man and woman bathroom signs indicating they can't hold it much longer

Roughly one in three women will experience urgency(that desperate feeling of needing to pee right now) or incontinence(not being able to keep the pee in until reaching the toilet) at some point in her life.  

It is more frequent later in life or shortly after childbirth, but it can hit any woman at any age.

In some cases, it’s a very short-lived issue, such as urgency caused by a urinary tract infection.  

In other cases, it can be a longer-lasting issue(about one-third of women have some form of urgency issue, usually stress incontinence, after vaginal childbirth).

That I-need-to-pee-NOW feeling is an incredibly frustrating experience.  

That ‘I gotta go’ feeling makes you willing to go anywhere.

The need to pee is a very deep-seated urge, and we, as humans, have instinctively recognized that need to pee and respond to it quickly by emptying our bladders.

Since toddlerhood, we have been trained that there are very few appropriate places to do this, primarily in the toilet(men get to do cool things like write their names in the snow with urine, or pee against a tree). 

There are times when you need to pee all the time(urge incontinence).

There can be times where you leak under the slightest pressure(stress incontinence).  When that happens, medical intervention is often needed to help fix the problem.

Today, we’re going to discuss how this feels and things you can do to help make life that little bit easier while dealing with the feeling of urgency, as well as how to handle those bladder leakage problems.

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Why do women get urge and stress incontinence?

Urinary urgency occurs when emptying our bladders does not lead to the relief of that pressure and urge to pee.

 That need to pee is a very distracting sensation, and it makes it difficult to focus on anything else. It can easily dominate your life when that urgency doesn’t go away.  

I am going through one of those phases right now, and even as I write this, I am extremely aware of the signals my body is sending me. 

It is leaving me feeling a bit antsy and filling me with the desire to run to the bathroom and see if I can squeeze any more out and feel that blessed empty feeling – the relief of not needing to pee!

 I also know, consciously, that I likely will not feel that relief for at least a few hours, as right now, I’m stuck in another round of urinary urgency.

So why is it mainly women?

Smile, even when you gotta go!

Incontinence and urgency issues occur much more often in women than men(though men do have urgency and incontinence issues too) due to anatomy.  

While men have a long urethra(in the shaft of the penis), the female urethra is very short and the muscles around it are often also associated with sex, adding to the potential for complexity in muscle behavior.

It is a much more frequent issue for women than men and has not been studied as thoroughly as many issues that both men and women have, or male health issues.  

Women have problems with incontinence often as a result of repeatedly stressing our urinary muscles.  

 Nurses and teachers are among the professions that frequently ‘hold it in’ for long periods of time, as their opportunities to pee are often limited while at work.  

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The mechanics: but what happens?

Over time, ‘holding it in’ behavior puts a lot of extra strain on the muscles involved, and they end up stuck in that tight mode(referred to as ‘in spasm’), and unable to relax.  

tension, not good news for those of us with incontinence issues!

Just like anywhere else in the body, tight muscles keep the area from working properly, and over time this strain weakens the muscle, as not enough blood is able to flow to the tightened muscles.  

While we generally don’t experience pain from this in the vaginal area, the muscles are still stuck tight and still straining, which makes them weaker and less functional over time.  

This muscle weakness can often lead to lessened control, where pee ends up leaking out. This accidental leakage is known as stress incontinence.

Stress and incontinence

All people express stress in a variety of ways through a variety of bodily symptoms, but the two systems that are most connected to mental/emotional stress are the digestive system and the urinary system.  

Yep. Think about how many conditions are considered stress responsive – most of them are primarily in one of those systems. Most people are more likely to need to pee when they are anxious or nervous.

What other symptoms do people tend to have when nervous?  Butterflies in the stomach, nausea, heartburn..problems in the digestive system!

So how do I get better?

Medically, your next step is to see a pelvic floor physical therapist.

Incontinence often decreases as stress and emotional tension decrease.  

The calmer and happier you feel, the less likely it is for your body to feel the urinary urgency or to leak.  

Of course, once you know the symptom has happened to you, the concern that it might happen again increases your stress level, which makes the symptom more likely to happen.  

