Urinary incontinence: Common and manageable

Monique Tello, MD, MPH
Monique Tello, MD, MPH, Contributing Editor

As a primary care doctor, I see a lot of women dealing with the inconvenience, discomfort, and embarrassment of urinary incontinence (unintended leaking of urine). Some are comfortable bringing this up right away. Others suffer needlessly because they feel too shy or awkward to mention it.

The truth is, an estimated 45% of women experience some form of urinary incontinence at some point in their lives. That’s almost half of all women! It’s a very big deal. Urinary incontinence can negatively affect physical and emotional well-being. For example, women may avoid going out because they’re worried about having an accident away from home. Other problems include sexual dysfunction and depression.

Types of urinary incontinence

We usually think of two main categories of incontinence:

  • Stress incontinence: Leaking of urine with coughing, sneezing, sex, or impact exercise, like running and jumping. This is related to damaged and/or weak pelvic floor muscles, and is common in younger women who have given birth vaginally.
  • Urge incontinence: Sudden and unpredictable overwhelming urge to urinate, with leaking of small to large amounts of urine. This sometimes also goes along with needing to go often that can occur day and night. It is more common in women who are overweight, or have diabetes or other neurological issues such as dementia or strokes. The problem is thought to be due to spasms of the bladder. A lot of things can worsen symptoms, such as caffeine, diuretics (“water pills” used for high blood pressure), drinking too much fluid, and bladder infections.

The most common form of incontinence, called “mixed,” has features of both these categories. But the kind of incontinence really doesn’t matter. What women need to know is that there are solutions.

Get your life back by taking charge of urinary incontinence — here’s how

First, talk to a healthcare provider: There are readily identifiable medical factors that can cause or worsen incontinence. Certain medications, uncontrolled diabetes, bladder infections, constipation, and menopausal changes to name a few. Your primary care doctor can help identify and treat many of these issues.

Then take care of the area: I have seen many patients who have skin rashes and infections in their genital area due to excessive moisture. Some are using menstrual pads, or even balled-up tissues or folded paper towels for their urinary leakage, or nothing at all. If moisture isn’t absorbed, it will damage the skin and cause problems. Sometimes the issue is reluctance to explore the world of incontinence pads (which are now available in a variety of brands and styles), but often, sadly, it’s the expense. Some insurances, including Medicaid, will cover incontinence pads; healthcare spending accounts are an option for some people as well. Barrier ointments, even plain old petroleum jelly, can help to protect skin from moisture. Daily bathing is also helpful.

Hold off on medication or surgery: Many women don’t realize that lifestyle changes, physical and behavioral therapies are the preferred first-line method of treatment.

Watch the fluid intake: Limit bladder-irritating beverages such as caffeinated or acidic drinks (alcohol, coffee, black tea, green tea, sodas and seltzers with citric acid added). For women who make nighttime trips to the bathroom, decreasing fluid intake in the evening (especially alcohol) can help.

Lose a few pounds: Extra abdominal fat can create pressure on the bladder. Losing just 5% of body weight can help a lot. But even losing a few pounds can improve symptoms.

Exercise: The more physically active a woman is, the less likely she is to suffer from urinary incontinence. This may be related to better core and pelvic floor muscle tone in women with increased fitness.

Pelvic floor exercises and physical therapy: Those Kegel squeezes can really work! They’re not difficult, but it’s important to do them correctly. Believe it or not, formal pelvic floor physical therapy with a trained provider can be hugely helpful. These therapists are usually women. They will take a careful history and then assess anatomy, muscle control, and strength, and then outline a guided exercise program. Once my patients get over their initial hesitation, they almost always see a benefit.

Bladder training: Scheduling bathroom visits can help women to “train” an overactive bladder. Sometimes bladder training is done along with pelvic floor physical therapy, and can be more successful that way.

