Bladder Blues: Don’t Let Urinary Leakage Get You Down

How to improve urinary incontinence symptoms for a better quality of life.

What is Urinary Incontinence?

Many women suffer from involuntary loss of urine, or “urinary incontinence.” For some, it’s just a few drops when sneezing or laughing. For others, it’s a large amount after a sudden urge to urinate. Others are fine during the day but get up several times at night to urinate.

Urinary incontinence has a significant impact on women’s quality of life. Unfortunately, many women think that urinary incontinence is a natural part of aging and do not seek medical help. Thankfully, there are many primary care providers, gynecologists, women's health specialists, surgical specialists in either urogynecology or female urology that care for such conditions.

How common is this condition?

Very common, in fact up to 1 in 3 women involuntarily leak urine. Even though this condition increases with age, it is not a normal part of aging and can affect a woman's quality of life. Over 100,000 procedures are performed yearly for stress incontinence in the United States. There are millions of women with urinary leakage. The first line therapy is medical. There are several types of incontinence, but the following are the most common in women:

1. Urgency incontinence is when you suddenly have to urinate—often without warning. Many women report needing to urinate many times throughout the day, which is termed “urinary frequency.” Some women have nighttime symptoms, where they get up one or more times at night to urinate. The term “overactive bladder” is often used interchangeably with urge incontinence and is characterized by urinary urgency, frequency and needing to urinate at night. Urgency incontinence is caused by the bladder’s contracting at times when you are not ready to urinate. Certain fluids and medications can aggravate urge incontinence. It also can be influenced by disorders that may affect bladder sensation, such as diabetes and neurologic conditions. Nighttime symptoms also can be due to other medical conditions, such as sleep apnea, heart failure and swelling in the legs.
2. Stress incontinence is when urine leakage occurs with any increase in abdominal pressure, such as with coughing, sneezing, laughing and/or lifting something heavy. It’s due to many factors, including muscle weakness and nerve damage to pelvic muscles, particularly around the urethra, the tube through which urine leaves the bladder. Risk factors for stress incontinence are pregnancy or childbirth, weight gain, chronic constipation, activities that involve high impact stresses on the pelvic floor, as well as genetic predisposition to weakness of the pelvic floor.
3. Mixed incontinence is when a woman has symptoms of both stress and urgency incontinence. Many women have this combination.

Take Back Control

Whether your incontinence is a slight nuisance during intense exercise or a major problem that keeps you from enjoying time with family and friends, don’t sit silently. Most types of urinary incontinence are treatable, and age should not be a barrier to seeking treatment.

Stress, Urge and Mixed Urinary Incontinence

Urgency Incontinence

Urgency incontinence or so-called overactive bladder is usually first treated with fluid management, behavioral management, pelvic floor physical therapy and weight loss. In 2013, one over the counter 4 day patch called Oxytrol® became available to treat overactive bladder without a prescription. Be sure to talk with your physician first to make sure there is no bladder infection, urinary abnormality or other medical problem, like acute angle glaucoma or constipation, that might preclude use of this patch or other medications.

A variety of prescription medications are traditionally used as a second line of therapy. Finally, nerve modulation therapies (sacral neuromodulation and percutaneous tibial nerve stimulation) and onabotulinumtoxin A (Botox®) can also be used.

Stress Incontinence

Non-Surgical Treatment

Stress incontinence is traditionally treated with pelvic floor muscle retraining. This can be done with a physical therapist trained in the pelvic floor. Your health care provider can give you basic instructions during your periodic pelvic exam. In addition, in 2014, an over the counter disposable non-absorbent product (similar in design to a tampon) which is inserted into the vagina to provide bladder neck and urethral support for up to 8 hours was FDA approved. This Poise Impressa® comes in three sizes. There are over the counter starter packs for a woman to try to see which one works best for her.

Another non-surgical option includes having your physician fit you for a continence pessary (a vaginal ring that provides support under the urethra). Pessaries are also used in women with pelvic prolapse who do not want pelvic surgery. A physician can inject a bulking agent that gets injected near the urethra to provide some non-muscle support to the bladder neck area. For a woman with menopausal vaginal atrophy (thinning) and very mild degrees of urinary leakage without pelvic prolapse, she may benefit from use of the three month prescription vaginal ring called Estring® vaginal ring.

Surgical Treatment

There are several types of surgery that can help women with stress incontinence. They can be done vaginally or abdominally and utilize one of the following:

• A woman’s own tissue
• A small piece of mesh tape
• A suture to provide support around a woman’s urethra

These surgeries can be performed in isolation, but are often done in combination with a surgery to correct pelvic organ prolapse. Women should be informed of all options prescription, non-prescription as well as medical and surgical. For more information on surgical options please visit the website through the American Urogynecologic Society for further reference.

How to Improve Your Incontinence Symptoms

There are several things you can do to improve your incontinence symptoms:

• Retrain your bladder. Keep a diary of how much you drink and how frequently you urinate. Find a pattern, and make a plan to use the bathroom at regular intervals — preempting any emergencies. As your bladder begins holding urine better, you can extend the time between bathroom breaks.
• Be wary of fluid consumption. Caffeine and carbonation (found in coffee, tea, sodas and energy drinks) are major bladder irritants as well as high dose vitamin B complex vitamins. Many women drink large amounts of water. Ease up on excessive and or caffeinated fluids, and your incontinence symptoms may ease up, too. If your urge to urinate increases at night, stop drinking beverages three to four hours before bedtime.
• Try squeeze-and-release pelvic exercises. Pelvic floor physical therapists and/ or your women's health are provider can teach you how to do Kegel exercises, simple squeeze-and-release techniques that strengthen the muscles of the pelvic floor. Women usually attend six to 12 weekly sessions with a therapist and do daily exercises at home. Success depends on the woman’s dedication to her therapy and the severity of her symptoms. Many patients see significant improvement with therapy.
• Lose weight. Even a small amount of weight loss (as little as 8 percent) has been shown to be effective in reducing urinary incontinence.
• Avoid constipation. Try avoiding constipation by eating a high-fiber diet, getting regular exercise, avoiding dehydration and establishing regular bowel habits. Consider the use of over-the-counter oral magnesium oxide and/or miralax powder after being evaluated by your physician.

When to Seek Treatment

Feel free to seek treatment anytime you feel bothered by your urinary incontinence. Urinary incontinence does not need to be your secret. Talk to your primary care physician or gynecologist. They can begin a course of treatment and refer you to a urologist or specialist if needed.

Be Strong. Be Healthy. Be in Charge!

- Holly L. Thacker MD, FACP, CCD, NCMP