Urinary Incontinence: The Health Problem Women Won't Talk About
Why It Happens
Most leaky bladder problems (85 percent) are triggered by a weak urinary sphincter, the muscle located between the bladder and the urethra that acts like a seal to control the flow of urine. Called stress incontinence, the leaking is set off by coughing, sneezing, lovemaking, laughing, heavy lifting, jumping, running, and other types of exercise -- any activity that puts pressure on the abdomen and bladder, which in turn put pressure on the weak sphincter, forcing its seal to open. Urine loss can range from a few drops to a full stream.
The hallmark of stress incontinence is that after it's triggered by physical activity, it can hit without warning, as in Quinlan's case. By contrast, urge incontinence -- the less-common type, especially among women under age 60 -- makes you feel an intense need to void your bladder even if it isn't particularly full.
How do women develop a weak sphincter? The problem usually starts farther up, in the pelvic floor -- the hammock of muscles that supports the bladder, uterus, bowel, and vagina. When the pelvic floor is damaged or out of shape, all the organs it supports drop, straining the sphincter.
The pelvic floor can lose its tone for a variety of reasons. Sometimes weight gain strains the supporting muscles. Estrogen loss during menopause can weaken pelvic tissue and growing older further weakens muscle tone. A hysterectomy can also damage the pelvic floor's nerves and muscles. Then there's family history: "A woman may be at higher risk for weak muscles if her mother suffered from the problem," says Ingrid Nygaard, MD, professor of obstetrics and gynecology at the University of Utah School of Medicine. (Quinlan found out she had a family history of urinary incontinence.)
Vaginal childbirth has been linked to stress incontinence, too. But even if you have never given birth or you delivered via cesarean section, you can still develop the problem.
One surprise finding? The risk of stress incontinence goes up within four months of beginning menopausal hormone therapy, according to a University of California at Davis and University of California, San Francisco study. A possible explanation is that hormone therapy decreases the amount of collagen around the urethra, leading to a looser seal.