By Dr. Mercola
Urinary incontinence, often the result of weak pelvic floor muscles,1 affects 25 million people, approximately 75 percent of whom are women.2
Urinary incontinence is the term used to describe an unintentional loss of urine. The types of incontinence range from stress incontinence to overactive bladder and nighttime urination.
Unfortunately, symptoms may be debilitating and cause embarrassment and anxiety. Finnish researchers surveyed over 3,700 people and found that although urinary urgency was common, stress incontinence was rated as most bothersome.3
The combination of millions of sufferers and a high rating of embarrassment by sufferers has created a significant market for pharmaceutical companies. Television, digital and print advertising advocate the use of medication and urinary incontinence pads to reduce symptoms and prevent embarrassment.
However, recent research has determined there is another way of addressing incontinence that results from weak pelvic floor muscles, without the added risks associated with medications. Interestingly, the solution may help support your posture and reduce lower back pain as well.
Stress Incontinence Linked to Higher Muscle Mass
Stress incontinence is a physical challenge more prevalent in post-menopausal women than in young women. In a study published in the Journal of the American Geriatric Society, researchers determined women who maintained lean muscle mass or strong grip strength were less likely to experience stress incontinence.4
Researchers theorized this population of women also maintained strong pelvic floor muscles, which support the pelvic floor organs.5 These muscles are responsible for urinary and fecal continence, stabilize connecting joints in the pelvis, perform as a lymphatic and venous pump in the pelvis and aid in sexual performance.
If these muscles become too weak, they allow urine to leak when you cough, sneeze, lift a heavy object or during exercise. This study examined data from over 1,400 women between age 70 and 79 at the start of the study.
They found those who didn't experience a decline in muscle strength over the three year study period were less likely to suffer from stress incontinence.6 Women also had reduced risk of incontinence if they lost weight and fat mass, as obesity contributes to the overall risk of incontinence.
Although a high body mass index (BMI) is a known risk factor for young and middle-aged adults, the relationship to incontinence becomes more complex in the elderly as there is a change in body composition as you age.
Researchers used questionnaires about incontinence and gathered data on BMI, grip strength, quadriceps power and walking speed.
Women who lost 5 percent grip strength were 60 percent more likely to suffer incontinence, while those who had a 5 percent or more drop in BMI were 54 percent less likely to experience incontinence. 7Dr. Anne Suskind, assistant professor of urology at the University of California, said:8"Our study found that changes in body composition and grip strength are associated with changes in stress urinary incontinence frequency over time, but not with changes in urgency urinary incontinence frequency over time.
This finding may be explained by the anatomic underpinnings of stress versus urgency incontinence."
Factors That Increase Your Risk of Incontinence
Overactive or urge incontinence may result from a bladder infection, bladder cancer, bladder stones or nerve injury.9 Once an underlying medical condition has been ruled out, treatment may include strengthening pelvic floor muscles and lifestyle changes.
Your risk for both urge and stress incontinence may increase if you are overweight, as this places increased stress on the pelvic floor muscles. Inactivity, diabetes and depression may also affect the strength of your pelvic floor muscles.10 Other factors that can increase your risk for developing incontinence later in life include:
- Pregnancy and childbirth
- High-impact exercises, as chronic shock to the pelvic floor may increase your risk of incontinence
- Hysterectomy may double your risk12The prevalence of urinary incontinence peaks during menopause and steadily rises thereafter, as women may lose more muscle tone while their hormone levels are slowly declining.13
Dr. Cindy Amundsen, urogynecologist at Duke University, North Carolina, commented on the need for weight reduction and muscle strength as women age: 14
"By reducing weight and abdominal fat there is less pressure on the bladder resulting in less stress urinary incontinence. Better muscle strength may be associated with higher pelvic floor muscle strength and function, decreasing the susceptibility to urine leakage.
Women should optimize their body composition by achieving a normal BMI and improve their muscle strength, and they should continue to do so well into their 70s."
