Incontinence: Why do I Pee my Pants?

By: Dr. Tanvi Maharaja PT, DPT, OCS, Pelvic Health PT

“When I pull into the driveway…”

“Every time I put the key in the lock to open the front door…”

“Just as I enter the bathroom…”

“As I turn the corner to get home…”

“When I hear water run or when it;s cold…”

If you have noticed leakage, even a few drops, with some of the triggers above, welcome to the world of Urgency Urinary Incontinence (UUI), where anywhere from 2% to 35% of women reside, struggling with this annoying and frustrating condition. In case you are wondering, why do I pee my pants, know that it is a lot more common than you think, a little more complicated than you think, and good news: often pretty simple to treat!

While UUI is a condition, urgency is a symptom, and it means having a strong desire to void (to pee). Urgency is present in several medical conditions such as painful bladder symptom (formerly known as interstitial cystitis), overactive bladder, urinary tract infection, diabetes, pregnancy, ingesting substances that may be bladder irritants (e.g., caffeine, citrus fruits, chocolate, soda… yeah, so basically all the good stuff!) etc. Urgency ranges from mild to severe, and this describes how badly one needs to pee once an urge to void is registered. This means that some individuals just have the urge to void, but do not leak. While others have both, the urge and the leakage.

Frequency is another symptom of UUI. Normally, we empty our bladder anywhere from 5 to 8 times a day, with a 3 to 4 hour gap between voids. Having to go more than that could be indicative of frequency. Nocturia may also be a symptom of UUI, where one needs to get up more than once a night to pee (or more than twice for folks over 65 years of age). Some individuals also have associated pelvic pain, pain with voiding, and other symptoms that tell you that something is just off.

Myofascial trigger points and tightness or overactivity in the pelvic floor muscles have been known to reproduce symptoms of urgency, as have muscles in the inner thighs, known as adductor muscles. 

UUI is associated with falls, especially in the elderly. Having a strong urge to go and being worried of wetting yourself on your way to the bathroom does not make for a very safe environment. In the elderly, where vision, balance, and bone health may be somewhat compromised, this is a huge safety hazard, particularly if urge is coupled with nocturia.

The treatment of UUI consists of medication, physical therapy, and surgery. Pelvic floor physical therapists (PFPT) specialize in treating conditions related to the pelvic floor, including UUI. A detailed exam is first conducted to make sure that there is no underlying issue that is masquerades as UUI. Then, PFPT treatment can include behavioral retraining, manual internal and/or external soft tissue mobilization if indicated, and urge suppression techniques. 

Our nervous system plays a key role in our bladder habits. There is a finely tuned, well balanced network of communication where our bladder talks to our brain about the status of it’s fullness, and the brain answers back letting the muscles know when to keep working to hold the urine and when it is time to go, prompting us to go the bathroom. Our nervous system works in two ways: the sympathetic system which is the flight and fight response, and the parasympathetic system, which is the rest and digest. Retraining this delicate network can help our brain better control our bladder and control the urge and thereby the incontinence.

Behaviour retraining consists of many key points, and once we review the voiding diary that patients complete, we go over the nuances of this. That being said, one of the most important ones being to stop the habit of just in case peeing (JIC-pee). Going to the bathroom even when we don’t need to, just in case… before going on a walk, before going to the mall, or maybe when you enter a mall and pass a bathroom… just in case. JIC-pee can disrupt the brain-bladder talk, and we get into the habit of wanting to go even when we don’t need to. 

If you experience UUI, know that it is very common, very prevalent, and a lot of men and women suffer from it (Yes, MEN too!). Help is available. And us pelvic floor PT’s treat this condition day in and day out; the results are amazing! Sometimes all it takes a little education and breaking some old habits. Once we unlearn the way we did things, and try new ways with some heightened awareness, people are surprised at how quickly and how effectively they see results. 

Remember this next time you put that key in the door, or are tempted to go… just in case!! 

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