Managing Urinary Incontinence

By Jane Farrell

Editor’s note: Bladder leakage, which can be caused by something as simple as a sneeze, is a common, annoying and even embarrassing condition for millions of women. But there are ways to manage and treat it. Here, the experts from the National Institute of Diabetes and Digestive and Kidney Diseases, one of the National Institutes of Health, offer some tips:

You may think bladder control problems are something that happen when you get older. The truth is that women of all ages have urine leakage. The problem is also called incontinence. Men leak urine too, but the problem is more common in women. About half of adult women say they have had leakage at one time or another, and many say it’s a daily problem.

Leakage occurs in a number of circumstances: Many women leak urine when they sneeze, exercise, laugh hard or cough. Additionally, women often leak urine when they are pregnant or after they have given birth. Menopausal women often report bladder control problems, and female athletes of all ages may experience urine leakage during strenuous sports activities.

Urine leakage is more common in older women, but that doesn’t mean it’s a natural part of aging. You don’t have to “just live with it.” You can do something about it and regain your bladder control.

Incontinence is not a disease. But it may be a sign that something is wrong. It’s a medical problem, and a doctor or nurse can help.

Not all bladder control problems are alike. Some problems are caused by weak muscles, while others are caused by damaged nerves. Sometimes the cause may be a medicine that dulls the nerves.

To help solve your problem, your doctor or nurse will try to identify the type of incontinence you have. It may be one or more of the following six types:

Temporary incontinence. As the name suggests, temporary incontinence doesn’t last. You may have an illness, like a urinary tract infection, that causes frequent and sudden urination that you can’t control. Or you may find that a new medicine has the unexpected side effect of increasing your urination. These problems go away as soon as the cause is found and corrected.

Stress incontinence. If you leak urine when you cough, laugh, sneeze, or exercise, you have stress incontinence. Mental stress does not cause stress incontinence. The “stress” is pressure on the bladder. When your pelvic and sphincter muscles are strong, they can handle the extra pressure from a cough, sneeze, exercise, or laugh. But when those muscles are weak, that sudden pressure can push urine out of the bladder.

Urge incontinence. If you leak urine after a strong, sudden urge to urinate, you have urge incontinence. This bladder control problem may be caused by nerve damage from diabetes, a stroke, an infection, or another medical condition.

Mixed incontinence. Mixed incontinence is a mix of stress and urge incontinence. You may leak urine with a laugh or sneeze at one time. At another time, you may have a sudden, uncontrollable urge to urinate just before you leak.

Functional incontinence. Some people have trouble getting to the bathroom. If you have urine leakage because you can’t walk or have other mobility problems, you have functional incontinence.

Overactive bladder. If you have to urinate eight or more times a day, you may have an overactive bladder. Getting up to urinate two or more times each night is another sign of overactive bladder. With an overactive bladder, you feel strong, sudden urges to urinate, and you also may have urge incontinence.

Urine leakage has many possible causes.

Weak muscles. Most bladder control problems are caused by weak pelvic muscles. These muscles may become stretched and weak during pregnancy and childbirth. Weak muscles let the bladder sag out of position, which may stretch the opening to the urethra.

Nerve damage. Damaged nerves may send signals to the bladder at the wrong time. As a result, a bladder spasm may push out urine without warning. Sometimes damaged nerves send no signals at all, and the brain can’t tell when the bladder is full. Nerves can be damaged by diseases or trauma. Diseases and conditions that can damage the nerves include diabetes, Parkinson’s, multiple sclerosis and stroke.

Trauma that can damage the nerves includes pelvic or back surgery; a herniated disc; or radiation.

Medicines, alcohol, and caffeine may also be to blame. Leaking can happen when medicines affect any of the muscles or nerves. You may take medicine to calm your nerves so that you can sleep or relax. This medicine may dull the nerves in the bladder and keep them from signaling the brain when the bladder is full. Without the message and urge, the bladder overflows. Drinking alcohol can also cause these nerves to fail. Water pills (diuretics) -take fluid from swollen areas of your body and send it to the bladder. This rapid filling may cause the bladder to leak. Caffeine drinks such as coffee and cola also cause the bladder to fill quickly. Make sure your drinks are decaf.

Infection. A urinary tract infection can irritate bladder nerves and cause the bladder to squeeze without warning. This type of incontinence goes away once the infection has been cured.

Excess weight. Being overweight can put pressure on the bladder and contribute to stress incontinence.

You can prepare for your visit to the doctor’s office by gathering the information your doctor will need to understand your problem. Make a list of the medicines you are taking. Include prescription medicines and those you buy over the counter, like aspirin or antacid. List the fluids you drink regularly, including sodas, coffee, tea, and alcohol. Tell the doctor how much of each drink you have in an average day.

Finding a Doctor

You will need to find a doctor who is skilled in helping women with urine leakage. If your primary doctor shrugs off your problem as normal aging, for example, ask for a referral to a specialist-a urogynecologist or a urologist who specializes in treating female urinary problems. You may need to be persistent, or you may need to look to organizations to help locate a doctor in your area.

Make a note of any recent surgeries or illnesses you have had. Let the doctor know how many children

You can use What Your Doctor Needs to Know and Your Daily Bladder Diary  to prepare for your appointment.

How is loss of bladder control treated?

Your doctor will likely offer several treatment choices. Some treatments are as simple as changing some daily habits. Other treatments require taking medicine or using a device. If nothing else seems to work, surgery may help a woman with stress incontinence regain her bladder control.

Talk with your doctor about which treatments might work best for you. And ask your doctor whether lifestyle changes, such as losing weight or avoiding caffeine, can help.

No medications are approved to treat stress urinary incontinence. But if you have an overactive bladder, your doctor may prescribe a medicine that can calm muscles and nerves. Medicines for overactive bladder come as pills, liquid, or a patch.

These medicines may cause your eyes to become dry, or result in dry mouth and . These medicines can also cause dry mouth and constipation. If you take medicine to treat an overactive bladder, you may need to take steps to deal with the side effects. Use eye drops to keep your eyes moist; chew gum or suck on hard candy if you’re bothered by dry mouth. Take small sips of water throughout the day.

Medicines for other conditions also can affect the nerves and muscles of the urinary tract in different ways. Pills to treat swelling (edema) or high blood pressure may increase urine output and contribute to bladder control problems.

Talk with your doctor; you may find that taking a particular medicine solves the problem without adding another prescription.

Reprinted courtesy of the National Institute on Diabetes and Digestive and Kidney Diseases. For more information on these issues, click here to visit the agency’s website.