Tips and Tools for Managing Urinary Incontinence

Is the women’s restroom one of the first things you look for when you go somewhere? If so, you have plenty of company. Urinary incontinence (UI, or urine leakage) is very common among women in America: According to one study, almost 62 percent of adult women reported having UI, and 32 percent reported having UI at least monthly (Female Pelvic Medicine & Reconstructive Surgery, April 2022). However, previous surveys have found that the majority of women who have UI have 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. “Some women wait for years to mention it to to their doctors, and some women never report it.”

You Need to Speak Up

It is important to tell your doctor if you are experiencing UI for several reasons.

“UI is associated with depression and anxiety. Also, many women become more isolated and less socially active because they are afraid they will be embarrassed in public,” says Dr. Chughtai. UI can also take a toll on a woman’s physical, sexual, and emotional health, and many women report a poorer quality of life.

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, such as urinary tract or bladder infections or bladder cancer. In short, if you have frequent and/or persistent UI, it’s wise to have a medical evaluation to establish the cause.

If you just can’t bring it up with your doctor, instead, mention it to your doctor’s nurse or assistant, who will relay the information; then, your doctor can initiate the conversation.

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 a strong, sudden need to urinate.

Start with Kegels

Treating UI usually begins with exercises and behavioral changes.

“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 and continue to do them daily,” 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 to make sure you’re doing Kegel exercises correctly, there are physical therapists who specialize in pelvic floor muscles. Typically, your physician would refer you to this type of therapist.

Eating, Drinking, and Timing

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 may trigger urge UI are chocolate, artificial sweeteners, carbonated drinks, and spicy foods.

Another strategy that can help is to cut back on beverages.

“The bladder only holds one-and-ahalf 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 reduce your fluid intake,” explains Dr. Chughtai. However, he notes that if your doctor has recommended a high fluid intake, you should check with him or her before cutting back.

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 or walking.”

Other Treatment

Options Another 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. A pessary must be fitted, and follow-up is needed to make sure the device fits correctly and is not causing irritation or pressure sores in the vagina.

If these strategies aren’t effective, consult with a urologist. Several medications are available for treating urge UI. Other treatments for urge UI include Botox injections and devices that stimulate nerves involved in regulating bladder activity.

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