Address Urinary Incontinence to Restore Your Quality of Life

Urinary incontinence (UI) is very common among postmenopausal women: According to a national poll, more than onethird of women in their 50s and early 60s had experienced urine leakage (incontinence), and more than half 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.

UI Impacts Quality of Life

“It takes an average of seven years for women to talk to their doctors about UI symptoms. For some women, UI is a very sensitive topic,” says Bilal Chughtai, MD, a urologist at Weill Cornell Medicine. However, it is important to tell your doctor if you are experiencing urine leakage for several reasons.

“UI is associated with depression and anxiety. Also, many women become more isolated and less active because they are afraid they will be embarrassed in public,” says Dr. Chughtai. UI also puts you at higher risk of a urinary tract infection. If you have frequent urine leakage, you may develop a rash or sores in your genital area. And sometimes, UI is a sign of a more serious underlying problem (see What You Should Know for more information).

Types of UI

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.

Risk factors for stress UI include obesity, smoking, and vaginal childbirth. Older age and obesity are risk factors for urge UI. This type of UI also can be caused by other medical conditions, such as stroke, diabetes, Parkinson’s disease, and Alzheimer’s disease.

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. He recommends Kegel exercises, which strengthen the muscles in the pelvic floor and help prevent or reduce leakage, for all types of UI.

“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,” advises Dr. Chughtai. “A Kegel exercise consists of contracting (squeezing) the muscles for several seconds and then relaxing them. Do these exercises every day; you have to do them regularly to get results.”

Dietary changes that can reduce urge UI include avoiding foods and beverages that may act as irritants, such as caffeine, alcohol, acidic foods, chocolate, artificial sweeteners, and carbonated drinks.

Dr. Chughtai also recommends checking the amount of fluids you are consuming. If you are drinking several cups of coffee or tea along with several servings of other liquids, cutting back on fluid intake will probably help. (If your doctor has instructed you to consume a lot of fluids, check with him or her before changing your fluid intake.)

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.”

Medications and Procedures

For urge UI, anticholinergic medications are sometimes used to reduce contractions in the bladder. These medications include tolterodine (Detrol), oxybutynin (Ditropan), darifenacin (Enablex), solifenacin (Vesicare), and fesoterodine (Toviaz). However, taking these medications has been linked with a higher risk of dementia, as well as problematic side effects—drowsiness, blurred vision, dizziness, confusion, and an increased risk of falls and fractures, especially in older adults—so many doctors are prescribing these drugs less often than they once did. Another medication, mirabegron (Myrbetriq), increases the bladder’s capacity to hold more urine.

Other treatments for urge UI include Botox injections and “bladder pacemakers,” in which an implanted nerve stimulator sends electrical impulses via wires to the sacral nerve in the lower back.

Another treatment option, percutaneous tibial nerve stimulation (PTNS), involves inserting a small needle into the lower leg and stimulating the tibial nerve, which sends signals to the bladder and pelvic floor muscles.

For stress UI, there are no FDAapproved medications. Surgical treatments include injecting a bulking agent that strengthens the urethra (the tube through which urine is emptied from the bladder) or inserting a sling that supports the urethra.

Finally, if you have frequent urine leakage that doesn’t improve with treatment, you need to notify your healthcare provider. If you’re uncomfortable broaching the subject with your physician, mention it to your physician’s nurse or physician assistant, who will relay the information to your physician. Or consider if you would feel more at ease talking to a urologist, who specializes in this type of disorder. Also keep in mind that there’s no need to feel embarrassed: Talking about UI is the only way to alleviate the problem and restore your quality of life.

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