Breaking Free from Incontinence: A Journey to Reclaiming Confidence and Comfort - Carolyn Sampselle

August 4, 2023

Carolyn Sampselle discusses urinary incontinence, a condition affecting one in three women. She underscores the impacts of urinary incontinence, including the cost of incontinence products and the negative influence on women's physical activity and social life. Dr. Sampselle presents three strategies to reduce or prevent urine leakage: pelvic muscle strengthening, a squeeze trick, and bladder training. She emphasizes the importance of understanding the body and the mechanisms causing incontinence, such as stress or urge incontinence. Her approach to managing incontinence includes specific exercises for strengthening the pelvic floor, maintaining a regular bathroom schedule, and using the squeeze trick before physical strain or a strong urge to urinate. Dr. Sampselle's research shows these strategies can halve the risk of incontinence and significantly improve women's quality of life.


Carolyn Sampselle, PhD, ANP, FAAN, Professor of Nursing, University of Michigan, Ann Arbor, MI

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Carolyn Sampselle: Hello, I'm Dr. Carolyn Sampselle. I'm a nurse researcher at the University of Michigan School of Nursing. I study urinary incontinence or unwanted urine leakage. It's a big problem for women. More than one of every three has it and often they have to wear pads to hide it. There are simple proven techniques to reduce or prevent urine leakage. You're going to view a presentation in the next few minutes that will explain them. They are pelvic muscle strengthening, a squeeze trick, and bladder training. Women who have used these techniques have been amazed at their increased control, reduction of troublesome leaks, and of frequent urges to go to the bathroom. After nearly 20 years of research, we've found that it's never too late or too early to think about bladder health. Even if you don't have a problem currently, making these small changes in your daily habits can make a huge change in your ability to enjoy your life. Thanks for your time. Enjoy the presentation.

Having babies and getting older are two things that can affect a woman's ability to hold her urine until there's a convenient time to empty. We've learned, in our research with women, important things that can keep the urinary tract healthy and functioning normally. We want to share those tips with you today.

Knowing about your body helps you to take better care of yourself. This bladder health program will teach you how to work with your body to decrease problems with urine leakage. If you were looking straight at me and could see inside, you'd see my bladder and a tube called the urethra. This tube allows the urine to leave the bladder. Ideally, that happens when we're ready to empty.
These are the most common reasons for urine leakage, also called urinary incontinence. Stress incontinence, when the pressure in the abdomen is too high like a big sneeze. Urge incontinence, when the bladder contracts without warning. Mixed incontinence is both of these together. The practices you'll be learning today will help with all three kinds of incontinence.

Incontinence is more common than we realize. It happens to as many as one of every three women during her lifetime. As this graph shows for every additional baby a woman has, her chance of urine leakage increases. Worry about urine leakage can keep a woman from living her life fully. To be physically active is vitally important to staying healthy.

As you can see here, the worse urine leakage is, the more it keeps women from being physically active. Another problem with incontinence is worry about being close. Women worry about leakage and odor affecting their attractiveness. Some women have told us that they leak with something as simple as picking up their grandchild. One woman told us that she was hiking with her family and she was running up a hill. She had an accident that leaked through her jeans. She said it was a wonderful day with her family, but she was afraid to go on hikes with them again.

Indeed, leaking and worry about whether or not it will show is a big problem for women. Fortunately, there are protective pads that they can purchase so that the leakage can be absorbed, but they're bulky and uncomfortable even though there is special underwear that can be also purchased so that they can fit inside this. But as you can see, these don't look like a lot of fun to wear. Should the leakage become more severe, women have to go to a protective pull up or a diaper, and these are much more expensive. These can cost up to a dollar each and depending on how frequently they need to be changed, we're talking about a cost of $800 or more per year.

