Health Topics

Regain Control Of Your Active Life

By Marie Fidela Paraiso, MD and Holly L. Thacker, MD

Regain Control Of Your Active Life

Urinary Incontinence

When you have to go, you have to go. But what if the seatbelt sign is illuminated and you won’t be landing for another half-hour? Or what if your daughter’s solo is coming up in the school concert?

Unfortunately, urinary incontinence affects as many as one in three women, at least occasionally. The most frequent cause is childbirth. It may just happen when you jump or cough, or it may be a constant, nagging problem. Some women become isolated and depressed, declining social invitations and forgoing travel because they fear embarrassment. Some gain weight and start to see themselves as old and disabled. The good news is that incontinence is finally getting the attention it deserves. You can be one of the growing number of women who are beating incontinence.

What is Incontinence?

Urinary incontinence is the involuntary loss of urine. Some women lose a few drops of urine, while others may feel a strong, sudden urge to urinate just before losing a large amount of urine. Many women experience both symptoms. Incontinence can be slightly bothersome or totally debilitating. Urine loss also can occur during sexual activity, causing tremendous emotional distress.

Women experience urinary incontinence twice as often as men due to:

  • Pregnancy
  • Childbirth
  • Menopause
  • Structure of the female urinary tract

But both women and men can become incontinent from neurologic injury, birth defects, stroke, multiple sclerosis, and physical problems associated with aging.

Incontinence occurs because of problems with muscles and nerves that help to hold or release urine. The body stores urine in the bladder, a balloon-like organ. The bladder connects to the urethra, the tube that carries urine out of the body. During urination, muscles in the wall of the bladder contract, forcing urine out of the bladder and into the urethra. At the same time, sphincter muscles surrounding the urethra relax, letting urine pass out of the body. Incontinence will occur if the bladder muscles suddenly contract or the sphincter muscles are not strong enough to hold back urine. Urine may escape with less pressure than usual if the muscles are damaged, causing a change in the position of the bladder.

Types of Incontinence

  1. Stress incontinence is one of the most common forms in women and is readily treatable. Coughing, laughing, sneezing, or other movements that put pressure on the bladder cause urine to leak from the bladder. It is commonly caused by physical changes resulting from pregnancy, childbirth and menopause.
  2. Urge incontinence – or overactive bladder – causes the loss of urine for no apparent reason while suddenly feeling the need or urge to urinate. The most common cause of urge incontinence is involuntary bladder contractions. The bladder may empty during sleep or after drinking a small amount of water. Usually, this is accompanied by frequent urination and the need to get up in the middle of the night.
  3. Mixed incontinence is both Stress leakage and Urge leakage. It is NOT normal to leak.
  4. Urinary incontinence should not be considered a disease, but rather a symptom or sign of an underlying problem, such as pelvic organ prolapse. This is not a “normal part of aging” but a condition that can be treated. There is no shame in seeking medical help for incontinence or related pelvic floor disorders. Treatment is often necessary in order to restore regular functioning and avoid pain and discomfort.

Incontinence Treatments

A thorough evaluation by a uro-gynecologist or a urologist or women’s health specialist who focuses on female patients will uncover the cause of incontinence. He or she can then tailor treatment for the particular disorder, which may include:

  • Electrical stimulations
  • Simple exercises
  • Biofeedback
  • Surgical therapies
  • Bladder training

Simple Exercises

Exercises may be recommended to strengthen or retain pelvic floor muscles and sphincter muscles can reduce urinary leakage. Brief doses of electrical stimulation can strengthen muscles in the lower pelvis in a way similar to exercising the muscles.


Biofeedback, sometimes combined with timed voiding or bladder training, can alter the bladder’s schedule for storing or emptying urine. Medical interventions include pills, injections, implants and devices that reduce many types of leakage.

Surgical Therapies

When surgery is indicated, patients benefit from newer approaches that can be performed on an outpatient basis, most often without the need for a catheter postoperatively. Many procedures can be performed entirely through the vagina, or through a small incision in the belly button, resulting in a barely visible scar. Most patients undergoing incontinence procedures alone return to normal activities in 1-2 weeks.

If you have been diagnosed with incontinence or pelvic organ prolapse or you suspect you have it, find a physician who specializes in these types of disorders. A specialist can discuss the variety of options and determine the best treatment for you.

For more information on prolapse and incontinence, download the Free Pelvic Organ Prolapse Treatment Guide.

- Dr. Marie Fidela Paraiso and Dr. Holly L. Thacker

Marie R. Fidela Paraiso, MD, is a Staff Physician in the Department of Obstetrics and Gynecology at Cleveland Clinic, where she also serves as Head of the Center for Urogynecology and Reconstructive Pelvic Surgery. Additionally, Dr. Paraiso holds a joint appointment in the Cleveland Clinic Urological Institute. She specializes in the treatment of urinary and fecal incontinence and pelvic organ prolapse. She also is Director of the Pelvic Floor Disorders Center at Lakewood Hospital.

Dr. Holly L. Thacker is Director of the Center for Specialized Women’s Health and Executive Director of Speaking of Women’s Health and is a certified physician specialist who offers InTone and Apex and Intensity pelvic stimulator devices in her practice.