That process of negative anticipation making the undesired effect more likely is known as a negative feedback loop. Stopping the process and breaking the cycle is your urgent next step.  

coloring can be a way to relax and distract yourself

So, yes, even though it sounds absolutely ridiculous, meditation, listening to music you like, reading a good book, practicing yoga, or coloring are all things that might also bring down your urgency and leakage.  

The problems usually develop over time, and the relaxation process often takes time, but the less stress you put your body through, the less likely it is that you’ll have urinary symptoms.

When you really really feel like you gotta go NOW but you just went, it’s time to relax.  

Your body is telling you that it’s really really stressed out(even if you do not feel stressed) and that it needs a break.

Figure out what activities relax you – and try to do those as regularly as possible. Over time, this will help bring down the urinary urgency, and the stress incontinence.

Really.

I mean it.

What do I do in the meantime?

Well, the most practical problem is that you still want to be able to go out in public and pretend to have a normal life(or at least enjoy everything as much as possible), and since wetting your pants is not publicly acceptable, you need to make sure that that doesn’t happen.  

hand holding sign saying 'it is well' I have to pee all the time
Take care of yourself and don’t worry about what other people think!

To do that, you need to be prepared! The best bet at first is to pick up some form of discreet liquid-soaking undergarment.

They do make some decent ones now – there’s an adult incontinence section in pretty much every pharmacy around.  

Buying the panties or pantyliners is embarrassing, with all the social stigma around anything to do with failing to go in the toilet, but that embarrassment is minor and short-lived compared to wetting your pants when out and about.  

Handling incontinence longer term

If it’s looking likely that these spasms are a longer-term issue, I’d suggest looking for a longer-term solution;  cloth pads! These pads are generally sold as cloth menstrual pads, but they also do the job when it comes to pee leakage (they also are marketed to new mothers for added protection)!  

I cannot stress enough how much these pads helped me. I now had a discreet and affordable way to handle both my periods and my leakage.   I can comfortably recommend Glad Rags, which is the company I bought most of my pads from!

I believe I bought my first set of cloth pads in 2005, and while the layer of latex for additional waterproofing has worn out(in the pads I got with that style), the pads are still doing their job!  

There are a variety of sizes, colors, and styles, so shop around a bit, but I highly recommend them as a solution if you are likely to continue to have urinary problems for more than a month or so.  

Once you do regain bladder control, they are still useful for periods, so it’s not a waste even if the bladder issues turn out to be shorter-term than feared.

I recently purchased speax pee-proof underwear and they are great for small leaks(they hold up to 8 tablespoons of liquid), but if I’m concerned about a complete loss of control, I also wear my pads.

The ‘ick’ and embarrassment factor

Yes, you can still wear a skirt!  Just wear a pad!

People don’t like talking about peeing, or incontinence, it’s just not a comfortable topic.  

Losing control is very embarrassing and disempowering and shameful.

But – if nobody knows you did it, it’s a lot less of an issue!  

So if you aren’t sure if you need leakage protection, wear some just in case…this is one of those situations where it’s so much better to have and not need than it is to need and not have!!

Also, since anxiety and stress dramatically increase your risk of urgency and leakage, knowing you are protected lowers your stress and fear about having an accident, which tends to make an accident much less likely to happen.  

See how we fought the negative feedback loop and replaced it with a positive one? My personal goal is to shift everything possible into a positive feedback loop!

Yep, constant urgency and the risk of leakage is going to make you a bit less eager to go out and about and do things.  I know this. You know this. Everybody gets that part. Any time you don’t feel great, there’s a temptation to stay home.  

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Things that make going out with urgency and leakage issues easier

The first thing that makes it all much easier is having protection from accidents.  Wear that pad or panties or whatever with pride. Nobody else needs to know, but you knowing you have something on to protect you can help you feel much more prepared

Make sure your first time out is successful

people eating in a restraunt
Going out for a meal with friends is a great option!

There are people in your life who are super supportive and nurturing (at least I would hope so!), and there are other people who fall short in those desires.

