Whether it’s a minor inconvenience or a larger problem, urinary incontinence has many different causes and can present many different symptoms. But there’s one aspect that’s truly universal: Most patients feel embarrassed about it.
Though it’s a common condition with many treatment options, some patients say they put off talking to their doctor. They anticipated an awkward or uncomfortable conversation about it.
The important thing to remember is that discussing your concerns with your doctor is the first step to addressing what is a very treatable problem— there is nothing at all to be embarrassed about.
Lots of people experience the occasional ‘leak’ while exercising or because they weren’t able to get to a toilet in time. This is perfectly normal and not generally cause for concern.
But if the symptoms are more frequent, and especially if you find they disrupt your daily activities or cause you to restrict your social interactions, it’s a good time to talk with your doctor.
Common symptoms include:
Urine leaks when exerting pressure on the bladder (coughing, sneezing, laughing etc.)
A sudden, intense urge to urinate followed by an involuntary loss of urine
Frequent need to urinate
Frequent or constant dribbling of urine
Many patients experience a combination of these symptoms.
Many patients are surprised to learn that urinary incontinence in and of itself is not a disease. It is, rather, a symptom that something else is going on.
Everyday habits may be the root cause of this condition, since things like caffeine and alcohol consumption can play a role in urinary incontinence. Artificial sweeteners, carbonated drinks and sparkling water are also known to cause symptoms in some patients, as are some foods like those high in spice, sugar or acid.
Some blood pressure medications can cause urinary incontinence, as can some sedatives, muscle relaxants and even large doses of vitamin C.
Some patients have what’s called ‘functional incontinence’ which is the result of some physical or cognitive impairment which keeps them from getting to the toilet in time. Someone with severe arthritis, for example, may find it difficult to unbutton or unzip their pants quickly.
Other common causes of urinary incontinence are:
Enlarged prostate (especially in older men)
Urinary tract infections
Damage to pelvic floor muscles as the result of a hysterectomy
Hormonal fluctuations as the result of menopause
More serious underlying conditions like prostate cancer, obstructions (such as a tumor or urinary stones) or neurological disorders can also be the cause of urinary incontinence, so it’s doubly important to have a conversation with your doctor if you’re having symptoms.
You start by taking a thorough history and physical exam.
As part of the history, your doctor may ask to explain or demonstrate activities that cause symptoms (like coughing or jumping), and may ask you to keep what’s called a ‘bladder diary,’ to track things like how much you are drinking throughout the day, how many times you need to urinate and the amount of urine produced.
These all give insight into what type of incontinence you may have, as well as what the best treatment plan might be.
Your doctor may also perform a pelvic exam, which can help diagnose issues like pelvic organ prolapse and other anatomical anomalies which might be causing the incontinence.
If more information is needed, the next step may be ordering imaging or other bladder function tests like a post-void residual measurement which shows the volume remaining in the bladder after urinating. This can help me diagnose whether there might be an obstruction or muscle or bladder nerve issues at play.
Other, more complex diagnostic tests like urodynamic testing and pelvic ultrasound are generally only performed if surgery is a consideration.
There are a number of behavioral techniques that many patients find effective for treating urinary incontinence. These include:
Bladder training, or delaying urination following an urge to go for a period of time (10 minutes for example) to gradually increase the period of time between trips to the bathroom.
Double Voiding, or waiting a few minutes after urinating once and trying again (to help you learn to empty your bladder completely each time you go)
Fluid and Diet Management, which can help you regain control of your bladder and may include decreasing or avoiding alcohol consumption altogether, reducing liquid consumption or cutting back on acidic or spicy foods.
Pelvic Floor Exercises, which can strengthen the muscles that control urination (these are also known as Kegel exercises), and are particularly helpful in cases of urinary incontinence triggered by exercising, coughing, sneezing or other activities that put stress on the bladder.
There are also a number of medications available to help treat urinary incontinence, including:
Anticholinergics, which calm what’s commonly referred to as an ‘overactive bladder’ and are especially helpful for patients who find they have a persistent and frequent urge to go.
Mirabegron, which relaxes the bladder muscle, increasing the total amount of urine your bladder can hold and may also increase how much you urinate when you do go.
Topical estrogen, which can be effective for women with urinary incontinence since a low dose topical estrogen cream, ring or patch has been shown to help tone and rejuvenate tissues in the urethra and vaginal areas.
If none of these treatments are appropriate, your doctor can walk you through other equally effective options, including medical devices like urethral inserts to control incontinence, or interventional therapies like nerve stimulators and bulking material injections.
Finally, you and your doctor may decide that surgery is the best way to treat the problem. If that’s the case, there are a number of different procedures to discuss based on the type of urinary incontinence symptoms you have. These include sling procedures, prolapse surgery, and bladder neck suspension surgery.
Work With Your Doctor To Find A Solution That’s Right For You
If urinary incontinence is keeping you from doing the things you enjoy with the people you love and is affecting your daily activity, there’s no better time than now to make an appointment with your doctor to decide which treatment is best for you.
For more information about urinary incontinence, we invite you to talk with your 4HER coordinator Johnson Memorial Women's Health Specialists.