Urinary incontinence is not a condition to be ignored or suffered in silence, especially for women. It can be annoying and embarrassing—and it can also be a sign of underlying medical problems.
It can interfere with sleep and daily life. In older women, it can increase the risk of falling, as it forces them to rush to the bathroom.
Approximately 15 percent of women will deal with the involuntary loss of urine at some point in their life. Fortunately, for many of them the treatment or adjustment is minor and the cause is easily identifiable.
Women should never feel afraid or embarrassed to discuss this sensitive problem with a doctor, who can rule out medical issues and help them get the relief they need.
Classification and cause
The first step is to understand that not all incontinence is the same. Many people don’t realize there are four different types of incontinence:
- Stress incontinence is characterized by a loss of urine with increased abdominal pressure caused by laughing, sneezing or exercising.
- Urge incontinence is less common. It’s presented with a sudden and strong urge to urinate, leaving no time to get to the toilet.
- Overflow incontinence is when there is constant dribbling because the bladder never gets emptied all the way.
- Functional incontinence occurs when there is a mental or physical barrier to getting to the toilet, such as severe rheumatoid arthritis, resulting in an inability to get the pants unbuttoned in a timely manner.
There are many causes of incontinence, but some of them are only temporary. Among them are bladder infections, chronic constipation and certain medications. Excessive caffeine and acidic or spicy foods are also sometimes to blame.
Pregnancy can cause urine loss as well, because of the pressure it places on the bladder. Child birth can cause the same issues from stretching and pressure on bladder nerves and pelvic damage.
Age is yet another cause. As you age, your bladder may be unable to hold as much urine over time. Menopause can also lead to weakening of the tissues due to low estrogen in the vagina, which leads to incontinence.
A polyp can cause urinary incontinence if it creates a blockage that keeps urine from passing through.
Neurological disorders such as multiple sclerosis and Parkinson’s disease are also known to cause incontinence issues.
Although there are a variety of reasons you may experience urinary incontinence, you should never ignore your symptoms if you suffer from this condition.
Left untreated, more serious conditions could result, such as kidney infection, skin irritation and limitations of physical activity or intimacy.
You may find the topic difficult to discuss with your doctor, physician assistant or nurse practitioner, but it’s certainly the first step in getting help.
Your medical professional can help start the process of evaluation and then refer you to Spectrum Health’s urogynecology office, where Elizabeth Leary, MD, and her experienced team can provide a multidisciplinary approach to relieve urinary incontinence.
They offer basic evaluation, such as performing a urine test to look for infection, and they’ll aim to determine all causes of incontinence before looking at treatment options.
Some testing options may involve keeping a bladder diary and performing a quick insertion of a catheter in the office to ensure the bladder can empty completely.
More detailed testing would require use of a camera to look in the bladder to confirm there aren’t any polyps or bladder cancer. Urodynamic testing may also be performed to determine the capacity of the bladder and to see if there are bladder spasms occurring.
The type of treatment will typically depend on the cause of the leakage.
Some patients will require simple bladder retraining and scheduled toilet times, while others may need surgery, although this is often the last option after other courses have been tried.
If constipation or a bladder infection are the culprits, your medical professional will help treat these issues.
You may be asked to do pelvic floor exercises, known as Kegel exercises, and physical therapy with a trained physical therapist.
Kegel exercises are the sequential tightening of the pelvic floor muscles. The best way to describe it: There is a ball in your vagina and you are trying to raise it to your chest, kind of like lifting weights.
A word of warning: Never do these on the toilet, as it may confuse your bladder!
If you can do Kegel exercises 10 times per day—practice until you can “hold the ball up” for 10 seconds—you will greatly reduce leaking.
Medications for urge incontinence can also be helpful. Intravagina support from a tampon or Impressa, a new product to help prevent leaks, can be helpful for activities like shopping, gardening or exercising.
Other remedies include pessaries, a removable device placed into the vagina, or an injection of Botox in the bladder. Surgery may be necessary to repair prolapse—parts falling out—or to address loss of tissue support around the bladder neck, as seen in stress incontinence.
On the other end of the spectrum, some women suffer from having pelvic floor muscles that are too tight. If you suffer from this issue, pelvic relaxation exercises are the best solution. Your medical professional can also help with this.
Here’s the bottom line: Do not be embarrassed if you are suffering from urinary incontinence.
See your doctor if leaking is a problem for you.