I have a weak bladder, could it be a sign of a bigger problem?
The medical term used to describe a weak bladder is urinary incontinence, and this is a very common problem that many women experience. One symptom of urinary incontinence is being unable to hold in urine, and having a leak of urine which you can’t stop or control.
This may happen when you do something as simple as cough or laugh, in which case it is known as stress incontinence. Some women may feel a sudden urgency to urinate, but find nothing comes when they get to the toilet, which is known as urge incontinence. For other women, they may have difficulty storing urine so there is a frequent leak, or they may find they are passing urine constantly, with absolutely no control at all.
What causes a weak bladder?
Stress incontinence is usually caused by a weakening of the pelvic floor muscles (muscles which support the bladder) or the urethral sphincter, which is a muscle that controls the opening and closing of the bladder.
Weakness of the pelvic floor muscle may come from damage or weakness after vaginal childbirth delivery, increasing weight, or age.
Pregnancy and childbirth can contribute to a weak bladder in many ways. During childbirth, there is an increase in weight from the pregnant womb on the bladder and on the pelvic floor that subsequently has to support both the bladder and the pregnant uterus.
As you can imagine, with constant heavy weight and stretching, the pelvic floor can become weakened. The pregnant uterus can also displace the urethra from the bladder, making this passage of urine from bladder to the outside more difficult.1 In addition, if an episiotomy (a cut made in the pelvic floor to help the delivery of the baby) is performed, this may also weaken the pelvic floor.
Therefore, after childbirth, it is more difficult for the pelvic floor to support the bladder well, and it does not form a tight seal around the bladder opening to keep urine in when it’s needed.2 This can lead to leaks of urine, particularly when the pressure in the abdomen increases at times of coughing, laughing or sneezing.
Conditions where a weak bladder can be a symptom
An abnormal or constant leak of urine may be caused by abnormalities of the bladder structure which can block it from emptying properly. These may be due to a developmental problem from birth or from internal damage. Women who have experienced severe road traffic accidents can suffer from tearing of the muscles of the bladder or urethra, this can make it difficult to pass urine and keep urine in.
Often these damages are severe and there may be damage to other surrounding organs such as the bowel and ovaries. So women may also experience leaking of faeces (faecal incontinence), constant pelvic pain from chronic scarring, and infertility if the reproductive tracts are also damaged.
Urge incontinence is caused by an overactivity of the bladder wall, which may be due to abnormality in the nerves controlling the bladder.3 This could be due to injuries to the spine, or neurological conditions such as cerebral palsy, Parkinson’s disease, or stroke.
The micturition centre in the brain sends signals down nerves from our spine to the bladder and the muscles controlling the opening and closing of the bladder, which is responsible for voluntary control of passing urine. When there is a neurological disorder, such as a stroke, the micturition centre is affected, or the nerves relaying the information are damaged, so the message does not get to the bladder, and there is an involuntary leak of urine in these conditions.
These conditions generally present with other symptoms alongside weak bladder. These can include weakness in the arms and legs, abnormal sensations, facial drooping, slowed movements, difficulty walking, and headaches. So, if you experience other neurological symptoms in addition to a weak bladder, it is worth visiting your doctor to get checked out.
Stress and anxiety
As previously explained, we have voluntary control of passing urine, thanks to the micturition centre. However, sometimes it can come about that we are passing urine frequently, using voluntary control, due psychological conditions, when there is nothing wrong at all with our bladder structure or nervous control.
An example of this is stress and anxiety. When we feel anxious, our brain may send false signals to the micturition centre that we need to go to the toilet because our bladder is full, even when it isn’t. One theory of why this happens is because our stress response system activated, with increased release of stress hormones, and it’s these nervous stimulations that travel to the bladder giving the sensation that it needs emptying.4
Other symptoms associated with anxiety include palpitations, sweating, breathlessness, and a tight chest. Generally when the stressful situation passes, the symptoms should go away. If your bladder problems continue after the stressful situation has passed, or despite being treated for anxiety, you should seek medical help to ensure you don’t have a different condition.
Finding you need to pee very frequently, and feeling that you have to pee urgently may be a sign of a urine infection. This is because the bacteria that is infecting the bladder irritates the bladder wall, sending signals to the brain that we need to pee. This may be an evolutionary adaptation in order to pee out the bacteria.
If a weak bladder is due to a urine infection, there may be other symptoms such as pain on passing, urine, pelvic pain, and the urine may be cloudy and smelly. If these symptoms are present you should seek help from your GP, so that they can take a urine sample and start you on a course of antibiotics if necessary.
General, there a three options when it comes to treatment for bladder problems: lifestyle, medical, and surgical.
When it comes to lifestyle or preventative measures, there are some simple things that may help with weak bladder. Losing weight if you are overweight will take some of the pressure off the pelvic floor, so you will have more control over the opening and closing of the sphincter.
Cutting down on caffeine and alcohol may also help, because both of these things inhibit production of anti-diuretic hormone, which means that your body reabsorbs less water into your body and converts more into urine. More urine in the bladder will mean there is more chance of leakage as opposed to if there were no urine in the bladder.
Doing pelvic floor exercises (Kegel exercises) can help make muscle tone stronger, so the bladder is better supported and there is a stronger closing of the urethral sphincter. This is particularly recommended to women after childbirth to prevent stress incontinence. Also, your doctor can refer you to a specialist who can advise you on bladder training exercises.
Medications include taking duloxetine to increase the tone of the urethral sphincter, or antimuscarinics such as oxybutynin or tolerodine, to stabilise the nerves in the bladder. Mirabegron helps the bladder relax, and therefore fill up and store urine. None of these medications should be taken except on the advice of your doctor or a specialist, who will be able to advise whether or not they are suitable for you and your condition.
Finally, if your condition is severe you may be advised to have surgery. There are a huge selection of surgical procedures available to treat urinary incontinence, and, if necessary, your specialist will be able to talk you through these and discuss the individual risks and benefits, as well as any alternatives.
Last updated January 2018
Next update due 2020
- Sangsawang, B., and Sangsawang, N., Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment, International Urogynecology Journal, June 2013, vol 24, no.6., pp 901-912
- Aoki, Y., et al., Urinary incontinence in women, Nature Reviews Disease Primers, July 2017, 3:17042, [online], https://www.nature.com/articles/nrdp201742 (accessed 7 July 2019)
- Lai, H.H., et al., The relationship between anxiety and overactive bladder/urinary incontinence symptoms in the clinical population, Urology, December 2016, vol 98, pp 50-57
With supporting information from
- NICE, ‘Incontinence – urinary, in women,’ Clinical knowledge summary, January 2017, [online], https://cks.nice.org.uk/incontinence-urinary-in-women#!backgroundSubSub (accessed 7 July 2019)