What Is Urinary Incontinence?
Learn the tips doctors share with their patients who suffer from urinary incontinence.
Sanaz Majd, MD
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What Is Urinary Incontinence?
Imagine this: You are leading a large business meeting where you have to deliver an important speech. You drank a cup of coffee in the morning to wake yourself up, and right before your meeting, you feel the urge to go. As you run to the ladies room (caffeine is a diuretic), you lose it. You were almost there. But your bladder couldn’t make it. And now you have urine running down your entire leg, soiling the new suit you purchased for today’s special occasion. If you run home now to change, you’ll be late for your meeting. What to do?
Women describe situations like that to me in the doctor’s office too often–and not only postmenopausal women, but young, healthy women too. Most women with this problem have had previous pregnancies and deliveries. Carrying and delivering a baby can be tough on our bodies, and can permanently change our pelvic anatomies.
What is Urinary Incontinence?
Involuntary leakage of urine is called urinary incontinence. Some women may leak urine on their way to the bathroom, and others may leak with coughing, sneezing, or laughing. Many admit that they wear a feminine pad on a daily basis “just in case.”
Women are reluctant to discuss this topic with their doctor because they may feel embarrassed. But it is very prevalent, and because it affects day-to-day activities, it can greatly diminish the sufferer’s quality of life. It also affects women’s self-esteem, their careers, and sexual functioning, and can even cause depression.
What Are the Different Types of Urinary Incontinence?
Believe it or not, there are various forms of urine incontinence in medicine — categorized based on the cause of each.
Urge incontinence: Those with urge incontinence report a sense of great urgency when needing to void. These are my patients who typically lose it before making it to the bathroom. With urge incontinence, the bladder muscles contract and are therefore termed “overactive,” squeezing the urine out of the bladder, into the urethra, and then out of the body.
Stress incontinence: A simple cough, sneeze, laugh, or other exertion can trigger urine leakage in those with stress incontinence. Exertion causes increased pressure on the abdomen, which then presses on the bladder and pushes open the sphincter, a “doorway” that allows the urine to leak out. This type is most common in women with prior pregnancies. And when the stress incontinence is severe enough, even very light levels of activity can trigger it.
Mixed incontinence: The most common of the three types of incontinence is a mixture of the two types already mentioned. These unlucky ladies have both overactive bladders and a leaky sphincter.
Overflow incontinence: A less common cause of urine leakage, this happens with the bladder isn’t able to empty completely. And once it gets full, it releases urine.
Pelvic organ prolapse: In women with a history of multiple pregnancies (although it can occur in those with a single pregnancy history as well), organs of the pelvis may hang loose and lower due to weakened pelvic muscles.
How to Treat Urinary Incontinence
If you suffer from urinary incontinence, you have a few treatment options:
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Avoid diuretics: Avoid caffeine and alcohol, which are both diuretics that cause you to urinate more.
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Restrict fluid intake: Drink no more than two liters of fluid daily, and don’t drink within two hours of sleep if nighttime urination is an issue, a medical symptom referred to as “nocturia.”
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Schedule powder room visits: Schedule powder room visits every two hours, whether or not you feel the need to void.
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Review your medications: Review your medication list with your doctor, as some over-the-counter and prescribed medicines can worsen incontinence.
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Get lab tests: See your doctor, who will likely order a urine and blood test to check your kidney function, check for urinary tract infections, and check for diabetes, which can affect urinary symptoms.
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Do Kegel exercises: Kegel exercises are pelvic muscle strengthening exercises performed in three sets of eight to twelve slow contractions that last eight seconds, and they should be performed multiple times a day for at least twenty weeks. For more information, see this link.
- Lose weight: Several studies have shown that losing weight can improve stress incontinence. And though we are not certain about its effects on the other types of incontinence, I don’t see how it could hurt!
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Try medication: Several medications, including oxybutinin and tolteradine, can improve urinary symptoms. They are prescribed at a small dose and you’re then re-evaluated every four weeks, as the meds can take that long to start working well. Some of the most common side effects I hear from my patients are constipation, dry mouth, and drowsiness.
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Get a pessary: In those with stress incontinence or pelvic organ prolapse, a small device called a pessary can be sized and inserted by a gynecologist to keep the organs in place. It’s a very popular option for many women, and it’s generally considered very safe.
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Try neurologic stimulation: Performed by a uro-gynecologist, a device with probes can be inserted and used to stimulate the pelvic muscles. You can think of it as almost a type of physical therapy performed on the pelvis.
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Get surgery: As a last resort, several procedures are effective in improving urinary incontinence, including what’s called a “sling” procedure in which a sling is literally inserted around the urethra to give it extra support.
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Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.
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