For various reasons, some women fear going to the doctor. Now imagine the stress of seeking help for a highly personal or socially awkward condition like urinary incontinence or sexual dysfunction.
Each day, urologists deal with numerous and different health conditions that are rarely discussed in public . Don’t let fear, anxiety or a feeling of awkwardness prevent you from taking care of an issue early on.
Bladder leakage (or “urinary incontinence”) is one of the most common such issues. It is the loss of bladder control or involuntary loss of urine. One in three adult women in the U.S. have urinary incontinence, yet less than 50 percent of them discuss their symptoms with their healthcare provider. In addition to feeling embarrassed, they may be unaware that their condition might be treatable or think that their symptoms are due to aging.
There are three types of bladder leakage:
- Urge incontinence is the strong, sudden need to urinate due to bladder spasms or contractions.
- Stress incontinence is an involuntary loss of urine that occurs during physical activity, such as coughing, sneezing, laughing, or exercise.
- Mixed incontinence is the combination of both urge and stress incontinence.
Of the 1 in 3 adult women who have urinary incontinence, about 50 percent are stress incontinence, 36 percent mixed incontinence and 11 percent urge incontinence.
Treatments for urinary incontinence vary, depending on the type of incontinence, the severity and the underlying cause. If an underlying condition is causing your symptoms, your doctor will first treat that condition. Behavioral techniques are the first line of defense. These techniques include:
- Bladder training, which is essentially delaying urination after you first get the urge to go. The goal is to lengthen the time between trips to the toilet.
- Double voiding, which means urinating, then waiting a few minutes and trying again, to help you learn to empty your bladder more completely.
- Scheduled toilet trips, to urinate every two to four hours rather than waiting for the need to go.
- Fluid and diet management, to regain control of your bladder (such as cutting back on or avoiding alcohol, caffeine or acidic foods). Reducing liquid intake, losing weight or increasing physical activity also can ease the problem.
Pelvic floor muscle exercises are another possible option. Also known as Kegel exercises, these exercises are especially effective for stress incontinence, but may also help reduce urge incontinence. These exercises strengthen the muscles that help control urination.
While not applicable in every case, medications are commonly used to treat incontinence. These include “anticholinergics,” which can calm an overactive bladder, Mirabegron, which relaxes the bladder muscle and can increase the amount of urine your bladder can hold, and topical estrogen. Applied in the form of a vaginal cream, ring or patch, topical estrogen may help tone and rejuvenate tissues in the urethra and vaginal areas.
Minimally invasive therapies that may help with incontinence include bulking material injections, Botox and nerve stimulators.
Bulking material injections are a synthetic material that is injected into tissue surrounding the urethra, helping to keep it closed and reducing leakage. It usually needs to be repeated regularly. Botox (“botulinum toxin type A”) injections into the bladder muscle may benefit people who have an overactive bladder. Nerve stimulators are devices resembling a pacemaker. It is implanted under your skin to deliver painless electrical pulses to the nerves involved in bladder control (the sacral nerves). Stimulating the sacral nerves can control urge incontinence if other therapies haven’t worked.
Lastly, there are surgical interventions that may be an option, depending the type and severity of your incontinence.
What you can do
A few isolated incidents of incontinence don’t necessarily require medical attention. And as they age, most people do have to get up to urinate at night. But if the problem affects your quality of life, don’t hesitate to have your symptoms evaluated.
Sarah Ryan MD is a urologist with Urology Specialists of Nevada