No woman wants to be caught too far from a bathroom, especially when the ability to hold your bladder is a struggle. But if it gets to the point where the thought of coughing or laughing leads to leakage anxiety, or you have to wear pads due to wetting your panties, well, it’s natural to have a few concerns.
Unfortunately, urinary incontinence is yet another health condition that affects more women than men: 25-45% of women aged 30 to 60 years, and 7-39% of women aged 20 to 30 years suffer from the condition. It can be a very embarrassing issue that can affect your self-esteem, confidence and quality of life.
Fortunately, for many women a few adjustments in diet and some exercises will significantly decrease minor incontinence problems.
Even though bladder concerns are an embarrassing issue, don’t be afraid to reach out for help, because, thankfully, there are a range of different treatments that can remedy the problem. So let’s have a grown-up talk about your options.
Types of Urinary Incontinence
There are two main types of urinary incontinence in women — stress urinary incontinence and overactive bladder, also known as urgency incontinence. Many women can experience both types at the same time.
Stress incontinence is characterized by urine leakage due to pressure, coughing, sneezing, laughing or physical activity. This is triggered by physical changes to the pelvic region and weakening of the supporting muscles or weakening of the urethra wall.
Overactive bladder is a strong desire or urgency to urinate that may result in unexpected urination or leakage of urine. This urgency is often triggered by involuntary bladder spasms that occur due to abnormal nerve signals to the bladder from the brain.
Causes of Urinary Incontinence
There are a range of causes in women, including:
- Urinary tract development problems from childhood
- Genetics: If other female family members have it, you’re more likely to
- Ethnicity: Caucasian women are more afflicted than other ethnicities
- Childbirth and/or pregnancy can damage the muscles and nerves that control urination
- Menopause: There is a reduction in hormones that keep the urethra and bladder lining strong and healthy
- Pelvic organ prolapse: The bladder, bowel or uterus sag and shift from their normal positions
- Neurological problems
- Lack of exercise
- Overweight or obesity
- Older age
For a diagnosis, you can visit your general practitioner, gynecologist, urologist or a urogynecologist. They will take your medical history, conduct a full physical examination, which includes a pelvic and rectal exam, and will order a range of diagnostic tests such as a urinalysis (standard urine test), urine culture (to test for urinary tract infection), blood test (to assess kidney function or chemical imbalances) and urodynamic testing (to determine bladder flow, capacity and function).
Once they diagnose the issue, they will may prescribe one in a range of medications.
Exercises and Minor Lifestyle Adjustments
If you want to avoid taking meds to deal with incontinence, lifestyle changes are a good place to start and include:
- Limit bladder irritants — coffee, tea, carbonated beverages, alcohol, tomatoes, spices, chocolate, citrus and high-acid foods
- Limit water at least 3 hours before bed
- Lose weight
- Treat constipation
- Engage in bladder training, using distraction/deep breathing techniques to help retrain nerve signals and suppress urgency sensations; or retraining of the bladder with scheduled visits to the toilet.
The pelvic floor muscles support the uterus, bladder and bowel in women. And according to research, strengthening these muscles via Kegel exercises is one of the best ways to regain control.
You don’t need any special equipment to perform Kegel exercises. And the best news is, you can perform them anytime — at work, on the train, or in line at the supermarket — because no one will ever know.
To perform the exercises, imagine you’re urinating and want to stop the flow; you squeeze your internal muscle up tight to stop mid-flow.
You’re simply contracting and relaxing the muscles that control urination, in order to strengthen them, and can perform the the exercises while lying down, sitting at a desk or standing up. The contractions should be performed several times per day for at least a few months to see if they have any effect.
Here’s a short video that explains how to do the exercises in more detail.
It can be difficult for some women to contract the pelvic floor muscles, so vaginal cones are often used. A vaginal cone is a small medical device that’s inserted into the vagina like a tampon. The device acts as an internal weight-training tool for you to squeeze around. As your pelvic floor muscles become stronger, you can increase the weight of the vaginal cone to strengthen the muscles even further.
If leakage continues to be bothersome, you may prefer to use a urethral insert, which is a tampon-like disposable device. It’s inserted into the vagina to prevent leakage and removed when you need to urinate. Another option is a pessary, a ringed device that presses against the urethra to decrease leakage.
Some electrotherapies such as electroacupuncture and electro current to the pelvic floor muscles show improvement in some women.
If your problem is overactive bladder, a medical professional will likely prescribe you anticholinergic/antispasmodic medications such as Ditropan XL (oxybutynin), Detrol (tolterodine), Enablex (darifenacin), VESIcare (solifenacin), Sanctura (trospium) and Toviaz (fesoterodine). The most common side effects of these are dry mouth, blurred vision, constipation, nausea, dizziness, drowsiness and joint pain — none of which are pleasant.
For stress incontinence, you may be prescribed a tricyclic antidepressant such as Tofranil (imipramine) and Elavil (amitriptyline); or selective serotonin reuptake inhibitors (SSRIs) such as Cymbalta (duloxetine). Antidepressants come with some nasty side effects, from constipation to vomiting, weight changes and decreased sex drive.
Alpha-adrenergic agonists are another prescription option and include ProAmatine (midodrine) and Sudafed (pseudoephedrine), with common side effects such as loss of appetite, insomnia and skin rashes or itching.
All the above medications can have more severe side effects also, which is why you may want to explore alternative options.
As a last resort, you may opt for surgical intervention. Research shows 73-83% of women are more than satisfied with the results of these surgical procedures.
Retropubic suspension involves surgical insertion of synthetic threads to lift up the bladder neck and urethra for additional support. Internal slings are another option and involve insertion of a man-made sling to cradle the bladder neck and urethra.
The most important thing is, don’t let your urinary incontinence go unchecked. Yes, it is an embarrassing thing to talk about, but we are all grown-ups here.