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Why am I Having Trouble Controlling my Urine?

Why am I having trouble controlling my urine?


In our office we hear so many concerns about the lack of urinary control and the irritating associated problems. When we are young and our tissues are firm and well estrogenized, the relationship between the bladder and the urethra, the pathway through which the urine leaves the bladder, has a protective downward angle to it. However, as we age, perhaps have children that stretch out the birth canal, and lose the protective estrogen to which the vulva, vagina and bladder are so sensitive, the angle of the bladder neck and therefore the relationship between the bladder and the urethra drops to more of a straight shot out, and we find that here is an increasing incidence of involuntary urinary incontinence.


There are two main types of urinary leakage which are known as stress incontinence and urge incontinence. Stress incontinence includes losing urine whenever there is an increase in intra-abdominal pressure, such as during coughing, sneezing, running, jumping or even bearing down with an orgasmic response. Urge incontinence reflects an overly sensitive system where the urge to empty a partially full bladder becomes overwhelming and the urine is lost outside of a controlled release. And lastly, there is mixed incontinence which is a combination of both types at the same time.


Thankfully there are several therapies that can be quite effective to regain urinary control. The first concern is if the skin in these areas is adversely affected with menopausal changes to regain the proper estrogenization of these tissues, as the lack of estrogen in postmenopausal women will lead to atrophy, shrinkage and weakness of the structures and skin that normally work to maintain dryness. This is done with either local bioidentical estrogen topical therapy, beneficial and safe systemic hormone replacement therapy, or a combination of both.


Stress incontinence is further improved by elevating the bladder neck which has been depressed. The initial therapy is usually trying Kegel exercises, where the muscles that are used to clamp down on urination, to grip with the vagina, and to stop defecation are tightened voluntarily and held for a count of ten, then released and retightened repeatedly for a total of 10 clamps in a row, then a small break, followed by two more 10 tightening sessions for a total of 30 iterations every morning and another 30 every afternoon. Some evidence says if followed religiously this regimen will improve stress incontinence 70% of the time if done religiously for 6-8 weeks.


Other progressive options include pelvic floor physical therapy with specially trained therapists utilizing an eight week training program, and there is a tampon available with a bulbous lower bulge that can push up on the bladder neck, offering some control although for a brief period of time. Laser vaginal rejuvenation can tighten then vagina and remoisturize it, but also similarly elevate the bladder neck, and lastly, there are several surgical procedures done in the OR that can elevate the bladder neck permanently with a sling procedure with high rates of success.


Urge incontinence is usually treated with medication that will suppress the irritation of the overly sensitive pressure nerves in the wall of the bladder such that the urgency becomes more able to be controlled. Those medicines suppress the parasympathetic nervous system and so sometimes have the side effect of a dry mouth, but yet many people find a balance that can offer great relief. So if you are tired of putting up with a chronic lack of urinary control of either or both types, do not hesitate to contact the physicians of Premier Obstetrics and Gynecology of Maitland to help guide your improved urinary control.

John van Wert, MD, FACOG Dr. John van Wert is a leading board-certified OB/GYN, serving patients in and around the Greater Metro Orlando for over 30 years. He provides services such as bioidentical hormone replacement, menopause management, vaginal surgery and rejuvenation, and robotic hysterectomies in addition to standard gynecology services. Dr. van Wert obtained his undergraduate degree at Duke University in North Carolina, his medical degree from Vanderbilt University Medical School in Tennessee and residency at the University of Florida in Gainesville. Dr. van Wert excels in gynecologic surgery, especially laparoscopic surgery and robotic hysterectomies. He has been named as one of Central Florida’s “Top Doctors” multiple times. Dr. van Wert is a long-standing board certified member of The American Board of Obstetrics and Gynecology and is also a member of the American Academy of Cosmetic Surgery and the American Association of Cosmetic Gynecologists.

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