- Aleece Fosnight, MSPAS, PA-C, urology and women’s health specialist at Aeroflow Urology
- Heather Jeffcoat, DPT, doctor of physical therapy, owner of Femina Physical Therapy, and author of Sex Without Pain
This progress, while both exciting and necessary, simultaneously begs the question: Has something changed for the worst in the broader scope of people's bladder health? The resounding conclusion from urinary health experts is that, while a reduced stigma around discussing bladder health issues is partially at all (we love to see it), the last few years haven't exactly fostered the healthiest of environments for bladders. TL; DR: It is very possible that the pandemic has taken a toll on your urinary system.
"There are some very likely correlations between the pandemics' effect on society and bladder health, in general," says Aleece Fosnight, MSPAS, PA-C, a urologist and women's health specialist of Aeroflow Urology. "These effects range across the board, but being more aware of them can help support people's effort in managing their bladder health as best as they can."
How has the pandemic impacted bladder health
1. There have been significant delays in one's ability to access bladder health care
"One of the primary ways the pandemic has impacted bladder health is a delay in access to care. Many individuals put off seeing a healthcare provider to discuss their bladder health concerns," says Dr. Fosnight. "This has led to significantly worse overactive bladder (OAB) symptoms and cases, more urinary tract infections (UTIs), worse complications from urinary tract diseases such as kidney injury, and a rise in urinary tract malignancies such as bladder cancer and prostate cancer." Oof.
Not only did the pandemic slam the health care system for a long time, which made it significantly harder to get in to see a provider, but it also became a space for risk of exposure to COVID-19. This delay in care makes an already hard-to-navigate system even harder. People who experience a slight burning sensation may not want to go in to see a doctor if they are at risk of exposure to severe COVID-19 cases or if they live with a family member who has the virus.
Additionally, the financial impact on families and individuals throughout the pandemic has led to even more unstable care accessibility. Some folks simply can't afford to find a primary care physician to talk to about their urinary incontinence when they sneeze or wake up to pee too often. Lastly, it can be hard to come to a physician with more open-ended concerns like OAB or incontinence because it can take time, money, and vulnerability to investigate.
2. More focus has been placed on acute bladder care needs and less on preventative care
Burnout in the healthcare field has also made it harder to get in to see specialists like urologists, and that has led to urgent care offices and emergency rooms to focus more on treating acute issues over preventative care—and same goes for patients.
Keep in mind that prioritizing preventative and long-term care options to prevent worse immediate illness is super important for bladder health. "The thing is, much like going to get dental cleanings can prevent larger problems down the road, staying in touch with a provider and getting care when you see concerning symptoms is important—even if this means stopping into urgent care when you feel burning," says Dr. Fosnight. "This is because UTIs often need antibiotics to resolve. And when left untreated, they can quickly progress into dangerous bladder or kidney infections. Additionally, providing a urine sample when you have a UTI is important so that you're not taking unnecessary antibiotics for symptoms that might simply mimic a UTI. This helps ensure that these antibiotics work for you in the future when you really do need them. The same goes for routine cancer screenings that can be life-saving in the long term."
3. Less active lifestyles impact bladder capacity and kidney functioning
"The results of a survey of 1198 people from Aeroflow Urology showed that 43 percent of people were less active and peeing more during the pandemic," says Dr. Fosnight. "The relationship between physical activity and bladder health is actually quite significant. Moving your body regularly throughout the day helps your heart and kidneys move blood through your body and into your kidneys. When this happens, your kidneys filter your blood and create more pee. Having movement in your life can help you keep your kidney and bladder function working optimally by improving circulation and filtration."
Getting up and walking around and not sitting for large chunks of hours is a great way to support your overall health—which includes your bladder.
4. Sitting can weaken your pelvic floor and lead to urinary incontinence
In addition to engaging in less physical activity, many folks have also simply been standing up less and sitting more throughout the pandemic. "Sitting can cause pelvic floor muscles to weaken, leading to urinary incontinence," says Dr. Fosnight.
Your posture also dictates the strength of your stability and muscles, and it determines how much strain we place on our pelvic floor. "When you sit hunched over or off to one side, this abnormal posture puts abnormal stress on your pelvic area, which isn’t ideal for your pelvic floor muscles — or your bladder," says Heather Jeffcoat, DPT, pelvic floor physical therapist and founder of Femina PT in Los Angeles. When the urge hits, if your pelvic floor muscles are under strain, they may not respond in the way you need them to in order to delay urge or prevent urinary leakage. Overtime if postural dysfunction (Dr. Jeffcoat's term for less than ideal posture) is not corrected, it can also be a contributing factor to urinary frequency.
As a general urological guideline, it's healthiest for your bladder when you pee as soon as your bladder is full of urine— basically, that stretching or fullness is what gives you the sensation that you have to pee. When you have the urge to go regardless of how much pee is in your bladder, it's a sign that there is something going on with your pelvic floor, bladder, or neurologic connection between these systems. "Sitting for long stretches doesn't help matters, which is why exercise throughout the day and programs to strengthen the hips, core, groin, and pelvic floor are really valuable," says Dr. Fosnight.
5. Mental health struggles amidst COVID-19 have left many bladders in a state of chronic stress
It's absolutely no secret that the pandemic has been incredibly hard on people emotionally. These mental health effects can range from increased anxiety and depression to exacerbated existing conditions like OCD, Schizophrenia, and bipolar disorders. The aforementioned delays in care can and have made it hard to manage worsening mental health symptoms, and accessing therapy is notoriously difficult from a cost and availability perspective.
"Believe it or not, your mental health and physical health are definitely related, and some stressors on the body affect people in different ways," says Dr. Fosnight. "For example, anxiety and stress can place the body into fight or flight mode, which increases your heart rate and increases how fast your bladder fills with pee. This can increase how often you're peeing, in addition to placing your body in a chronic state of stress."
All in all, these impacts that the pandemic has placed on people are largely not in the control of the individual. Many people are stressed about keeping their jobs, so they don't necessarily have the option to exercise throughout the day. Some folks have kids or at-risk family members, so pursuing treatment for incontinence doesn't feel worth it to them in the face of potential exposure. The burnout that has ripped through the healthcare industry like a wildfire has made it a lot harder to get care for those who do have the time, money, insurance benefits, and energy to seek treatment. Hopefully, though, there are small things that you can do and remember to protect your bladder and overall health as we continue to endure the ongoing pandemic.
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