When Lisa goes out with a group of ladies, any girl-talk about shopping, restaurants, and the men in their lives stops once they find out what she does for a living, and a conversation about LBL begins. Lisa Odabachian, MPT, RN, BSN, is a pelvic floor dysfunction specialist at the Women's Urology Center, at William Beaumont Hospital in Royal Oak Michigan. I asked her to share the typical reactions she gets from women, and the top three questions they ask her. “Light bladder leakage can be difficult to talk about, but somehow when you’re with a gathering of women, it’s easier,” Lisa said, “Especially when you’re sipping wine with friends and you’re relaxed.” Lisa notices something that you may have noticed too – the conversation starts when one woman brings up LBL in a light-hearted kind of way. “I sneezed so hard, I peed my pants a little,” someone might say. Then, another woman says, “Yeah, I know. The same thing happens to me.” Next thing you know, everyone’s sharing, laughing and supporting each other. What do women want to know? Here are the top three questions Lisa is asked:
QUESTION #1: “WHY DO I LEAK WHEN I COUGH, LAUGH, OR SNEEZE?” Of all the questions Lisa is asked, this is by far the most common. If you leak when you cough, laugh, sneeze, exert yourself, or do a transitional activity, like moving from laying to sitting, or sitting to standing, it’s considered stress incontinence. “It’s not emotional stress,” Lisa said, “It’s stress that puts pressure on the bladder, and your pelvic floor muscles aren’t strong enough to prevent leakage.” Pelvic floor strengthening exercises help to tighten those muscles and prevent leaks. Unfortunately, women don’t know how to do them properly. Many don’t know how to even find their pelvic floor muscles. “That’s the value of physical therapy,” said Lisa, “We make sure they know how to do it properly. And if you tighten up the muscles before a cough, laugh, or sneeze, it can help prevent leaks.” Lisa suggests that women do three things. Strengthen the pelvic floor muscles. Empty the bladder before any exercise, and when doing pelvic floor muscle exercise, notice if you’re barring down (which makes it worse) rather than pulling the pelvic floor up and in.
QUESTION #2: “WHY DO I HAVE SUCH A STRONG URGE TO GO?” Lisa calls this urge incontinence, or key-in-the-door syndrome. You pull into your driveway, and you can’t get the key in the door fast enough, because you have to go so badly. “When you get the feeling of urgency, walk calmly to the bathroom,” Lisa said, “When you start running, you’re doomed.” Women’s lives can be extremely impacted by urgency. They always have to know where a bathroom is, and it affects their social activities. Sometimes their jobs are in jeopardy because they have to go to the bathroom so frequently. “You can have a lot of urgency but never get leakage, or you can have urgency with leakage. Pelvic floor strengthening can help with both types,” Lisa said. Here are some of Lisa’s other suggestions: Avoid or decrease dietary irritants, like alcohol, coffee, chocolate, artificial sweeteners, tomatoes, citrus (like oranges, lemons, limes, and grape fruit,) spicy foods and spices like curry. Steer clear of coffee – even decaffeinated coffee, because the coffee bean itself causes acidity. The tannic acid in tea can also be irritating to the bladder. Though, herbal teas are not a problem. The only way to know what foods may be contributing to the feeling of urgency is to cut everything out and add it back in one at a time. It may also be a matter of quantity. You may discover that one cup of coffee is okay, but with a second cup, you have a problem. You can dilute the effects of dietary irritants by drinking water. A lot of women who experience LBL reduce their intake of fluid. They’ll keep drinking bladder-irritating coffee, orange juice, and wine, but decrease water because it doesn’t have flavor. This concentrates the urine, which irritates the bladder, and increases urgency. “So, if you’re having pizza and a glass of wine, have a glass of water along with it,” Lisa said.
QUESTION 3: “WHAT CAN I DO TO PREVENT LEAKING DURING SEX?” Worrying about leaking during sex can impact the intimacy in a woman’s relationship. ( to read an entire post on this topic.) It can be extremely embarrassing and hard to talk about. Lisa’s advice? • Empty your bladder prior to intercourse • Experiment with different positions • Avoid barring down as that’s when you‘re more likely to leak • Do Pelvic floor strengthening exercises
PELVIC FLOOR THERAPY CAN HELP Many states require a doctor’s prescription for a woman to see a pelvic floor physical therapist. “Pelvic floor strengthening therapy involves more than just Kegel exercise. Professionals like Lisa evaluate to see if there are other key muscle groups that need to be strengthened or stretched and they provide additional patient education. “For many, LBL can be treated in less than eight visits,” Lisa said, “Sometimes the leaking is completely gone, and sometimes it’s reduced. Getting our pelvic floors in tip top shape makes us feel young again, and if you are young, it keeps you from feeling old.”
What about you? What questions do you have about LBL? Share them here.