And if all that doesn’t help…

Talk to a healthcare provider again. There are several medications that may help. For women with postmenopausal vaginal and vulvar changes (called atrophy), an estrogen cream or ring can help a great deal. It may take as long as four months to see an effect, and though topical estrogen is low-risk, hormone therapy is not for everyone. There are also medications specifically for urinary incontinence, though frankly none are likely to be a cure. In fact, all the pills we see advertised (such as anticholinergics, the most commonly prescribed) only result in one or two less incontinence episodes per day, at best. Plus, there are many side effects, such as sleepiness, confusion, dry eyes, dry mouth, and constipation. These medications are especially dangerous in the elderly. Even the newer medications aren’t much different in terms of efficacy and side effect profile.

The important takeaway messages about urinary incontinence

Here’s what women really need to know:

  • If you suffer from incontinence, know that you are not alone.
  • Talk to your healthcare provider about it. Make sure there’s nothing else going on that should be addressed.
  • Try lifestyle changes, behavior and physical therapies first, and second, and third.
  • Be cautious with all medications, and weigh risk, benefits, and side effects carefully with your doctor.

Resources

Evaluation of women with urinary incontinence. UpToDate, September 14, 2017.

Treatment of urinary incontinence in women. UpToDate, August 28, 2017.

Urinary Incontinence and Associated Female Sexual Dysfunction. Sexual Medicine Reviews, October 2017.

MGH Primary Care Office Insight chapter on Urinary Incontinence in Women (Mary Hohenhaus, MD and Shana Birnbaum, MD, Specialist Reviewer: May Wakamatsu, MD)

Nonsurgical Management of Urinary Incontinence in Women: A Clinical Practice Guide from the American College of Physicians. Annals of Internal Medicine, September 16, 2014.

Effectiveness of pelvic floor muscle training in treating urinary incontinence in women: A current review. Actas Urologicas Espanolas, June 2016.

Related Information: Better Bladder and Bowel Control

Comments:

  1. Dr NimerAlkhatib

    I thank you for your informative article,Iam working as family doctor in my private clinic and I saw many patients with this problem , and the best way ,which I found, is to strengthen the pelvic floor muscle by Kegel squeezing exercises that using sphencters of both anus and urethra.Dr Nimer Alkhatib

  2. Susan McKee

    For unknown reasons I lost all feeling from my bladder. Have done the pt and bio, medication, cut back on fluids in the evening, and still go through 3-5 overnight diapers a day. Have had bleeding and clots, 2 subsequent infections and am now on 30 days of preventative antibiotics. I also have to cath 3 times a day as my bladder does not empty. I am only 58 and refuse to go through this the rest of my life plus being disabled I can not afford too. I am going to push my urologist for surgery per my endocrinologists recommendation

  3. Zoey

    It was really helpfull article .👍

  4. Peter

    This really is a big issue! But this article sums up all the mainstream solutions. My wife really tried all kind of kegel exercises, but they do not work. I do not see any new solutions to this huge problem.

    And men: on a certain age, the prostate starts to grow. After 40 / 50.
    Then it is time to take natural tinture to prevent this. The growing prostate first starts to prevent emptying the complete blader, hence dripping as a result. Later it will be the main reason for cancer.
    I do not know why this is not common knowledge.

    • Monique Tello, MD, MPH
      Monique Tello, MD, MPH

      Thanks for reading- I suggest that your wife seek formal pelvic floor physical therapy (which is far, far more than Kegels) and also inquire about biofeedback, if that is available where you are.

  5. Scott Holmgren

    We men have this issue too: Urinary incontinence!

    Not to be one sided about this important matter (especially with us having prostate cancer operations and all!

    How about issuing a similar piece to us as
    well!?!

    Scott Holmgren 517.648.5723 (scottholmgren@Comcast.net)

    • Monique Tello, MD, MPH
      Monique Tello, MD, MPH

      Thanks- urinary issues in men are common and need to be discussed. These issues are also physiologically quite distinct from those in women, and deserve a separate article. As I am principally a women’s health physician, I will ask our editors to approach one of our men’s health experts about addressing male urinary incontinence and prostate issues.

  6. Reginald

    How about men I had prostate removed and 3 yrs later I still have urinal incontinence What can be done to help men like me?

