Bladder Leaks are not normal.

I just caught a commercial for a new brand of tampons and pads. The gist of the commercial was natural products and female empowerment and I’m all for it! Until the part where they proudly said “We bleed, We leak…” and I was throwing my shoe, cursing: “$*&% Noooooo!! WE DON’T NEED TO LEAK!”
Yes, it is extremely common for women to have bladder leaks. 26% of women between the ages of 18-59 experience involuntary urinary leakage and this problem affects more than 25 million people in the US overall. But COMMON does not mean NORMAL. Normalizing bladder leakage adds to the problem. Our medical system often waves people away if they complain of urinary incontinence (bladder leaks), especially if the person voicing their concern happens to be older or postpartum.
I’m all for products that will help people be more comfortable and confident on their path to recovery, but the cynical side of me recognizes that these companies have a lot to gain from this normalization and lack of treatment. Especially since the incontinence industry was estimated at $65.9 billion in 2007, with projected costs up to $82.6 billion in 2020 and some women spend as much as $900 per year on leakage products and costs related to incontinence.
It doesn’t need to be this way. There’s a lot we can do to treat bladder leaks! Some thoughts to consider:

1. Find what triggers your leaks: Is it a mechanical reason like coughing, laughing, sneezing, or the enemy of many women - the trampoline 😱? Or, is it more related to times you experience a strong urge to pee, such as seeing a bathroom, hearing water, or turning your key in the door when you get home? Maybe you leak in both types of situations? Knowing these triggers helps decide treatment.
2. Log how frequently you actually go to the bathroom: For overwhelmed postpartum women, you may be forgetting to pee! If you’re drinking a lot of extra water for breastfeeding and forgetting to go to the bathroom regularly, this may be a big part of your problem. Make sure you’re going to the bathroom every 2-3 hours. Conversely, if you’ve been leaking for a while, you may have overcompensated by going to the bathroom too frequently. Your bladder may have learned not to hold. Getting a clearer picture of how frequently you pee and when you leak helps us make smart changes.
3. You’re doing kegels but they aren’t working: Research estimates 15-25% of women do kegels incorrectly with only verbal instruction. Many women compensate with other muscle groups instead of the pelvic floor, or they overuse the posterior pelvic floor muscles (the ones closer to the anus). The muscles that help with bladder leaks are up front (around the urethra), so overusing the back pelvic floor won’t help! An internal pelvic floor exam will determine if you’re using the correct muscles at the correct time.
4. Kegels aren’t always the answer: A tight and overactive pelvic floor can also lead to leakage. If your muscles are overworked, they may give out when you really need them and not be there to prevent leaks, especially at the end of the day.

If you experience bladder leaks, please seek treatment!

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Sources:
1. https://www.nafc.org/
2. Koyne KS, et al. (2014). Economic burden of urinary urge incontinence in the United States: A systematic review. Journal of Managed Care Pharmacy. 20(2). 130-140.
3. Subak, L, et al. (2006). The “Costs” of urinary incontinence for women. Obstetric Gynecology. 107(4). 908-916.
4. Bump, R., et al (1991). Assessment of kegel pelvic muscle exercise performance after brief verbal instruction. American Obstetrics and Gynecology. 165(2). 323-329.
5. Henderson, JW., et al. (2014). Can women correctly contract their pelvic floor muscles without formal instruction? Female Pelvic Medicine & Reconstructive Surgery. 19(1). 8-12.