A Greek study showed that smokers were more likely to suffer from incontinence than those who didn’t smoke. National Kidney Foundation research showed that former or current or heavy smokers were more than twice as likely to develop severe incontinence.
Research also shows that compared with other incontinent women, female smokers develop incontinence at a younger age, despite having stronger sphincter muscles. Sharon Knight, MD, professor of obstetrics and gynecology asserts “some explanations have been proposed, such as nicotine-induced bladder contractility and some other toxins that can be bladder irritants”. This relationship between smoking and incontinence can come as a shock and have a huge impact on quality of life. We always hear of smoking damaging our lungs and breathing, however how often do we hear of people talking about incontinence? Joanne, 62 shared her daily struggles with smoking associated incontinence. She states, “I have smoked for thirty years. I get exhausted walking more than a few metres. I am incontinent, and because I can’t move quickly to the toilet, I wet myself”.
“Smoking and Incontinence…What?!”
Thinking about the impact smoking has on the body can make this relationship seem less bizzare. The persistent cough that develops in long-term smokers, often called “smoker’s cough” is a common contributing factor towards this problem. Smokers tend to cough more than non-smokers, placing the pelvic floor muscles under stress. A theory postulated by Bump and McClish concluded that chronic coughing in the elderly patient often causes anatomic and pressure changes in the continence mechanism. The type of incontinence triggered by the coughing is most commonly stress incontinence, which occurs when pressure is placed on the bladder. Chronic coughing, particularly in elderly patients, can cause anatomic and pressure changes in the continence mechanism. The American Urological Association Healthcare Provider Pocket Guide states, “smoking cessation is critical in reducing chronic cough which results in pressure on the pelvic floor muscles.”
The bladder can also become irritated and damage by the harmful chemicals in tobacco smoke. When you smoke, nicotine is absorbed into your bloodstream. These chemicals then pass through your kidneys and collect in the urine that is stored in the bladder. Urine then sits in your bladder for a period of time until it is eliminated. As the toxic chemicals remain in contact with your bladder, this causes damage to the cells of the bladder wall. Contact with these chemicals increases your chances of getting bladder diseases and conditions. After all, the more your bladder is damaged, the less the muscles can support you. The impact of this is much more severe in excessive smokers. Additionally, the nicotine consumed can also lead to increased bladder contractions, causing symptoms of urgency that are associated with an overactive bladder. Nicotine has a stimulating effect on the detrusor muscle. Chronic nicotinic detrusor muscle stimulation accompanied by increased intra-abdominal pressure unsurprisingly causes unwanted leakages.
Another explanation for the relationship between smoking and incontinence is that the diaphragm lowers when a smoker inhales to fill their lungs. When you breathe in or inhale, your diaphragm contracts, moving downward. This increases the space in your chest cavity for your lungs to expand. Whilst this moves downwards however, it places more pressure on your bladder. Your kegel muscles and urethral sphincter are designed to prevent accidental loss of urine when this occurs. However, if your bladder muscles become weaker and weaker by excessive smoking, you no longer have this support.
As you’d expect, Doctors you talk to about urinary incontinence are likely to suggest quitting smoking or gradually reducing the number of cigarettes you smoke. Urology specialist Bob Parker asserts, “besides kegel exercises, which have been used for decades to strengthen muscles associated with urination, quitting smoking is one of the best ways to keep these muscles strong”. Sharon Knight, MD, an associate professor of obstetrics Knight explains, “there seems to be a dose-related risk of having overactive bladder symptoms such as frequency and urgency, so I expect that these symptoms would improve as the smoking decreased”. The American Urological Association Healthcare Provider Pocket Guide also points out, “smoking cessation is critical in reducing chronic cough which results in pressure on the pelvic floor muscles”.
It is important for urologists to ensure patients are aware of the relationship between incontinence and smoking. Quitting smoking can be incredibly difficult, so you should talk to a Doctor about a plan that combines quitting techniques with bladder-control tactics. To succeed at ditching the nicotine, experts recommend a combination of these stop-smoking strategies:
- Nicotine replacement gum
In the meantime, kegel exercises can be very helpful in preventing leaks and strengthening the kegel muscles. You can read how to do kegel exercises here.