Where to turn for treatment of incontinence

Many types of specialists offer incontinence help, including urologists and urogynecologists.

Incontinence in middle and older age is common. You may realize it's a problem if you have a frequent need to go to the bathroom (urge incontinence), or if you leak urine easily when you cough or have a good laugh (stress incontinence). Fortunately, incontinence help is readily available.

Finding an expert

To find treatment of incontinence, the Harvard Special Health Report Better Bladder and Bowel Control recommends that you start with your primary care physician. But not all physicians have the necessary interest or experience. If your doctor seems unable to help, keep looking.

These specialists and clinics also offer incontinence help:

• Urogynecologists. These are gynecologists who have taken additional training in problems affecting a woman's bladder and pelvis—including urinary and fecal incontinence or prolapse. This board-certified subspecialty is also known as female pelvic medicine and reconstructive surgery.
• Urologists. These medical doctors treat the urinary systems of both men and women as well as the male reproductive organs.
• Pelvic floor disorders centers. Some hospitals have developed clinics to provide one-stop shopping for the evaluation and treatment of many pelvic floor disorders, including urinary incontinence. These clinics may combine the expertise of many specialists, including urogynecologists, urologists, neurologists, and physical therapists.
• Biofeedback professionals. Health professionals who practice this technique include nurses and physical or occupational therapists. Look for someone with experience in bladder training. Start by asking the physician treating your incontinence.
• Pelvic floor physical therapists. If you need help learning to strengthen and control your pelvic floor muscles and to use other behavioral strategies to maintain continence, a growing number of physical therapists specialize in this area and have undergone advanced training to earn a Certificate of Achievement of Pelvic Physical Therapy. Ask your physician for a referral.
• Nurse specialists. If you are having skin problems related to incontinence or if you have not been able to find acceptable ways to manage your incontinence, a specialist in continence or ostomy nursing can offer practical advice.

Treating the problem

There are many approaches for the treatment of incontinence, and most don't involve medication. For example, first-line interventions for women often involve Kegel exercises, bladder training, weight loss, and exercise. Pill-free treatments are also helpful for men.

If these approaches aren't effective, the next step might be treatment with medication, surgery, or even an injection of botulinum toxin (Botox) to relax overactive bladder muscles.

Lifestyle changes

Other pill-free strategies for the treatment of incontinence involve lifestyle changes, such as:

• Watching your fluid intake. Drink only when you feel thirsty, and don't exceed six to eight 8-ounce cups of fluid per day from all sources, including soup.
• Quitting smoking. This reduces coughing and pressure on the bladder, among other well-documented benefits for heart and lung health.
• Minimizing bladder irritants. These include caffeine, alcohol, carbonated drinks, spicy foods, and citrus.

But most importantly, seek professional incontinence help if you start having any issues with urinary incontinence. You don't have to live with the condition, and you most likely can fix the problem.

– By Heidi Godman
Executive Editor, Harvard Health Letter