    • Monique Tello, MD, MPH
      Monique Tello, MD, MPH

      Thanks- urinary issues in men are common and need to be discussed. These issues are also physiologically quite distinct from those in women, and deserve a separate article. As I am principally a women’s health physician, I will ask our editors to approach one of our men’s health experts about addressing male urinary incontinence and prostate issues.

  7. Genia

    Good article. I will try to stop my intake of fluids at least 2 hours before bedtime

  8. Stephen Draper

    I would agree that an article addressing Male incontinence issues would be appreciated.

    • Monique Tello, MD, MPH
      Monique Tello, MD, MPH

      Thanks- urinary issues in men are common and need to be discussed. These issues are also physiologically quite distinct from those in women, and deserve a separate article. As I am principally a women’s health physician, I will ask our editors to approach one of our men’s health experts about addressing male urinary incontinence and prostate issues.

  9. Murali Banerjee

    I have the same question put forward by David zeiger.

  10. Siegfried Othmer

    It’s nice to see that the author recommends holding off on surgery and medication in favor of an initial trial of physical and behavioral therapies. Kegel exercises are mentioned. Kegel supported his work with instrumentation, and his early work blossomed over the years into a major preoccupation with incontinence within the field of biofeedback. There is simply no question any more that physical therapy for incontinence is substantially aided if appropriate biofeedback instrumentation is introduced, so that trainees can get feedback on their initial success. The value of such reinforcements throughout the training process is simply no longer in question. Physical therapy for incontinence cannot be declared to have failed unless biofeedback instrumentation was used. Lately there have been developments in this area that allow the training to be accomplished without the intrusive instrumentation such as was utilized by Kegel.

  11. john

    Was disappointed that male urinary incontinence was not addressed. This problem is very annoying to aging males most of which have BPH [Benign prostatic hypertrophy) or have had therapy for prostatic carcinoma which frequently leads to incontinence ( although most of these men will be treated by their urologist).

  12. Carole Lyle

    I am postmenopausal and had bladder infections due to drying and thinning in the vaginal area. I had a fabulous gynecologist who pinpointed the issue as atrophy of the surrounding tissue. I was prescribed a topical and intravaginal cream and it made all the difference in the world. I also am very carful about the products I use to cleanse with and the quality of TP. Don’t wipe, just pat dry. I also only use cotton underwear. I couldn’t have imagined going on with the constant urges to go to the bathroom. One thing women need to know is the brain changes when you have recurrent infections and will trigger urges when you no longer actually need to go. So I had to do a lot of self talk after beginning treatment to “retrain” my brain.

  13. John Tempest

    What about for men with these issues?

  14. sgk123

    What an outstanding article. Full of great advice and good sense.
    Especially appreciated the intelligent comments on the use of medication in the middle age/elderly

    Thank you.

  15. Deborah Culbertson

    Nothing worked until…I had an interstim implanted. Voila! Much better! Amazing!
    See Medtronic manufacturer.

  16. david zeiger

    How about an article that would address MALE urinary incontinence?

    • John Tempest

      Can you comment on these issues for men please?

    • Monique Tello, MD, MPH
      Monique Tello, MD, MPH

      Thanks- urinary issues in men are common and need to be discussed. These issues are also physiologically quite distinct from those in women, and deserve a separate article. As I am principally a women’s health physician, I will ask our editors to approach one of our men’s health experts about addressing male urinary incontinence and prostate issues.

  17. Don

    No mention of men dealing with the same issue?

    • Monique Tello, MD, MPH
      Monique Tello, MD, MPH

      Thanks- urinary issues in men are common and need to be discussed. These issues are also physiologically quite distinct from those in women, and deserve a separate article. As I am principally a women’s health physician, I will ask our editors to approach one of our men’s health experts about addressing male urinary incontinence and prostate issues.

  18. Lisa Graham

    Do you have any information or articles on urinary incontinence after having spinal anesthesia for a joint replacement?

    • Monique Tello, MD, MPH
      Monique Tello, MD, MPH

      This is potentially an intraoperative complication, a specific problem that requires a specialist input, and I recommend that the patient seek care from a urologist.

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