Report Incontinence to Your Doctor
Urinary incontinence (UI) can have a significant impact on a woman’s quality of life, especially if she begins avoiding activities and situations due to concerns about urine leakage. A recent study suggested that women with the problem tend to get less exercise—and that’s unfortunate, since other research suggests that exercise can ease incontinence symptoms by helping women lose weight and also strengthen the pelvic floor, a group of muscles that support the bladder.
Reporting UI is Important
UI is very common: Statistics suggest that one in three women suffer from the problem. But, for many of them, UI is a hidden condition, says Bilal Chughtai, MD, a urologist at Weill Cornell Medicine. “It is a very sensitive topic,” Dr. Chughtai explains. “It takes an average of seven years for women to talk to their doctors about UI symptoms.” However, even if you find it embarrassing to talk about UI, it is important to tell your doctor if you are experiencing urine leakage, for several reasons.
WHAT YOU SHOULD KNOW
There are three main varieties of UI: stress incontinence, urge incontinence, and mixed, which is a combination of both stress and urge types and is the most common type among women.
Stress incontinence refers to urinary leakage that occurs with movement, such as exercising, laughing, or sneezing. Urge incontinence refers to an urgent need to urinate.
Risk factors for stress UI include obesity, smoking, and childbirth; giving birth vaginally can weaken pelvic muscles that affect the ability to “hold in” urine. Older age and obesity are risk factors for urge UI. This type of UI may also be caused by other medical conditions, such as stroke, diabetes, and Alzheimer’s disease.
“Hiding UI takes a toll; it can lead to depression and anxiety,” says Dr. Chughtai. “Also, many women become more isolated and less active because they are afraid they will be embarrassed in public.” Research published online Feb. 22, 2017 in the journal PLOS ONE confirmed a lower activity level among women with UI: Study participants (women ages 48 to 55) who had pelvic floor dysfunction (a contributing cause of UI) reported engaging in fewer moderate-to-vigorous-intensity physical activities than women without pelvic floor dysfunction.
In addition, if you have urine leakage, it is important to be evaluated by a doctor to rule out other conditions and determine the causes and the best treatment options. For example, UI can be a sign of infection, cancer, or vaginal prolapse.
Non-Drug Treatment Options
Treating UI usually begins with exercises and behavioral changes.
The first thing Dr. Chughtai recommends for all types of UI are Kegel exercises, which work the muscles in the pelvic floor. Kegel exercises strengthen the muscles, which helps prevent or reduce leakage.
“To identify the muscles, when you are urinating, stop the stream—these are the muscles that need to be strengthened. However, don’t do the exercises when you are urinating,” advises Dr. Chughtai. “A Kegel exercise consists of contracting (squeezing) the muscles for several seconds, and then relaxing them; do 50 to 100 Kegels every day. Continue to do Kegels daily for at least two months; you have to do them regularly to get results.”
Behavioral changes that can reduce urge UI include avoiding foods and beverages that may act as irritants, such as caffeine, alcohol, and acidic foods, including citrus fruits and tomatoes. Other items that trigger urge UI for some women are chocolate, artificial sweeteners, carbonated drinks, and spicy foods.
Exercise can help, too: Regular physical activity (150 minutes of weekly walking and twice weekly strength training classes) cut episodes of urine leakage by as much as 50 percent among women in their 70s and 80s, according to a study published in the Journal of the American Geriatrics Society, March 1, 2017.
For stress UI, timed voiding can help. “If you follow a schedule and urinate every two hours, there’s less urine in the bladder, so if there is leakage, it’s a smaller amount,” says Dr. Chughtai.
Medications and Surgical Options
For urge UI, anticholinergic medications, such as tolterodine (Detrol), darifenacin (Enablex), and solifenacin (Vesicare) are used. Another medication, mirabegron (Myrbetriq), increases the bladder’s capacity to hold more urine, but it can affect blood pressure.
Other treatments for urge UI include Botox injections and “bladder pacemakers,” in which a nerve stimulator sends electrical impulses via wires to the sacral nerve in the lower back.
For stress UI, there are no medications. Surgical treatments include injecting a bulking agent that strengthens the urethra (the tube through which urine is emptied from the bladder) and inserting a sling that supports the urethra. However, before you can get treatment for UI, you have to stop hiding it. If you have UI, talk to your primary care doctor and discuss what you can do to treat it, and whether you need testing or you should see a specialist.”
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