You experience a little uncontrollable leak when you laugh. Or maybe it’s more of a sudden urge and a mad dash—in vain—to the bathroom. There are several forms of urinary incontinence, or the involuntary loss of urine, and many treatment options, but not every treatment is appropriate for every patient.
Many women are too embarrassed to speak about their incontinence with their doctors. But without help, the problem will only continue. Your best bet? Work with your doctor in pinpointing a cause and coming up with a solution that best fits your lifestyle.
Are you at risk?
An estimated one-third of women age 70 and older suffer from urinary incontinence. The disorder occurs when muscles and nerves that help you either hold or pass urine are weakened or damaged and can no longer do their job. Women are twice as likely as men to experience incontinence, a statistic that can be attributed to conditions such as:
• Menopause, when estrogen loss can damage tissue in the urine-transporting tube (urethra).
• Pregnancy and childbirth, which can damage pelvic floor muscles and lead to incontinence.
Other possible factors that can cause either temporary or long-term incontinence are constipation, smoking, medication such as water pills (diuretics) and hormone replacement, caffeine, urinary tract and bladder infections, obesity, immobility, nerve disorders, and changes to the body resulting from aging. Surgery in the pelvic area can also increase leakage risk.
What’s your type?
Determining exactly what kind of incontinence you have can help doctors recommend the most appropriate, effective treatment. Do any of the following sound familiar?
Stress incontinence is the most common type of incontinence in women. You laugh, you sneeze, you cough—any one of these is enough to trigger leakage. You may also find that exercise or lifting heavy objects can trigger leakage, too. Previous vaginal births, menopause, and weight gain are common causes.
Urge incontinence is characterized by a sudden, overwhelming urge to urinate, followed by leakage if you can’t make it to a toilet in time. Urge incontinence can be triggered by acts as simple as drinking a beverage, putting a key in the door when you arrive home, or hearing the sound of running water. It’s also the type of incontinence that wakes you up more than once at night to use the bathroom, a symptom called nocturia. Urgency may be accompanied by frequent urination (more than eight times in 24 hours), sometimes referred to as overactive bladder.
Overflow incontinence occurs when the bladder doesn’t empty completely and leaks urine. It’s more common in men than it is in women.
Mixed incontinence is the combination of two or more types of incontinence. Typically, stress and urge incontinence occur together.
Functional incontinence can affect women with certain physical and cognitive restrictions, such as having to use a wheelchair or having Alzheimer’s. Getting to the toilet or even being able to recognize that a bathroom trip is needed is difficult.
Treatment for incontinence usually starts with more conservative measures, such as the following behavioral and lifestyle changes, before moving on to drugs and more invasive treatments:
• Drinking less, or avoiding consumption of large amounts of fluid at one time, may help reduce leakage in those with stress or urge incontinence. If you have nocturia, try to stop drinking three or four hours before bedtime. Just don’t cut back too much (you need about eight cups of fluid a day) or you may find yourself dehydrated or constipated. Being constipated can worsen incontinence. Consume 20 to 30 grams of fiber daily to keep things regular.
• Performing Kegel exercises, which focus on squeezing and relaxing the pelvic floor muscles, can help with stress incontinence. However, Kegel exercises will yield effective results only if done properly, making it important to seek initial instruction from a medical professional who can help you properly target the muscles you need to strengthen.
• Avoiding potential bladder irritants, such as caffeine, alcohol, spicy foods, tomatoes and tomato-based products, and artificial sweeteners may help some people with urge incontinence.
• Training the bladder, which involves urinating at certain intervals, perhaps once every hour, before an urge materializes in those with urge incontinence. (This learned habit is called timed voiding.) From there, you can increase the time between bathroom breaks to help increase bladder capacity, aiming for bathroom breaks on a more normal schedule, or every three to four hours. When an urge strikes, use diversionary tactics, such as performing Kegels or standing still.
• Completely emptying your bladder each time you use the bathroom. One way to do this is by “double voiding”: After you relieve yourself, stand up or shift position. After about a minute, urinate again to rid your bladder of residual urine.
