The Biology of Bladder Leaks: What Every Woman Should Know

Bladder leaks are more common than many women realize—and happen earlier than you might think. In this episode, we talk to Dr. Karen Koffler, integrative medicine specialist, and break down what’s happening in the body and share effective tactics for managing symptoms with confidence and comfort.

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Episode Transcript

Speaker 1 (00:00):
Each week, we aspire to bring you the good news
on women's health by talking to renowned scientists and medical experts,
and by sharing health advice that can help you live
healthier and happier. Today, we're talking to integrative medicine specialists
doctor Karen Koffler, on a topic that doesn't get discussed enough,
but it is more common than many women realize, bladder leaks.

(00:22):
The good news is that there are effective strategies and
products that can help women manage symptoms with comfort and confidence.
Doctor Koffler is a professor of Medicine at the University
of Miami School of Medicine and a physician at life
Span Medical with an emphasis on longevity medicine. She also
has her own private practice focus on women's health and longevity. Welcome,

(00:43):
doctor Koffler.

Speaker 2 (00:45):
Thank you.

Speaker 1 (00:46):
So today we're going to talk a little bit about
something that happens to many women, although a lot of
people don't share that, and that of course is bladder leaks.
What are bladder leaks or also known as urinary incontinence
and how common is it?

Speaker 2 (01:01):
Well, really, very simply, it's the involuntary loss of urine
when you're not intentionally voiding your bladder and there's essentially
a leak, and it's actually far more common than people realize. So,
for instance, just focusing on older women, about fifty percent

(01:23):
of us over the age of sixty will experience bladder leaks.
But actually if you look at younger women, even as
young as eighteen, almost one in four women actually experience
bladder leaks. So it's actually far more common than people realize.

Speaker 1 (01:40):
It's true, as you said, that it happens in younger women.
Does it likely increase with age or is it across
the board.

Speaker 2 (01:47):
So it is across the board for a variety of reasons.
For instance, postpartum, very often women will experience incontinence. You're
a airy incontinence, But clearly we do see the greatest
increase and urinary incontinence in women who are older, and
there's a variety of reasons for that.

Speaker 1 (02:06):
I know that menopause has a big impact, but interesting
that even sort of younger athletic women, young women even
pre pregnancy, pre childbirth, also experience incontinence. Why is that.

Speaker 2 (02:18):
First of I think it's important to understand that the bladder,
the uterus, and the rectum are held up by the
pelvic floor. Which is a key part of our core.
You know, we all talk about the core and palladius.
I'm constantly talking about the core, and a key part
of the core is the pelvic floor, which actually looks

(02:40):
like a around hammock. And women may not have a
strong core, a strong pelvic base in that way, and
you can be old or young and suffer from that.
But certainly any trauma, for instance childbirth, which completely stretches
that tissue, both the muscles as well as the ligaments

(03:02):
and tendons supporting those tissues, or surgeries can interfere with
the strength of those tissues. So it really is a
broad spectrum of ages that can ultimately experience urinary incontinence.

Speaker 1 (03:18):
And sort of the overactive bladder signals that some people get,
like I think, as you mentioned, when the pelvic floor
is either stretched or not strong enough. What's that about?

Speaker 2 (03:31):
So overactive bladder has a lot to do with the
bladder muscle tissue, which is called the detruser that becomes hyperactive.
It's not responding to signals completely right. It's innervated by
a nerve called the pedental nerve, and that can change
over time. It can be less responsive to sort of

(03:55):
like a reflex the way someone's reflexes are not as sharp,
the pental nerve might not or sharp, So for things
simple things like a cough or a sneeze or jumping,
the detrucer may actually contract and release. You're in that way.
Understanding the anatomy is really important in understanding why someone's
affected by this, and this is where experts can really

(04:18):
help women control this issue.

Speaker 1 (04:21):
So we have the weak pelvic support on the one hand,
this overactive bladder signals on the other hand, And it's
happening across life stages, but what happens in menopause in particular,
that seems to sometimes at least exacerbate things.

Speaker 2 (04:36):
So as we age, there's a quality of sarcopenia or
muscle loss that's inevitable in all of us. And because
the pelvic floor, which is supporting the bladder is a muscle,
it's a series of muscles. Actually, there can be a
weakening just by age. But add to that the loss

(04:58):
of estrogen. Now you have some fragmentation of the collagen
which helps the tendons and ligaments remain strong. There's a
fraying essentially of those tissues. There's also estrogen receptors lining
the urethra and probably the muscular tissue as well, And
so the loss of estrogen during menopause really affects several

(05:25):
layers of what would otherwise be a more sustained tissue
with stronger base. So through the loss of nerve impulse,
through the pudental nerve, through the loss of muscle integrity,
and through the loss of the connective tissue, all mediated
essentially by a loss of estrogen.

