the urge to go to the bathroom. Once you reach the toilet, your brain sends a message down to the sphincter and pelvic floor muscles. It tells them to relax.

The brain signal also tells the bladder muscles to tighten up. That squeezes urine out of the bladder.

Bladder control means you urinate only when you want to. For good bladder control, all parts of your system must work together.

• Pelvic muscles must hold up the bladder and urethra.
• Sphincter muscles must open and shut the urethra.
• Nerves must control the muscles of the bladder and pelvic floor.

Most bladder control problems happen when muscles are weak or too active. Problems also may happen when nerve signals don't work properly.

If the muscles that keep your bladder closed are weak, you may have accidents when you sneeze, laugh or lift a heavy object. This is called stress incontinence. It is the most common type of bladder control problem.

Stress incontinence often occurs when women are pregnant or after childbirth. The pelvic floor muscles stretch and weaken in pregnancy or childbirth.

The same muscles become weak after a woman stops having periods (menopause). They weaken because they no longer get female hormones.

Sometimes, the bladder muscles become too active. Then you have a different problem. You may feel strong, sudden urges to go to the bathroom, even if your bladder has little urine. This kind of bladder problem is called urge incontinence or overactive bladder.

Several things can cause your bladder to be too active:

• A bladder infection
• Nerve damage (sometimes from childbirth)
• Drinking alcohol (beer, wine, etc.)
• Some medicines

Your treatment will depend on the type of bladder control problem you have. Some treatments are simple. Others are more complicated. Your health care team may suggest one of the following treatments:

Do-It-Yourself Treatments

• Pelvic muscle exercises. You can learn simple exercises that can strengthen the muscles near the urethra. These are called pelvic muscle exercises or Kegel exercises and take only a few minutes a day.
  Before exercises: Weak bladder control muscles    After exercises: Strong bladder control muscles

• Bladder training. You can train your bladder to hold urine better. Follow a timetable to store and release urine. You also can learn to decrease the urge to urinate.

• Weight loss. Sometimes extra weight causes bladder control problems. A good meal plan and exercise program can lead to weight loss.

• Food and drink. Some drinks and foods may make urine control harder. These include foods with caffeine (coffee, tea, cola or chocolate) and alcohol. Your health care team can suggest how to change your diet for better bladder control.

• Electrical stimulation. Certain devices stimulate the muscles around the urethra. This makes the muscles stronger and tighter.

• Biofeedback. This takes the guesswork out of pelvic muscle exercise. A therapist places a patch over the muscles. A wire connects the patch to a TV screen. You watch the screen to see if you are exercising the right muscles. The therapist will help you. Soon you learn to control these muscles without the patch or screen.

• Medicines. Certain drugs can tighten or strengthen urethral and pelvic floor muscles. Other medicines can calm overactive bladder muscles and nerves. A skin patch can be worn to treat symptoms of overactive bladder.

• Surgery. Some bladder control problems can be solved by surgery. Many different operations can improve bladder control. The operation depends on what is causing the problem. In most cases, the surgeon changes the position of the bladder and urethra. After the operation, the bladder control muscles work better.

• Pessary. Your doctor can place a special device called a pessary (PESS-uh-ree) in the vagina. The device will hold up the bladder to prevent leakage.

• Urethral inserts. Your doctor may give you a small device that goes directly in the urethra. You can learn to insert the device yourself. It's like a little plug. You remove the device when it is time to go to the bathroom and then replace it until it's time to go again.

• Urine seals. This is a small foam pad you place over the urethra opening. There it seals itself against your body to keep urine from leaking. When you go to the bathroom, you remove the pad and throw it away.

Dryness Aids

• Pads or diapers. Pads or diapers help many people. But diapers do not cure bladder control problems. See a doctor or nurse, even if diapers are working for you.

• Bedside urinal. Some people use a bedpan or a bedside chair urinal or commode.

• Assistance. If you are disabled, health care workers can help you move more easily to a toilet. Your doctor or nurse may teach you to urinate on a schedule that prevents wetting.

• Renovations. Sometimes, you just need a carpenter to make changes to your house. Perhaps you need a hallway light. Or a downstairs bathroom. Another solution could be widening a bathroom door to fit a wheelchair.

Additional Resources

American Foundation for Urologic Disease
1000 Corporate Blvd., Suite 410
Linthicum, MD 21090
1-800-828-7866 or (410) 689-3990
E-mail: admin@afud.org
Internet: www.afud.org

American Urogynecologic Society
2025 M St., N.W., Suite 800
Washington, DC 20036
(202) 367-1167
E-mail: augs@dc.sba.com
Internet: www.augs.org

National Association for Continence
P.O. Box 1019
Charleston, SC 29402-1019
1-800-BLADDER (1-800-252-3337) or (843) 377-0900
E-mail: memberservices@nafc.org
Internet: www.nafc.org

The Simon Foundation for Continence
P.O. Box 835
Wilmette, IL 60091
Phone: 1-800-23-SIMON (1-800-237-4666) or (847) 864-3913
E-mail: simoninfo@simonfoundation.org
Internet: www.simonfoundation.org

Society of Urologic Nurses and Associates
P.O. Box 56
East Holly Ave.
Pitman, NJ 08071-0056
1-888-TAP-SUNA (1-888-827-7862) or (856) 256-2335
E-mail: suna@ajj.com
Internet: www.suna.org

Updated: May 2003