While they might be wonderful people otherwise, you’re best served by going out with friends or family members who know what you’re dealing with and can be sensitive to your needs.

The biggest risk, once you have protection from leaking, is damaging your self-esteem and self-image, which is often already a possibility when you’re dealing with new urgency or leakage problems.  

That’s why you’re best off starting with the more sensitive and supportive people in your life.  

After you feel more confident, the issues are likely to go down a bit(or at least not be much worse than usual), and your confidence is less likely to be damaged by somebody doing or saying something stupid.  

Think about where you are going

waterfall into a stream. Even the image leaves me feeling the urge to pee
beautiful, but not a great place to hang out when you’re dealing with urgency and incontinence

You also want to minimize your exposure to anything that will trigger your urgency.  

For example, you don’t want to go on a picnic by a flowing stream or eat at a restaurant with a fountain as a centerpiece.  

That sound of flowing water babbling by gets me every time!

Again, this is an issue all people deal with -water-type sounds or sensations are likely to make anybody have an urge to pee – it’s just on a hair-trigger for those of us dealing with urgency and leakage issues.

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To drink, or not to drink?

three different alcoholic drinks next to one another on the bar
Alcohol can be tasty, but think before you drink!

Another consideration is alcoholic beverages.  

Alcohol is a diuretic.

I’m not saying you can’t drink(unless, of course, you have a reason you shouldn’t), but alcohol also tends to reduce self-control and lower inhibitions.

Lowered inhibitions tend to mean you’ll be less concerned about losing bladder control.  

Self-control includes bladder control.

By drinking, you’ll be increasing your urgency(after all you are drinking liquid, and alcohol can irritate the bladder) and your chance of leakage(more liquid in the bladder usually leads to more leaks – and muscle control is affected by alcohol), but you might reduce how much you care about these details.  

Be aware of the potential pros and cons of alcohol and think through what will be more comfortable for you.

As far as non-alcoholic beverages go, you need to make sure that you keep drinking!

A lot of times, people with incontinence issues end up becoming dehydrated because (consciously) they don’t want to do anything that will make them need to pee more and (subconsciously) that mental signal to drink is a bit muted by the urgency, which usually only happens when the bladder is full of liquid.

Pelvic floor dysfunction and sex

Okay, so peeing outside of your control isn’t sexy.  Message received.

Getting in the mood is hard when you really need to pee.  Yep, makes absolute sense.

There’s an extra whammy in there though.

If you are experiencing incontinence, that can be a form of pelvic floor dysfunction.  With pelvic floor dysfunction, sex can become painful.

The short version of that is that tight muscles in the vaginal area(the cause of stress incontinence) can also make vaginal penetration painful.  Joy.

This doesn’t mean sex is totally off the table(especially for people who don’t need a penis for sex!), but it might mean getting creative in bed.

First of all, it isn’t always painful, it just is for some women.  You won’t know until you try!

If sex is painful, you(or you and your partner) will need to get creative.  

Good thing we have the internet!

You and your partner(or partners, or vibrator, I don’t judge) might be able to still have vaginal fun, just not penetration.  

If the area is just too sensitive to enjoy(I’ve been there too), it’s time for some more creative searching.

You can try focusing on other areas of the body(the entire body actually is an erogenous zone), or find other sensitive bits to focus on(and of course you can return this favor to your partner).  

Discuss mutual masturbation, fantasies, and possibly some other often taboo topics.  

Think of this as the perfect excuse for you to explore new and exciting sexual possibilities!  

Will this take you out of your comfort zone? Most likely!

But like most things, it gets easier with practice!  

Handling a major change in your life(like urinary incontinence, a disability, or injury) is also going to take you out of your comfort zone, and possibly push on some things that have never come up before in your relationship.  

You might as well make the best of that, and on top of the uncomfortable conversations, add in some that can lead to some joy!

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I have to pee all the time: Living with incontinence and urgency

Having to pee all the time is no fun.  It sucks. It’s a drain on your physical and emotional energy, a drain on self-esteem, and a drain on your wallet(both buying the right protective stuff and paying for treatment).