This is Lee. She was a successful real estate agent, but she was so embarrassed by the leaking and frequent bathroom visits that she was experiencing that, she had to quit her job. Ask yourself, are there things you like to do that you'd have to stop if you developed urinary incontinence? Leaking urine has always been a problem for women and the healthcare community has become more active with research into this predicament. A recent study we conducted with older women was a great success in preventing urinary incontinence. We taught women how to do pelvic floor muscle training, the squeeze trick and bladder training. They cut their risk of incontinence in half. We are going to show you these same three things today. If you use them, they will help you stay dry all your life. The first is pelvic floor muscle training and we'll talk about why and how to do it. Pelvic floor muscle training exercises, which you may know as Kegel exercises are often taught to women during pregnancy. They can be very beneficial after the baby is born and for older women as well.

Let's take another look at the parts of your pelvis that are involved with urine control. At your lower right, is a side view of the pelvic area. The main components are the urethra, the bladder muscles, the sphincter muscles, and the pelvic floor muscles which are in red in the upper version, they support the pelvic organs and control urine leakage. When those muscles get weak, it's sort of like not having a good tie on a water-filled balloon. Pressure from a sneeze or a laugh can be too much for the support muscles to hold back and urine leaks out. Exercise can make the pelvic floor and sphincter muscles bigger and stronger. Then they can easily counter any pressure on the bladder and urine stays in until there's a good time to use the bathroom. With each exercise, the area squeezed by the muscle becomes thicker and stronger.

This is an image of a real pelvis, the woman is facing to your left. The darker looped region in the center is the uterus. The arrow follows the vagina to the outer vaginal opening. The bladder is circular and lighter in color. Just in front of the vagina is where the urethra is located. The almond shaped, dark part of the picture is the pubic bone, which is at the front of your pelvis. Now watch as this woman contracts her pelvic muscles. This is a Kegel. When she contracts her muscles, she shifts her pelvic floor muscles and the internal organs inward and upward. It is the same muscle movement you might use if you were trying to stop or hold back your flow of urine. Now you will view three fast contractions.

Again, pay close attention to the upward movement of the muscles and organs as the woman contracts her pelvic muscles. This slide provides a good guide on how to develop healthier pelvic muscles. We start with five fast contractions or squeezes that you hold for one second each. Then do 25 slow squeezes. Relax for 10 seconds in between each contraction. Build up your slow, squeeze time until you reach a six-second hold. Do 30 squeezes a day and remember, they don't all have to be done at once. Let's take a look at a contraction in slow motion. The right direction to squeeze is up and in. It feels like you are tucking the muscles up towards your tailbone. The wrong way to squeeze is to push down and out. If you find that you can't pull up and in, don't do this exercise and contact the project staff.

In this next segment, I'm going to demonstrate pelvic muscle exercise. You can do this exercise lying down, sitting or standing. The easiest way to learn is to lie on the floor or a bed with your knees bent. For now though, just lean back in your chair for a short practice session. You could put your hands on your abdomen to be sure you're not pushing down and out. No one can see your pelvic muscles contracting, so I'll show you with my hands how my muscles are moving. We'll start with five fast or one second contractions ready, squeeze. Now, relax and rest for 10 seconds between contractions. This lets your muscles get ready for the next contraction. Ready for another one? Squeeze.

Now, relax and try to make each fast contraction as firm and as tight as you can. Ready for another. Now, squeeze quickly and relax. Remember, each pelvic muscle exercise session starts with five fast contractions. Now contract again and relax. That was the fourth fast contraction. Get ready for the last one and contract, relax. Now, we'll rest for 10 seconds and then we'll do three long contractions. With the long contractions. We'd like you to try to hold each one for six seconds. Okay, ready for the first long contraction? Squeeze. Hold. Relax, and we'll relax now for 10 seconds, and don't worry if you weren't able to hold for the full six seconds. It takes some practice. Next contraction, squeeze.

Hold. Okay, relax. It really does take some time to build up to holding to a full long contraction. Don't worry, it will happen. In fact, once you can hold for six seconds, we want you to try to hold for 10. Okay. Ready? This will be the last contraction for this practice session. Contract, hold. Try to hold it. Hold it, relax. Great, that was a great first try. When you're doing this at home, remember you'll start with five fast contractions and then do 25 long contractions. If you can't do them all at once, that's fine. Just divide them into two or three sessions. We learned from our last study that women who do pelvic muscle training at specific times or during regularly occurring events like when they brush their teeth every day or watch the TV program, if they linked the pelvic muscle training to that, they were 12 times more likely to still be doing the exercises three months later and they were still doing it a year later.

