Try Self-Help Strategies to Reduce Urine Leakage

Urinary incontinence (UI) is very common among postmenopausal women: According to a national poll, 43 percent of women in their 50s and early 60s had experienced urine leakage (incontinence), while 51 percent of the women over age 65 sometimes had leakage. However, two-thirds of the women who had urine leakage had not discussed it with their doctors.

“Many women don’t report UI to their doctors because they aren’t comfortable talking about it,” says Bilal Chughtai, MD, a urologist at Weill Cornell Medicine. “It takes some women several years after UI symptoms begin to talk to their doctors about it—and some never report it.”

There are three main varieties of UI: stress incontinence, urge incontinence, and mixed, which is a combination of both stress and urge types. 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.

Lifestyle Strategies

Treating UI usually begins with exercises and behavioral changes. “These options are safe, and they are very effective for many women,” notes Dr. Chughtai.

“The first thing I recommend for all types of UI are Kegel exercises, which strengthen the muscles in the pelvic floor and help prevent or reduce leakage. A Kegel exercise consists of contracting (squeezing) the muscles for several seconds and then relaxing them. To get results, you have to do these exercises every day,” advises Dr. Chughtai. “To identify the pelvic floor 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.”

If you’d like a healthcare professional to help you learn to do Kegel exercises correctly, there are physical therapists who specialize in pelvic floor muscles. Typically, your physician would refer you to this type of therapist.

Dietary Factors

Behavioral changes that can reduce urge UI include avoiding foods and beverages that may act as irritants, such as caffeine, alcohol, and acidic foods. Other items that may trigger urge UI are chocolate, artificial sweeteners, carbonated drinks, and spicy foods.

“Also, check the amount of fluid you are consuming,” says Dr. Chughtai. “The bladder only holds one-and-a-half to two cups of fluid, so if you are drinking several cups of coffee or tea along with several glasses of other liquids, you may need to drink less.”

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. “Another strategy is prompted voiding, such as urinating prior to exercise.”

Treatment Options

If lifestyle strategies aren’t effective, you’ll need to discuss treatment options with your doctor.

A noninvasive option for stress UI is a device called a pessary. A pessary is placed inside the vagina; it provides support to vaginal tissues as well as the urethra. Pessaries come in different sizes and styles and are also used for uterine prolapse and other pelvic conditions. A pessary must be fitted, and follow-up is needed to make sure the device fits correctly.

For urge UI, the medications tolterodine (Detrol), darifenacin (Enablex), and solifenacin (Vesicare) can help reduce contractions in the bladder. And there are two beta-3 agonist drugs, mirabegron (Myrbetriq) and vibegron (Gemtesa), that affect specific bladder muscles so the bladder is able to hold more urine.

Other treatments for urge UI include Botox injections and sacral nerve modulators, in which a device that is surgically implanted under the skin of the lower back sends electrical impulses to the nerves that regulate bladder activity.

“For stress UI, there’s a new bulking agent called Bulkamid that was approved by the FDA last year,” says Dr. Chughtai. “It’s like a filler for wrinkles; it builds cushions in the tissues in the urethra, which helps the urethra stay closed.”

Talk to Your Doctor

Although it may be difficult to talk about urine leakage, if it has a negative effect on your quality of life, you need to speak up.

“Women with UI are more likely to suffer from depression and/or anxiety. And many women limit their physical and social activities, which can have a negative effect on a woman’s overall physical, mental, and emotional health,” says Dr. Chughtai.

In addition, frequent and/or persistent urine leakage is a possible symptom of urinary tract infections and, in rare cases, bladder cancer, so it’s wise to have a medical evaluation to establish the cause.

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