If you’re a woman who’s over 35 and the conversation turns to dribbling, there’s a good chance you’re not talking basketball.
It might happen when you cough, sneeze, run or when you look the wrong way on a Thursday — whatever the cause, most women at this age find they’re suddenly weeing themselves for the first time since kindergarten, circa ’79.
Here, Balm explores some of the more infrequently asked questions around leakage, with the help of Manhattan-based OB-GYN and author Dr. Adrienne Simone. Among the most pressing queries: “Is everyone secretly peeing themselves all of the time?”
What to Expect When You’re Not Expecting Perimenopause
Well? Are they?
If you’re talking about the 35-plus set, the answer is yes, pretty much. Balm’s survey of 750 U.S. women ages 35 to 50 found that 35% occasionally pee when they cough (8% said they are peeing and coughing right now). According to the American College of Obstetricians and Gynecologists, up to 57% of middle-aged and postmenopausal women experience urinary incontinence. If you need more evidence, look no further than the explosion of companies like Knix that have found huge success making leakproof undies that don’t make you look like you’ve given up on life.
Is there a more scientific term for it than “weeing oneself?”
Why, yes. It’s called incontinence, and there’s more than one kind. Urgency urinary incontinence (sometimes linked to urinary tract infections, or UTIs) is what it’s called when you consistently have the sudden feeling that you need to go — like, now — and aren’t able to hold it in. But when you find yourself leaking while running on the treadmill or picking up something heavy, it’s called stress urinary incontinence.
Balm’s survey of 750 women 35 to 50 found that 35% sometimes pee when they cough (8% said they are peeing and coughing right now).
Basically, anything you do that puts additional pressure on your abdomen and bladder becomes a dripping hazard (it can even happen during sex). The third main type is called mixed urinary incontinence and is — you guessed it — a little from column A and a splash from column B. Stress incontinence is twice as common in women as it is in men and is the type that most often affects young women.
Meet Our Chief Derm and Go-To Expert for All Things Skincare
What are the causes of stress incontinence?
When your estrogen levels begin to decline as you enter perimenopause (which usually starts in your late thirties or forties), your muscle tissues become thinner, including the ones in your pelvic floor. The pelvic floor is a hammock-shaped group of muscles that support your bladder, bowel and urethra, which is the short tube that passes urine from the bladder out of the body. When the pelvic floor is too weak to hold the urethra in its proper position, the urethra drops (doctors call this “hypermobility”) and the waterfall flows. You’re more at risk if your pelvic floor muscles have been stretched out by pregnancy or a vaginal birth, says Simone, but you’re not home free if you haven’t. “That’s a common misconception,” she says. “Hormonal and gravity issues eventually affect all women.”
If everybody’s doing it, why does it feel like I’m the only one?
“Most patients are too embarrassed to bring it up,” Simone says. “It’s so common, I think it’s sad we don’t talk about it.… It can be a very disturbing problem — people get depressed, they may limit interactions outside of the home, and they may have sexual dysfunction.”
Can I strengthen my pelvic floor?
Yes! The most well-known technique is Kegel exercises, where you basically squeeze the muscles of your pelvic floor — but those muscles can be hard to find. Simone has a little trick for that. “I always tell my patients, ‘When you’re urinating, try to stop the flow and hold it for three to five seconds.’” Those are the pelvic floor muscles. (A bonus? Strengthening your pelvic floor can also increase your enjoyment during sex.) A specialized pelvic floor physical therapist and different exercises can be helpful in more extreme cases.
Are you there, Judy Blume? It’s Me, Again
Where do I find a pelvic floor physical therapist? I asked Siri, but…
You can ask your doctor for a referral — some health plans might require that anyway — or check with your state’s physical therapist association.
Are there other (read: solo) ways to control urinary incontinence?
“Most people can manage it with conservative measures,” says Simone. Weight management can help decrease pressure on the bladder, she says. Limiting fluid intake — especially drinks that contain bladder irritants like caffeine — can go a long way. She also suggests peeing at timed intervals, even if you don’t feel like you need to go. That way, your tank is always closer to empty and can’t get you with a surprise attack.
Can’t I just wear a pad and cross my fingers? (And legs?)
You can use menstrual products to deal with urine leakage, says Simone, but they’re not ideal. They aren’t designed to hold the amount of liquid a surprise pee can unleash, and incontinence-specific products are sometimes treated with baking soda to absorb odors. (Pro tip: Never use artificially fragranced products near your vagina, as they can be irritating and cause bladder infection–like symptoms.) Leakproof garments are worth a try for smaller issues. But your first step should always be talking to your doctor.