By Heather van Raalte, M.D.
If planning activities around bathroom visits or leaking urine during exercise is having a major impact on your daily life, you’re not alone.
An estimated 25 million people in the United States experience urinary incontinence, according to the National Association for Continence, and rates are rising as baby boomers age.
While bladder leakage can be embarrassing and affect quality of life, it also poses larger risks. Urinary incontinence can lead to skin rashes and sores, urinary tract infections and sleep disruptions.
According to the National Library of Medicine, it also increases risk of falls and fractures from rushing to the bathroom in the middle of the night.
However, urinary incontinence does not have to be a normal part of aging. There are a number of safe and effective treatments available that can have a big impact on your quality of life.
No “One-Size-Fits-All” Approach
Urinary incontinence is the loss of bladder control that causes accidental urine leakage. Leaks can range from drips of urine to large amounts, including emptying the entire contents of the bladder. While it occurs in men and women, it is more common among women.
Over time, wear and tear on the body can weaken the pelvic floor, or the muscles, tissues and ligaments that hold your pelvic organs in place. Certain events affecting women, including pregnancy, childbirth and menopause, can put added strain on the bladder, urethra and pelvic floor and lead to incontinence.
The most common types of urinary incontinence are stress incontinence and urge incontinence.
- Stress incontinence. Urine leaks with movements, such as coughing, sneezing, laughing or exercising. These activities put pressure on the bladder and supporting structures. Stress incontinence is the most common type and is much more common among women than men, according to the National Library of Medicine.
- Urge incontinence. Characterized by a sudden, intense urge to urinate, people with urge incontinence are often unable to get to the bathroom in time and may feel the urge to urinate many times throughout the day.
- Mixed incontinence. A combination of both stress and urge incontinence.
There is no “one-size-fits all” solution to urinary incontinence. It is important to talk with a doctor about your symptoms so they can provide a diagnosis and treatment plan.
What’s New in Treatments?
Typically, a doctor will review your medical history and conduct an exam to help determine the cause of urinary incontinence. The National Association for Continence recommends preparing a list of questions for your doctor and keeping a log of symptoms which may help with diagnosis.Â
Treatments for urinary incontinence depend on the type and severity of the condition.
Certain lifestyle changes, including avoiding food and drinks that stimulate the bladder, such as alcohol, caffeine, carbonated drinks and spicy foods, can help to relieve discomfort caused by urinary incontinence.
Eating high-fiber foods to relieve constipation can also help prevent symptoms of urinary incontinence. Physical therapy exercises can help by strengthening the pelvic floor.
Sometimes these therapies are not enough. Fortunately, there are other safe and effective treatment options, including:
Medications. There are a number of newer medications that are effective and well tolerated. They are designed to relax bladder muscles to help decrease urgency and frequency, giving people with urinary incontinence more time to get to the bathroom.
Injections. Botox injections administered into the bladder muscle can reduce overactivity and improve bladder control. Bulking agents can be injected in tissues surrounding the urethra to reduce leakage associated with stress incontinence. Both of these procedures can be performed in the office under local anesthetics with no significant down time or recovery.
Nerve treatments. These are alternatives to medication for patients with an overactive bladder and urge incontinence. Techniques like tibial nerve stimulation can help regulate bladder function. This non-surgical approach involves placing a thin needle under the skin of the ankle near the tibial nerve. A stimulator sends mild electrical pulses through the needle to the tibial nerve and other nerves that control bladder function. A second technique involves a surgeon implanting a small device called a neurostimulator, about the size of a flash drive, under the skin of the buttock. The device sends mild electrical pulses to the nerves that help regulate bladder function.
Sling procedures. A small support is placed under the urethra to prevent leaks. This minimally invasive procedure does not require hospitalization and is one of the most commonly used treatments for stress incontinence.
Vaginal pessary. This removable device is inserted into the vagina to help support the pelvic floor muscles and treat stress incontinence.
When To See a Doctor
It is important to consult a doctor as soon as urinary leakage affects your day-to-day life. If it is keeping you from being active or social, preventing you from wearing certain clothes, such as light-colored pants, keeping you from drinking water because you don’t want to urinate as often, or if you are regularly wearing pads, it’s time to see a doctor.
With many treatments available today, there is no reason to suffer in silence with urinary incontinence.
Penn Medicine Princeton Urogynecology and the Center for Pelvic Wellness at Penn Medicine Princeton Medical Center (PMC) offer highly specialized, progressive treatment for a wide range of pelvic disorders, including urinary incontinence.
To find a physician affiliated with Penn Medicine Princeton Health or for more information about the Center for Pelvic Wellness at Penn Medicine Princeton Medical Center call (888) 742-7496 or visit www.princetonhcs.org
Heather M. van Raalte, M.D. is double board certified in obstetrics and gynecology as well as female pelvic medicine and reconstructive surgery. She is the chairperson of the Department of Obstetrics and Gynecology at Penn Medicine Princeton Health and medical director of the Center for Pelvic Wellness at Princeton Medical Center.