Speaker 1 (05:46):
Makes a lot of sense. I love to talk to
you because when we do talk to you, we learn
that so many things are very typical happen to everyone
as the normal part of aging or just as a

(06:08):
normal part of our anatomy. So I think it's so
important as you break it down for us, what can
we do right? I think, as you mentioned, it happens
at all ages for different reasons. But what strategies can
help women manage mild or occasional bladder leaks so they can,
you know, feel like they can go about their life
and not be interrupted.

Speaker 2 (06:30):
Well, First, we know that women who are exercising through
mid life and beyond tend to have less incidents of
bladder leaks or urinary incontinence. So you know, once again,
exercise as an important medical strategy to keep bladder health intact.

(06:54):
Weight loss, so, obesity puts undue pressure on the pelvic
floor and that increases the tendency towards incontinence. So getting
to your ideal weight is important. You know, there's a
whole field now in physical therapy devoted to pelvic floor
and improving pelvic floor function, and that's a simple referral

(07:18):
to a pelvic floor physical therapist and they can really
assess in you what is the issue and give corrective
exercises and they do incredible work. Being on estrogen improves
the integrity of those tissues, particularly if one is on
vaginal estrogen, which really acts locally. So having a conversation

(07:39):
with your gyn about the applicability of a vaginal estrogen
to help secure those tissues better. Practical things like not
drinking excessively before you go to bed at night and
timing you know, when you go to the bathroom is
an effective strategy. And then if leaks do happen, there's

(08:01):
very effective products that can help a woman not feel
like she has to be bound to her home or
to her place or to a bathroom because you know,
she'll suffer a leak and have no recourse. So there's
all kinds of paths that are actually quite different from
those that we use in mentuation, and that they really
absorb fluids better and neutralize odors, so women don't have

(08:26):
to feel ashamed or uncomfortable if they do suffer a
small leak.

Speaker 1 (08:31):
On that note, I think the emotional impact or the
emotional side of incontinence and bladder leaks is very real
in a lot of women. What can we do to
address that because I think a lot of these things,
as we mentioned at the top of the conversation, is
you know, people keep this a secret, they feel that
they're sort of alone in this, and they're embarrassed about it.
What can we do on the emotional side to help

(08:53):
all of us recognize that this is a pretty normal occurrence.

Speaker 2 (08:57):
I think it is exactly that Kim, I think gets
you know, just like we've had our cycles, you know,
and we'll have our periods, so we're a little different
at those moments. We can have leaks and it is
actually quite common. You know, line up three of your
girlfriends and one of y'all is probably suffering from some
degree of urinaryan continence. So recognizing number one, you are

(09:21):
so not alone in it. It is a part potentially
of aging, and that you can correct it very very often,
far more often than not. Urinarian continence is correctable. So
seeking the guidance of urologists, your gyn and most certainly
a pelvic floor physical therapist can really change the quality

(09:43):
of your life. If you find this to be very problematic.

Speaker 1 (09:47):
Super interesting. There is a statistic that said that I
think it's like one in four women or something like
that say they've never even brought up this issue to
their doctor, because they're even embarrassed to bring it up
with their doctors. So I think normalizing the conversation, as
you say, recognizing that this is biology, this is normal
at all ages is key. Just understanding the biology helps

(10:08):
us all a lot. And then of course the strategies
you've given us today super interesting, that PT is a
really effective tool for us, and of course the other
ideas that you gave us, and of course the product.
So thanks so much for joining us.

Speaker 2 (10:21):
Well you most welcome.

Speaker 1 (10:25):
Here are our top takeaways for today. First, bladder leaks
are common, more common than you may realize, and they
affect women at almost every age. That's why normalizing the
conversation around bladder leaks is key. The many women with
this condition need to know they're not alone. Second, there
are proven strategies to help. From exercise and physical therapy

(10:49):
for the pelvic floor, to wait management to proper hydration.
There are effective approaches that can help at every life stage.
Be sure to consult your physician on the right plan
for you. Third, products today offer real protection. Pads and
liners made specifically for bladder leaks absorb fluid effectively and
neutralize odors, allowing women to stay active and confident at

(11:12):
every age. Thank you for listening, and please share today's
episode with others in your life. Have a great day.
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