Coping With Urinary Incontinence
Is it normal?
Though it's common, doctors say that urinary incontinence isn't normal. "Leakage should never be considered ‘normal’. Often, urinary incontinence has been considered to be part of the aging process, but it need not be," says Gary E. Lemack, MD, professor of Urology and Neurology at University of Texas Southwestern Medical Center. "Most forms of incontinence can be readily treated. Since there are various forms of incontinence, one size most certainly does not fit all when it comes to treatment, and therefore an evaluation by a health care provider with expertise in this field is recommended when the symptom becomes bothersome."
Urogynecologist Mary South, MD, of University of Cincinnati Academic Health Center, agrees: "Bladder leakage is never normal. Treatment is available and a woman should seek consultation with her physician or ask for a referral to a urogynecologist. In very rare circumstances, urinary urgency and frequency can be a symptom of a more serious health condition, but this is the exception. This condition is very common and experienced by many women, particularly as they age. Consultation with a physician will most likely put a woman's mind at ease and help her determine what treatment options exist."
"More sanitary napkins are used for incontinence than for menstruation," says Philip Hoekstra, MD, Chief of Spectrum Health Medical Group, Division of Urology, and Associate Clinical Professor of Surgery at Michigan State University.
Types of incontinence
All incontinence issues are not the same. "The two most common types of incontinence are urge incontinence -- which is the more common of the two -- and stress incontinence. They account for about 90 percent of all incontinence. Urge incontinence means you cannot get to the bathroom fast enough. Stress incontinence means leaking occurs when you laugh, cough, lift something, sneeze or exercise," explains Lisa N. Hawes, MD, urologist with Chesapeake Urology Associates in the Baltimore area. "There are other kinds of incontinence, but these are less common including overflow incontinence, sphincteric deficiency, and leaking for other neurologic reasons, such as with multiple sclerosis (MS) or Parkinson’s Disease which can impair bladder function."
Causes of bladder leakage
The common causes of urinary incontinence are varied. Excessive urine production can be an issue due to uncontrolled diabetes or excessive fluid drinking. Too much caffeine can also stimulate the bladder. Additionally, disorders and diseases such as the aforementioned MS and Parkinson's as well as spina bifida, strokes and spinal cord injury.
"While it can be a sign of a more serious problem, this is the case only in rare circumstances. More often, it is due to either a primary bladder storage problem, which can be attributed to the bladder not holding enough urine (or developing bladder spasms), or the bladder outlet or urethra losing strength over time. Very rarely, it may be due to other conditions such as stones, or bladder tumors. When urge incontinence comes on suddenly and has not been previously experienced, it might be associated with a severe urinary tract infection," says Lemack.
"For causing incontinence, risk factors include obesity, pregnancy, vaginal delivery and high birth weight babies, as well as diabetes, neurological disease, and finally maturity with associated estrogen deficiency," says Philip Hoekstra, MD, Chief of Spectrum Health Medical Group, Division of Urology, and Associate Clinical Professor of Surgery at Michigan State University. "The most common diagnosis for admission to a long term care facility is urinary incontinence. Urinary incontinence can result in recurrent urinary tract infections, skin irritation and break down, social isolation and depression."
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If you are suffering from more than rare bladder leakage, you shouldn't be ashamed. Millions of women (and men) experience urinary incontinence at some point in their lives. To cope with incontinence issues, consider wearing pads, such as those from Poise, and always carrying a change of underwear or clothing with you to deal with unexpected urine leakage. Seek treatment with your primary care doctor, who may refer you to a urologist or urogynecologist. Treatment options vary tremendously and may include Kegel exercises, timed voiding, urethral injections, oral medications and possible surgery.
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"Stress urinary incontinence and urge urinary incontinence are treated differently. Stress urinary incontinence can be treated with pelvic floor rehabilitation to strengthen the Kegel muscles, an incontinence pessary, or surgery. The primary surgical treatments include a midurethral sling (which is a 20 minute procedure done in the operating room) or a urethral bulking agent injected directly into the urethra. These treatments are minimally invasive. More invasive and older treatments have been performed in the past (for example, the BURCH procedure or MMK) but these are less and less commonly performed," explains South.
"Urge urinary incontinence can be treated with a combination of behavioral modification, pelvic floor rehabilitation, and anticholinergic medications. In addition, if these therapies do not work, other options include sacral neurmodulation, percutaneous tibial nerve stimulation, or Botox injections into the muscle of the bladder. All of these procedures are relatively minimally invasive and have a place in the care of patients with urge urinary incontinence that have not responded to more traditional therapies."
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No matter the severity of your bladder leakage, there's no need to be ashamed. Visit your doctor as soon as possible to develop a treatment plan.