By James Bunker, MD

James Bunker, MD
James Bunker, MD

Urinary incontinence is strictly defined as an involuntary loss of urine which negatively impacts one’s quality of life. It is a very common condition affecting over 20 million people in the United States. The true number is likely higher since many are too embarrassed to report their symptoms. The amount of health care dollars spent on urinary incontinence in the US is significant, estimated at 15-20 billion dollars per year. Over her lifetime, a woman has a 25% chance of being effected by urinary incontinence.

While there are several different types of incontinence, two are most commonly encountered. The first is called stress incontinence where leakage of urine occurs during episodes of straining, such as coughing, laughing, lifting or exercising. With stress incontinence, increases in abdominal pressures exceed the body’s ability to prevent urine from leaking. This usually results from a loss of bladder support or from a weak urethra. Loss of support (also known as prolapse) is usually a consequence of childbirth. However, it can occur because of the aging process, obesity, chronic cough, repeated heavy lifting, or even weakened tissues due to smoking. A weak urethra can also be a consequence of childbirth, but is more commonly associated with aging or previous pelvic surgery.

The second most common type of incontinence is urge incontinence, sometimes referred to as “overactive bladder.” People with this type of incontinence usually have a sudden, uncontrollable urge to urinate and will consequently leak urine, occasionally in large amounts. They also report certain things will trigger their urge, such as unlocking the door to their house or hearing and seeing water running. People with urge incontinence typically know where all the public bathrooms are located, since the urge often arises outside the home. There are many causes of urge incontinence, including urinary tract infections, bladder stones, certain foods, alcohol, caffeine, and tobacco products. Neurologic diseases such as multiple sclerosis, dementia, and stroke can also cause urge incontinence. However, in most cases no obvious cause can be identified.

When evaluating incontinence, it is critical to determine which type is present, as treatments will vary. Sometimes a person has more than one type, which can complicate the diagnosis. Therefore, it is important to see someone with expertise in evaluating urinary incontinence. For women, this is typically a gynecologist or urologist. At the initial visit a detailed medical history will be obtained to see if you have any risk factors for incontinence. A review of all your medications, supplements and diet is crucial. A physical exam should also be performed, especially a pelvic exam to assess for any evidence of prolapse, weak pelvic muscles, or evidence of nerve damage. Often times you will be asked to keep a “bladder diary,” tracking what you drink and how much you urinate and leak. Finally, special studies may be ordered to evaluate for problems involving the bladder or urethral muscles.

Once all of this information is reviewed, your doctor will decide what type of incontinence you have (remember it could be a combination). He or she will then discuss what treatment options are available. Recommendations may include simple interventions such as adjusting your diet or doing pelvic muscle exercises, also known as Kegel exercises. Sometimes a referral to a physical therapist who specializes in treating incontinence is advised. In fact, pelvic floor physical therapy using biofeedback has been shown to improve incontinence in over 50% of cases. Medications are also available to treat incontinence and can be very effective. However, side effects may occasionally be an issue. If obesity is a contributing factor, weight loss has been shown to result in significant improvement. Alternative therapies such as acupuncture and naturopathic treatments have been used with varied success. Finally, a device worn in the vagina known as a pessary can be tried, especially if prolapse is present. If conservative measures fail and/or a pessary is not desired, surgery may be an option. Typically, surgery only helps with stress incontinence that is related to prolapse or a weak urethral muscle. It can actually worsen urge incontinence, once again highlighting the importance of seeing an expert.

In conclusion, urinary incontinence is a very common condition which can significantly impact one’s quality of life. Fortunately, there are effective treatments available. However, many women don’t take advantage of these treatments because they are too embarrassed to talk about it. If you are one of the millions who suffer from urinary incontinence, let your health provider know so you can begin to take back your life!

James Bunker, MD is board certified in obstetrics and gynecology. He practices at Brattleboro OB/GYN, a department of Brattleboro Memorial Hospital. He can be reached at 802-251-9965.