About three years ago, Becky Beach let out a loud, head-back guffaw during a work meeting. Full-body laughter is typical for Beach, now 37, but what happened next took her by surprise: She released some urine — enough to leave a wet spot on the front of her pants. “I used my notepad to cover it, then changed into workout pants to wear for the rest of the day,” says Beach.
This wasn’t the first time. After having her first child, Beach noticed that certain movements and activities, like coughing, sneezing and running, caused her to leak a little. But this was the worst accident yet, by far. “I was afraid I could lose respect at the workplace if people knew I wet myself,” she says. “I had to keep it a secret from others.” She made an appointment to see a doctor and started wearing feminine pads.
Many people decades away from an AARP card experience bladder leakage. “The problem is common enough in women in their 20s and 30s that I see it every day,” says urogynecologist Angel Marie Johnson, director of the Women’s Health Center at Greater Boston Urology.
Even so, bladder leakage isn’t something that younger women discuss openly. When Cora, a brand that makes pads and liners for light bladder leaks, surveyed 1,000 women between 30 and 50 years old, 89 percent reported that they are more likely to talk with their friends about relationship issues, body image fears and taboo lifestyle habits like drinking or drug use than bladder leakage. Luckily, there are ways to help manage light bladder leakage and reduce feelings of shame and isolation that often accompany the issue.
What is it?
Light bladder leakage is not a medical term. “It’s a term people use to describe their symptoms,” Johnson says; some companies that sell pads use it as well. When people talk about LBL, they usually mean overactive bladder syndrome, stress urinary incontinence or mixed urinary incontinence.
Overactive bladder is defined by frequent urination (meaning eight or more times during the day or more than twice at night) and strong, sudden urges to pee that occasionally make you leak before you reach the bathroom. Stress incontinence is when you pee a little upon coughing, laughing, sneezing or exercising. Mixed incontinence is a combination of the two conditions.
Overactive bladder is a functional problem; spasms in the bladder cause urges to pee even when it’s not full. “The bladder is like a reservoir,” Johnson explains. “It stretches to hold urine, and it has sensors that indicate when the bladder is full. When this happens, it then squeezes to empty.”
Stress incontinence, on the other hand, is a structural problem. That means leakage stems from weakness in the muscles around the urethra (the tube that expels urine), not an improperly functioning bladder. When an action, like laughing, causes an abdominal contraction, the weakened muscles can’t fully hold back the flow of urine.
Although the exact cause of incontinence is unknown, several things can increase the risk of these conditions. “The biggest cause of overactive bladder that’s within our control is consuming irritants,” Johnson says, a category that includes artificial sweeteners, caffeinated drinks and alcohol. The more you consume, the worse it is.
As for stress incontinence, smoking weakens the pelvic floor muscles and being overweight increases pressure on the bladder. Beyond that, “childbirth is probably the biggest risk factor,” says Jonathan Shaw, a urogynecologist at Dartmouth-Hitchcock Medical Center. “A vaginal delivery can put a lot of strain on the pelvic floor.” Complications that require the use of forceps or a vacuum can also cause muscle tears.