A woman struggles to avoid accidents and asks why do women have pee accidents in midlife and what can be done to avoid them? Jessica explains the physical reasons why women in midlife can experience incontinence and then shares tips on what you can do to minimize the risks of accidents.
Ask Jessica is an advice column for women in midlife. We cover all things related to midlife from changing bodies to career transitions to parenting teens to sandwich generation challenges to shifts in marital or life partnerships and everything in between. My hope is that in sharing these questions and answers I can women as we face the midlife journey together. Got a question or challenge you would like me to address? Fill out this form to submit your issue! Want to see the answers to other questions, check out our archive here.
I Gotta Go! Why do women have pee accidents in midlife?
HEY JESSICA: This is beyond embarrassing, but could you please talk about why women have pee accidents in midlife? As I get older I find that it is hard to hold my pee. For the most part, I can make it to the bathroom OK, but sometimes, when I laugh, cough, or workout really hard, I’ll feel a little pee leak out. And even worse, occasionally, I’ll be just going along with my day when all of a sudden I have to pee SO BAD and find myself rushing to the bathroom to try to avoid an accident (there have even been times when I didn’t make it before some leaked out). I know this is a thing that some women experience later in life, but does this mean that I have to start wearing Depends like my grandma did? I’m way too young for that! ~Holding It In
DEAR HOLDING IT IN: Thank you for being brave enough to ask this question, as I am sure many other women are struggling with this issue as well. To help you to manage this difficulty, which can be incredibly disruptive and embarrassing, I first want to explain why people have pee accidents in midlife this and then offer up some ideas of things to try.
Let’s first start with a mini anatomy lesson. A woman’s pelvic region is made up of bones, connective tissues, and muscles which all work together to support (and hold inside) the pelvic and reproductive organs that are found in the pelvic cavity. Essentially, you have the tailbone at the back, the pubic bone at the front, and the ischial tuberosities on either side and these four bones are connected together by a “hammock” of connective tissues and muscles which form what is called the Pelvic Floor. The Pelvic Floor is important not only for providing support for the pelvic organs, but it also helps stabilize the trunk, regulate intra-abdominal pressure (i.e., sneezing, coughing, laughing, lifting, etc.), and constrict the vagina, the anal canal, and the urethra – all of which have an impact on being able to control your pee. Now, these muscles and tissues, like all muscles and tissues in our body, are influenced by aging and by usage. So, if they weaken, they aren’t as able to support you as you try to hold in your pee.
In addition, there is the fun fact that our bladders have a good number of estrogen receptors, which means that as our estrogen levels fluctuate (and drop) during menopause, a number of things can happen: the structural support of the urethra and bladder can weaken, the contractions of the muscle that controls the flow of urine can decrease, and the urethral tissues can thin out, which leads to less support and an increase chance of leakage. Fun.
So, now that you understand why women have more pee accideents in midlife, the question becomes what do you do about it? Well, the first thing is to take a deep breath and know you are not alone and have nothing to be embarrassed about (19% of women ages 40-45 report having such issues and by the time we get to post-menopause that rate goes up to 84%!). Then, it’s time to assess. If this is something that is happening a lot and is really getting in the way of you living your life, I would recommend talking to your OB/GYN or a pelvic health physiotherapist to investigate what treatments might be best for you (e.g., pelvic floor rehabilitation, vaginal estrogens, systemic hormone therapies, etc.). If it has only happened a few times, then you might also be able to work on reconnecting with and strengthening your pelvic floor.
One simple exercise you can start with is called Connection Breath. Sit on a hard chair or bench and spread out your glutes so that you can feel yourself sitting on your sitz bones. As you inhale, imagine you are inflating your pelvic floor, pushing those sitz bones apart with air (this should feel like a “letting go” rather than a “bearing down”). Then, on the exhale, think about engaging the pelvic floor muscles, lifting them up towards your head (note: only pull up about 30% of a full contraction – so you are gently pulling up rather than clenching tight). If this is hard to do, then imagine that your pelvic floor is shaped like a diamond and as you exhale you are pulling the four points of the diamond in toward the center. Cycle through this action, releasing everything with your inhale and then pulling up with your exhale for about 10 breaths. Doing this will help you to become more attuned to your pelvic floor and will allow you to then work on strengthening those muscles over time.
I also want to encourage you to think about when these leaks are happening. Is it when you’ve been holding your pee and just not listening to your body for a while, when you are exerting yourself (such as lifting weights), when you are super tired, etc. If there are patterns, then you can also consider making some adjustments such as tweaking your workout routine, making sure to listen to early cues that you need to use the bathroom, etc.
Finally, I just want to reiterate that this is nothing to be ashamed of and is definitely something to talk to your doctor about because there are a number of solutions. Many of my friends have said that their pelvic floor physiotherapists changed their lives and others have felt a lot of relief from hormonal support. Bottom line, this does not need to become a source of stress in your already busy life.