How about you? Can you think of a time each day when you could fit these exercises into your life? You will receive a TULIP magnet when you leave today. You might want to put that up where you'll see it and can use it as a reminder. Now that you know how to control your pelvic muscles, you can use them whenever you think there's a chance that you might leak, like when you're exercising or coughing or lifting something heavy. This is a good trick to know about.

We call that trick the squeeze trick. Very simply put, we want you to squeeze, tighten those pelvic muscles before you sneeze, cough, or blow your nose or before you lift something heavy or stand up. Also, when you feel the urge to go to the bathroom, the squeeze trick can make that urge fade away. By squeezing your muscles before you do these things, you can strengthen your muscles and lessen the chance of having a leak. Just remember, squeeze before you sneeze. Healthy pelvic muscles are so important to your overall health and well-being. The squeeze trick can help you to develop these healthy muscles. Now let's talk about one more important component to improving urinary continence and that is bladder training. If frequent bathroom trips are a problem for you, you can learn to decrease this frequency. Increasing the time between bathroom visits allows you more freedom and you can train your bladder to hold for a longer time.

We've found that when women with incontinence follow a bathroom schedule of visits every three to four hours, about 10% of them become completely dry and 75% cut their leaking in half. Some women have told us they go to the bathroom every time they have a chance. In fact, we know of some women who go as often as every hour, but we've found that the healthiest schedule for bathroom visits is about every three to four hours. Do you need to use bladder training? Well, to find out, keep track of your bathroom visits for a few days. If you're going to the bathroom more often than once every three hours, you should be using bladder training.

Here's how to do bladder training. Start where you are. Let's say you're going to the bathroom every hour. Increase that time from one hour to one hour and 15 minutes. The first week of bladder training. The second week, increase the time to one and a half hours between visits to the bathroom. Add 10 to 15 minutes each week until you get to about four hours between visits. If 15 minutes is too much, then just add 10 or even five minutes each week. If you need more time with a new schedule, take another week until it feels comfortable waiting to use the bathroom with that longer time. What if you can't wait until it's time to go? Well, that's okay. First, if you're getting the urge, take a deep breath and relax. Squeeze your pelvic muscles in five short, hard squeezes. That should make the urge go away, but if it doesn't, try to get your mind on something else.

Read something or make a phone call, but if you just can't wait, then go. Then try to get back on schedule for the rest of the day. As with everything, any new habit takes some effort and practice and it may be hard to learn. It's a good idea to think about why you should use each of the techniques that we've talked about today, what things could keep you from using them and how you can plan to work them into your day. So many women think that their family should come first before they take care of themselves, but it's important to remember that if a woman develops urinary incontinence, it takes a toll on her whole family as well. So make time and remember you're doing it for yourself and for your family. Take a minute to think of small rewards that you could give yourself for taking on these new habits that will keep you healthier.

Maybe a special candy or a flower is a reward you would feel good about. Having a healthy, dependable bladder is something many women take for granted, but when you do have to worry about leaking, it can be a major hassle and can get in the way of living your life. It can make you less confident and less able to enjoy your life. The things we've talked about today can really help you stay healthy and full of life. Life is so much more enjoyable when you are in control and doing those things that you enjoy. Let's review these three easy steps to bladder health, pelvic muscle exercise, five fast contractions that you hold for one second each and 25 slow contractions.

Relax for 10 seconds in between each contraction. Build up your slow squeeze time until you can hold for six seconds and when six seconds gets easy, try to hold for 10 seconds. Do 30 squeezes a day and remember, they don't all have to be done at one time. Use the squeeze trick before you do something that could cause you to leak, and it's also a good trick to control bothersome urges to empty.

Use bladder training so that you are only visiting the bathroom every three to four hours and use the squeeze trick to help you wait until it's time to go. Remember taking time now to keep your bladder healthy, can pay you back in years to come with a bladder that doesn't leak when you do things you want to do, like going for a walk, going shopping, gardening, or making love. Thanks for watching. We hope you will use this bladder health information and have a happier, healthier life.
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