If you’ve ever dreaded laughing at a good joke or sneezing for fear of an “oops” moment, then you know what it’s like to live with urinary incontinence. You may be hanging back from doing things you love, worried you can’t get to a bathroom and embarrassed about leakage you can’t control.
Here’s a start to learning more about the condition — its causes and treatments — so you can see that it’s possible to get back to living your best life.
Incontinence is more common than you think.
An estimated 15 to 25 million Americans deal with incontinence. But it’s hard to put a firm number on it because so many people are too embarrassed to talk about it.
We do know women are two times more likely than men to develop urinary incontinence — and that physiology plays a part. The structure of a woman’s internal organs, pregnancy, childbirth and menopause all have an effect. Aging does too because pelvic floor muscles that support the urinary tract muscles weaken as you age, making it harder to hold in urine — though it’s not necessarily a normal part of getting older.
There are different types of incontinence.
The most common types of incontinence in women are stress incontinence, urge incontinence, and a mix of the two.
Stress Incontinence
Stress incontinence makes having fun unpredictable. Things like laughing, dancing and exercise put pressure on your bladder, causing uncontrollable leakage. You don’t feel an urge to urinate; it just happens. Weak pelvic floor muscles or the bladder out of its normal position are usually the culprits.
Urge Incontinence
A “gotta go” feeling you can’t ignore is urge incontinence, or overactive bladder (OAB). OAB can happen when certain nerves and bladder muscles don’t work together. Your brain tells your body you need to go to the bathroom, even if your bladder isn’t full. That signals the bladder muscle to contract, and the sphincter — the muscle that controls urine flow — relaxes.
The urge comes on suddenly, even if you’ve recently emptied your bladder, and you may not make it to the bathroom. Some people have a frequent urge to go — up to eight times a day — and then barely go when they get to the bathroom.
Mixed Incontinence
Having more than one type of incontinence isn’t uncommon. If you do, stress and urge incontinence are usually the two that combine and lead to leakage.
You don’t have to live with it
Too many people stay silent about incontinence, assuming events like pregnancy, childbirth and aging make it an inevitable part of life you have to get used to. Not true. It’s very treatable, and often with self-help methods you can do it yourself.
Lifestyle Changes
For some people, reducing the risk of leakage is as simple as making lifestyle changes, such as:
- Avoiding lifting heavy objects
- Avoiding liquids in the evening
- Limiting caffeine and alcohol, which make you produce more urine
- Losing weight to relieve pressure on the bladder
Kegel Exercises
Weak pelvic floor muscles — those that support the bladder — are often at the root of leakage problems. Kegel exercises involve strengthening the muscles that control urine flow by tightening and relaxing them. Doctors often recommend women do Kegels during pregnancy to prevent incontinency problems. You can work with a physical therapist to learn how to do Kegels effectively.
Bladder Retraining
Timing is everything when it comes to staying dry. Finding the sweet spot takes practice. It may involve making sure your bladder is empty to prevent the urge to go. Make a pit stop every two hours if you know the urge to go hits every 2 ½.
But you may have to retrain your bladder if the urge to go too often is a problem. That involves gradually extending the time between bathroom visits. For instance, if you go to the bathroom every hour, stretch it to an hour and 15 minutes, increasing the time over a few weeks.
Medications, Devices or Medical Procedures
If self-help approaches don’t help, your provider may suggest other options, such as:
- Medications that can help relax bladder muscles or block nerve signals that cause an urge to go
- Vaginal inserts available over the counter can be used to reduce stress incontinence
- A pessary, a ring-like device your doctor fits you for to support pelvic floor muscles and reduce stress incontinence
- Injections of a bulking agent in tissues around the bladder to help keep the opening closed and prevent leaks
- Pelvic floor stimulation to nerves and muscles to strengthen them and to reduce the urge to go
- A sling is a small piece of synthetic material surgically placed to support the urethra to improve leaking from stress incontinence
Incontinence doesn’t have to control your life. Yes, it can feel awkward to talk with your doctor about bathroom habits. But incontinence is a very treatable condition. A full evaluation with a pelvic medicine and reconstructive surgeon can help you determine the best treatment for you. Asking for help can get you back to a life free of worries about leakage.
Aparna Ramaseshan, MD, is a Female Pelvic Medicine and Reconstructive Surgeon (FPMRS), at the Women’s Center for Pelvic Health. To make an appointment, call 443-481-1199.
