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Urology/was it urine?


Woke up this morning. My underwear was wet and part of my pyjamas!! Sheets blanket  all ok!  Didn't have a smell or anything but I am so worried.  I do pee a little sometimes when I jog or do jumps but never have this happen . I peed at the toilet as usual even after I saw them wet.  I am 39 female have had 3 children.  69 kgs/1.65 height.  I am very embarrassed

Tonia, there are several types of urinary loss in women.  The most common types are stress incontinence, urgency incontinence and involuntary loss without stress or urgency.  One often has a combination of these. The loss you noted with jogging or jumping is stress incontinence.  The loss of urine during sleep is the last type of incontinence mentioned.  The loss during sleep may be due to a cough, sneeze or just turning over with a partially full bladder (a form of stress incontinence).  It may also occur if during a dream your bladder was noted to be full and you voided a small amount of urine in response to that.

Any process that causes the diaphragm to push downward toward the lower abdomen such as coughing, sneezing, laughing, straining, certain exercises, etc. can cause urine to leak.  This is called stress incontinence.  In a woman, the bladder, bladder neck and urethra are supported by the muscular vagina.  Normally this is adequate to keep the bladder in proper alignment and position which allows for the bladder neck to stay closed during such activities.  Weakening of the vaginal muscular support can occur from many factors, the most common being childbirth, aging, and obesity.  In this instance, with stress, the bladder and bladder neck are forced downward toward the vaginal opening and the neck of the bladder opens resulting in urine leakage.   Mild cases may be helped by doing Kegel exercises.  These exercises are easily found on the internet and but must be done properly and religiously for them to be helpful. There is absolutely no  harm in doing Kegel exercises.  If you imagine that you are urinating and trying to stop the stream by contracting your pelvic muscles, you are exercising the correct muscle group.  You do not necessarily have to do this when urinating. The same effect can be accomplished by tightening your anal muscles.  You should contract the muscle for 1-2 seconds and then relax for 10-15 seconds.  One set should consist of 10 contractions and relaxations.  One should do 4-5 sets (ie 40-50 contractions) daily.  It usually takes 4-6 weeks before any benefit might be noted., Kegel exercises are not harmful and there is no downside to doing them.  If they do not help enough or the stress incontinence is more severe, there are a number of surgical procedures that can correct the problem.  Originally, the operation (Burch procedure) was performed via an incision in the lower abdomen whereby the bladder and bladder neck were pulled back into a normal position with sutures.  If there was an associated cystocele (sagging of the bladder into the vagina), this was also corrected.  The Burch procedure can now be performed laparoscopically.  In the past 10-15 tears, the operation has been greatly simplified and most of these operations can now be done vaginally through small incisions using needle suspensions or slings under the bladder neck.   The latter techniques are quicker, less uncomfortable and the post-operative period is shorter.  The success rate is about 85%. They can be performed by either a gynecologist or urologist and I suggest you make an appointment to discuss the options that are best for you.  A new technique uses radio frequencies generated from a machine to shrink the lax tissue hoping to reduce the hypermobility of the bladder neck.  I have no experience with this but the early results are promising.  

With urgency incontinence, it is important to have appropriate studies to try and find the underlying cause of the problem.   This would require consultation with a urologist.  An extensive history is needed to try and determine if there are any potential underlying factors that could contribute to your symptoms.  Some of the common related causes are chronic constipation (which can affect the pelvic nerves and secondarily irritate the bladder), caffeine containing products, coffee, tea & carbonated beverages (with and without caffeine), alcohol, excessive over or under hydration.  In addition, there are medical disorders that can produce urgency incontinence.  Some of the common ones include urinary tract infections, an enlarged prostate in men (BPH), a variety of neurologic disorders (such as multiple sclerosis, stroke, Parkinsonism, traumatic etiologies, etc.), inflammatory bowel diseases, etc.  If all of these problems can be ruled out, the condition is called "overactive bladder syndrome".  

A thorough history, physical examination, laboratory tests (at the very least a urinalysis) and usually urodynamic studies are needed to fully evaluate this symptom.  Simple measures such as eliminating caffeine and alcohol from the diet, moderation in hydration, keeping bowels habits regular, etc. are very important.  There are also biofeedback & Kegel exercises that your urologist can offer that may well differ from those you may have tried.  I have found that "timed voidings" often help.  This means urinating by the clock.  For example, if you have urgency every 2 hours while on moderate hydration, urinate every one and a half hours to avoid the critical volume of urine that generally produces the urge.  

In patient's refractory to the above modifications, symptoms are best controlled by medications in the anticholinergic drug group such as Detrol, Ditropan, Enablex, Vesicare & Sanctura.   These medications have a 20% risk of annoying dry mouth.   However, most patient's usually can find one that will work for them & yet is tolerable.  If it controls your frequency but the dry mouth is intolerable, your dentist can offer some other options to keep your saliva flowing freely.   

Involuntary loss of urinary without stress or urgency also requires urologic consultation to determine the underlying cause.   Many of the disorders mentioned above, as well as other unusual ones can present in this manner.  Good luck.

Addendum:  I suspect this was urine.  The only other possibility is a vaginal discharge but you should be easily able to differentiate this from urine.


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Arthur Goldstein, M.D.


Problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, etc. I no longer answer questions related to erection problems or male sexual dysfunction.


I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in endourology.

American Medical Association, American Urological Association, American College of Surgeons

College degree - BS Medical degree - MD Master of Science - MS

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