• Losing excess weight can relieve your bladder and muscles of added pressure if you have stress or urge incontinence; talk with your doctor about starting an exercise and diet regimen.
• Quitting smoking could have a positive impact on incontinence, although the “why” isn’t quite clear. Research has shown that smokers seem to have more frequent and severe leakage.
Taking care of underlying medical conditions you may have, such as high blood sugar, can help relieve incontinence. A study appearing in June 2013 in the journal BJOG, for example, associated urge incontinence in women ages 75 to 85 with more severe limitations with balance and gait when compared with women who didn’t have urge incontinence—and their limitations worsened as incontinence increased in severity.
This link is likely because women with impaired mobility take longer to reach the bathroom, increasing their risk of leakage. Researchers hope that improving walking ability and balance may reduce urge incontinence symptoms. Separate research has already shown that improvement in activities of daily living could result in remission of urge symptoms.
If lifestyle measures alone don’t help, a number of medical treatments and procedures can aid in bladder control.
Drug therapy. Urge incontinence and overactive bladder can sometimes be managed with drugs—best used in conjunction with bladder training. The most effective of these medications are a group of drugs classified as anticholinergics. They include tolterodine (Detrol, Detrol LA), oxybutynin (Ditropan XL), solifenacin (VESIcare), fesoterodine (Toviaz), trospium (Sanctura), and darifenacin (Enablex). The Food and Drug Administration recently approved an over-the-counter form of oxybutynin (Oxytrol for Women), which is available as a skin patch that’s applied twice a week.
Anticholinergics can relax bladder muscles and prevent bladder spasms that trigger urge incontinence. But researchers have raised concern about drugs with anticholinergic properties.
Research published in the April 2013 issue of Aging Health found that some anticholinergics could increase the risk of problems with memory and other cognitive tasks in older people. The study found that even small amounts of these medications could contribute to cognitive problems in older people—perhaps because of the traditional reasons for drug reactions in this age group (such as reduced ability of the body to absorb or remove the drug from the system). Of the anticholinergics used for incontinence, tolterodine and oxybutynin were found to have high and moderate accumulation in the body, respectively.
A separate study published in the July 2013 issue of Alzheimer’s & Dementia found that the risk of memory and cognitive problems could be doubled in as few as 60 to 90 days after starting a treatment regimen, depending on the drug.
Other potential side effects of anticholinergics include dry mouth, constipation, heartburn, and blurry vision. If you use anticholinergics, speak with your doctor about the risk of adverse effects. If you’re bothered by side effects, or if one type of anticholinergic isn’t working, your doctor can switch you to a drug that may be more effective for you.
A vaginal pessary. A pessary is a flexible silicone ring that a doctor inserts into the vagina. The device presses up against pelvic organs, repositioning the urethra to reduce stress leakage. Typically, you’ll need to visit your doctor every three to six months to have the pessary removed and cleaned to prevent infection, but some women feel comfortable enough to remove and reinsert the pessary on their own.
Nerve stimulation. Nerve, or electronic, stimulation involves the painless application of electrical current to help strengthen pelvic floor muscles and improve the timing of muscle contractions to activate in time to stop a leak. All the different types of nerve stimulation are typically reserved for women with urge incontinence who don’t respond to standard treatments.
Biofeedback. Biofeedback is a training technique for stress and urge incontinence that helps you learn to control your bladder and urethral muscles. It’s usually combined with Kegel exercises, bladder training, or nerve stimulation.
Surgery. Surgery is used after a definitive cause for stress incontinence is found and other treatment methods have failed. A variety of procedures can be used, depending on the cause of leakage. Common surgeries include several types of vaginal suspension and sling procedures (often the top choice for stress incontinence) to help support pelvic structure, injections of bulking agents such as collagen to thicken the urethral area and help control urine leakage, and anterior vaginal repair to treat a bladder that’s bulging into the vagina.
Leakage may still happen, even with treatment efforts. In these cases, you’ll need a way to cope with these incidents. A wide array of products is available, from absorbent pads and protective undergarments to more specialized products, such as urethral caps and foam pads that fit between the labia. You can ask your provider for recommendations, although many aren’t covered by insurance.