 The big thing that influences how much it sucks is your attitude about it. It’s totally natural to be upset, frustrated and embarrassed. That’s going to be the emotions you’re going to tend towards, and what you’ll initially feel.  

outhouse, in case you get that need-to-pee feeling
You still can go anywhere when dealing with urgency!

You can’t change the emotions you initially have.  What you can change is your attitude and the emotions you try to cultivate in yourself.  

The more you give in to embarrassment, fear, shame, and the urge to avoid people and situations, the harder your healing process is likely to be.  

The more you focus on what you can’t change, the worse you’re likely to feel about your current situation.  

I’m not telling you that you should celebrate having urinary issues. 

I do want to normalize it for you – there are a lot of people out there who at some point in their lives have to deal with that absolutely horrible feeling of needing to pee all the time.  There really are.

They just don’t talk about it, for the same reason you don’t want to talk about it, and the reason I don’t tend to talk about it.  

It’s a taboo subject that causes a lot of embarrassment. And there isn’t much we can do about that.

What we can do, however, is separate the issue from the person having the issue.  

If you are living with that constant need to pee, or if you find yourself leaking every once in a while(or leaking all the time), I want you to know that even though it sucks, you’re not alone.  

You’re not the only one who has dealt with it.

You have the right to live your life and enjoy yourself even when you leak, and even when you’re constantly keeping an eye out for the next available bathroom.  

This problem can be treated, can be cured, and can get better. All you need to do is acknowledge the problem, and the rest will flow into place.

If you find this comforting, please share it with your family, friends, or others who might be dealing with these issues.

A really large percentage of the population has had urgency and incontinence issues.

I believe that incontinence and the stigma attached needs to be acknowledged and handled in a respectful way. 

By sharing this information, you are taking a step towards making the world a little more comfortable for people living with incontinence issues!

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6 Comments

  1. An excellent and very informative post about a topic that makes me uncomfortable. I admit it! You’ve provided everything here that I need to know and I really appreciate it. Asia – bathrooms are few and far between. Very frustrating! I read your therapist post as well and found it very helpful! Thanks for sharing, Alison!

    1. Carrie, thank you!
      I am so glad you found this post (and the pelvic floor PT one) helpful.
      It is embarrassing and it makes life challenging, but being able to keep going anyhow is really important!
      Believe it or not, there are bathroom-finding apps, and apps for when you can best afford to take a bathroom break during movies!
      I hope you are doing well, and I appreciate your bravery in commenting on here!

  2. This was really helpful and I can vouch for pelvic floor therapy for this issue.

    Before my endometriosis surgery, I went through pelvic floor therapy to help strengthen my muscles because my bladder muscles were bound to go weak post surgery. I also faced a bladder complication during surgery and post surgery I am back to strengthening my muscles all while also dealing with painful bladder syndrome which makes holding any amount of urine quite painful.

    I also hope this issue is taken more seriously because I find many women uncomfortable to speak about it and then the muscle keeps getting weaker.

    Thank you for such an informative post Alison.

    1. Shruti,
      Thank you! Pelvic floor therapy can be so incredibly useful – but you need to know to ask for it – which is why sharing this knowledge is so important!
      I’m really glad that you had support ahead of time so you could prepare and get used to the process – and I’m so sorry that you have painful bladder syndrome on top of everything else! It’s so frustrating to have the conditions that nobody really wants to talk about and you’re worried about getting shamed for. Restrengthening the muscles is so important too. I’m debating about going back to my pelvic floor PT to see if my FND symptoms have died down enough for her to be able to help me yet.
      Thank you so much for reading!

  3. I have the urge to pee due to interstitial cystitis / bladder pain syndrome. Luckily mine comes and goes so I don’t deal with the issue all the time. I’ve found pelvic floor physiotherapy to be really helpful and it identified some issues that we are dealing with. Thanks again for an informative post Alison!

    1. Claire,
      thank you! Mine is variable in terms of degree/intensity, for sure! I wrote this when I was having a really bad flare and realized that I kept finding images of water and fluids and both the topic and pictures were only making the urgency worse!

      I’m a big fan of pelvic PT as an option, and I’m so glad that you found it helpful too!

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