Not for Women Only
Compromised pelvic floor muscles may be seen as a sign of aging, but it is not. In this short video, Katy Bowman, a biochemist who educates people on the role movement plays in the body and the world, discusses poor pelvic alignment and pelvic floor muscle shortening as one challenge that may increase your risk of experiencing symptoms of pelvic floor muscle weakness.
Although strengthening your pelvic floor muscles will help reduce your risk for urinary incontinence, these muscles do more than hold back the flow of urine. In fact, according to Harvard Medical School, men suffer from some of the same issues when pelvic floor muscles become weak, including urinary incontinence, bowel issues and even problems with erections.15
Women tend to experience weakened pelvic floor muscles from childbirth, and both sexes may suffer tight muscles from prolonged sitting.16 Pelvic floor muscles also help stabilize your lower back and hips. When these muscles are tight they may be just as dysfunctional as when they are weak. Just as with other muscles in your body, tight muscles are not as functional or balanced, reducing the support they offer your body.
Loss of strength in the pelvic muscles may result in pelvic organ prolapse, when pelvic organs slip downward with gravity and bulge through the vaginal wall.17 It may also result in back and pelvic pain, or instability of the back and pelvis, contributing to loss of balance.18
Many women will forget to exercise these muscles and most men aren't aware the exercises will benefit them as well. Building a strong core will also sometimes weaken your pelvic floor muscles if the exercises are done improperly. Traditional sit ups and crunches increase abdominal pressure and strain pelvic floor muscles, much the same way pregnancy and added weight increases pressure on these muscles.19,20
The key is to engage your internal core muscles, which will help prevent weakening the pelvic floor. Working core muscles vigorously doesn't necessarily provide an added benefit.
Build Strong Pelvic Floor Muscles With More Than Kegels
Kegel exercises are traditionally recommended to strengthen pelvic floor muscles. And, while they are powerful and effective, they are not the only exercises that will help improve your muscle strength and reduce tightness in the area. Here's a short list of exercises, including Kegels, and protective mechanisms to help both men and women enjoy continence and improved sexual satisfaction.21,22,23
What's in Your Incontinence Pads?
Last but not least, let's talk about the safety of the products you might use to prevent an embarrassing accident. In this short video Andrea Donsky comments on her frustration with the inability to get full disclosure on the ingredients in a product that comes in close contact with a highly vascularized area of the body. She also burns two feminine hygiene pads to demonstrate the differences in product ingredients.
Since incontinence pads and feminine hygiene products are classified as "medical devices," manufacturers are not required to disclose the ingredients. To give pads their pristine white appearance, the product must first be bleached, leaving behind chlorine. This interacts with carbon based organic matter (human tissue) to create disinfection by-products (DBPs). These by-products are some of the most dangerous substances to which you may come in contact.
There are safer alternatives that may reduce your exposure to toxic chemicals. Look for products manufactured from organic cotton, as some pads contain the equivalent of four plastic bags per pad. With everything that is now known about exposure to plastics, this alone is cause for concern.
National Association for Continence, Urinary Incontinence
2 Phoenix Physical Therapy, Urinary Incontinence in Women Statistics
3 European Urology 2014;65(6):1211-1217
4 Journal of the American Geriatric Society December 2016;651):42-50
5 Beyond Basics Physical Therapy, Anatomy of the Pelvic Floor
6, 7, 8, 14 Reuters, December 15, 2016
9 MedlinePlus, Urge Incontinence
10 New York Times, Stress Incontinence Risk Factors
11 American Journal of Obstetrics and Gynecology 1992;167(5):1213-1218
12 Medscape Nursing, October 26 2007
13 Reviews in Urology 2001;3(supp1):s2-s6
15, 16, 24 Harvard Health Publications, Harvard Medical School, February 6, 2017
17 Self, July 7, 2016
18, 23 Wellness Mama, December 30, 2016
19 Marianne Ryan, Physical Therapy Sit Ups are Dangerous? Pilates “Hundreds” Exercises Can Damage Your Pelvic Floor Muscles?
20, 21 Core Exercise Solutions Trust Your Pelvic Floor Again Strengthening Beyond Kegels
22 Intimina January 27, 2015