Bladder Health: Let Go of the Embarrassment, Not the Urine

by Stephanie Ziegler

December 2022

"I pee a little when I sneeze or laugh" or perhaps, "I leak, but I just know to always wear a pad" are common remarks from people that are experiencing a condition that healthcare providers refer to as urinary incontinence (UI). Certainly not the topic of choice for the morning coffee circle, especially in the mighty Midwest where a "tough it out and deal with it" approach exists to issues like this. However, doctors say there is no need to tough this medical condition out.

Who gets UI? According to the National Association for Continence, it is likely that almost 60,000 North Dakotans will struggle with UI at some point in their life. Many people in the Dickinson area might have the idea that only women have this issue and that leaking happens as a natural part of aging. However, UI affects both women and men and it is not a natural part of aging. In fact, there are many different causes of leaking.

Figuring out the cause of UI begins with understanding that UI starts with the bladder, an internal organ made of muscle that has several valves that control the release of urine. Doctors emphasize that knowing what is not working right, whether that be a problem with the valves or the bladder muscle itself, is important to determine how to stop the leak.

Being that not all UI is the same, the first step in figuring out the cause of UI is by answering a few standard questions. For example, "Do you leak with coughing or sneezing?" or "Do you have a sudden urge to pee? If so, are you actually able to make it to the toilet in your own home?" Others may not even feel the leak, but friends and family instead notice the urine smell. Keeping a diary to track urine leakage may even be needed to help find possible trends or triggers of the leakage. After these questions, a healthcare provider might do a physical exam, checking to make sure everything looks normal on the outside. Additionally, laboratory tests are often done on a urine sample.

With the history, physical exam, and labs completed, doctors can usually classify what is causing the urine leakage into four or five different categories. These categories range from weak bladder muscles or muscles around the bladder, to an overactive bladder, to even a nerve problem that is sending the wrong signals to the bladder to empty at the wrong time.

Once doctors figure out the most likely category type of UI, they will be able to better give advice on how UI can be relieved or at least lessened. Some people simply need to do muscle-strengthening exercises for better control of urinating. Others will see improvement in their UI by avoiding soda, or any carbonated drink, as bladders can be sensitive to the chemicals used in the carbonization process that create that "fizz." Caffeine is commonly suggested to avoid since it can trigger the bladder to want to urinate more. Because science has proved that smoking and carrying extra pounds may be triggers to leaking, doctors might recommend quitting nicotine use and losing weight. Lastly, people might even need to see a specialist to further nail down the cause and correct treatment.

Although UI is commonly an unspoken topic, education and discussion on this topic can result in a life that is drier. Now is a good time to let go of the embarrassment, not the urine, and start the conversation with a healthcare provider: "I might have urinary incontinence and I understand there might be ways to make it better."

This article also appeared in the December 28, 2022 issue of the Dickinson Press.

About the Author

Stephanie Ziegler is a third-year medical student at the University of North Dakota School of Medicine & Health Sciences. She was selected as the Dickinson participant for the school's ROME program, or Rural Opportunities in Medical Education. The program includes teaching student doctors the importance of rural newspapers' role in sharing health information. As a future rural healthcare leader, Ziegler has written this column to provide health information for her ROME community. The information is not for diagnosis or treatment and should not be used in place of previous medical advice provided by a licensed practitioner.