Understanding urinary incontinence in women

You don’t need to be ashamed of urinary incontinence. It’s more common than you might think and can be very treatable. Because of embarrassment, incontinence is often underreported to medical professionals. However, it’s estimated that at least one in three women experience bladder leakage, with some research saying the percentage is much higher. Though incontinence is extremely common, it’s not considered normal or healthy by doctors and it doesn’t have to be part of your life just because you are getting older.

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Types of urinary incontinence

“There are many different types of urinary incontinence,” says Philip Hoekstra, MD, Chief of Spectrum Health Medical Group, Division of Urology, and Associate Clinical Professor of Surgery at Michigan State University. “For younger women, the most common is Stress Urinary Incontinence (incontinence associated with activities like coughing/sneezing, laughing, lifting and exercising). Urge incontinence is loss of urine when feeling an uncontrollable urge to urinate. This is due to the bladder’s contracting too forcefully at inappropriate times. Insensible incontinence occurs spontaneously, without warning. Total incontinence refers to complete inability to resist the passage of urine. This may be the result of injury, radiation therapy, neurological disease, complications from diabetes, or dramatic estrogen deficiency states.”

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Incontinence testing

Diagnosing the cause of incontinence is essential for proper treatment. Your first step is to contact your primary care physician who may refer you to a specialist, such as a urologist or urogynecologist.

“Taking a detailed history, including onset, duration, associated factors, caffeine use, and fluid intake, is the foundation,” Hoekstra notes. “A pelvic exam is essential to assess anatomy, particularly of concern is the loss of structural support to the urethra (the urine passageway from the bladder) and other pelvic organs. Finally, the fundamental test done to assess bladder function is called a urodynamic study, or cystometrogram. This test measures the ability of the bladder to store urine and empty completely, and coordination of the sphincter (the ‘control valve’ muscle) for both storing and emptying. The urodynamic study is a simple, in-office test,” explains Hoekstra.

“A urodynamic study is used to learn how it fills, stores and releases urine,” says Lisa N. Hawes, MD, urologist with Chesapeake Urology Associates in the Baltimore area. “A small catheter is used to fill the bladder with liquid, and then the health care provider takes measurements of the bladder’s function, either by observation or with sophisticated imaging equipment.”

Another test that your doctor may facilitate is a cystoscopy. “A cystoscopy is a way to look inside the bladder by inserting a small scope through the urethra to make certain there is no serious pathology in the bladder like cancer. Both these studies are minimally uncomfortable and take only a few minutes,” explains Hawes.

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Lifestyle changes

Before dispensing medication or scheduling any surgery, your doctor should talk to you about lifestyle changes that can help manage your incontinence issues.

“In general, avoiding fluids that can have an irritating affect on the bladder (caffeine, spicy foods, acidic foods, alcohol and fruits high in citrus content, for example) might help some conditions resulting in leakage,” says Gary E. Lemack, MD, professor of Urology and Neurology at University of Texas Southwestern Medical Center. “Timed voiding (emptying every hour or two) will help keep the bladder empty and prevent some leakage episodes. Lastly, practicing pelvic floor exercises, which many women may have learned around the time of pregnancies, may help as well.”

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Medical treatments

Lemack explains there are a number of medical treatment options for urinary incontinence including pelvic floor muscle training, oral medications, urethral injections for stress incontinence (leakage with physical activities) and surgery, typically a “sling” procedure, for stress incontinence.

Michael Feloney, MD, of The University of Nebraska Medical Center in Omaha also describes various treatments including oral pharmacologic solutions — drugs such as fesoteridine (Toviaz), solfenacin (Vesicare), trospium chloride (Sanctura XR), darifenacin (Enabelex), oxybutinin (ditropan XL) and tolteridne (Detrol LA).

Feloney also utililizes sacral neuromodulation (nerve stimulation) with the implantation of a bladder pacemaker (Interstim). Feloney says this surgery is typically performed as a staged procedure beginning with a test prior to implantation of the permanent battery under the skin. You can view a short video of Feloney below describing the device.

With the number of treatment options available, you can make urinary incontinence part of your past. Don’t be ashamed about bladder leakage. Manage it with the use of pads (such as Poise) along with the aforementioned lifestyle changes while seeking medical advice and treatment.

More about incontinence

Understanding urinary incontinence
Bladder control surgery
Managing menopause: Incontinence


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