By Heather M. van Raalte, MD
Enjoying everyday life can be challenging when your activities must be planned around frequent visits to the bathroom, or you experience urinary leakage or other bladder-related problems.
While an estimated 25 million people in the United States experience bladder leakage every day, according to the National Association for Continence, many hesitate to discuss their condition with a doctor out of embarrassment.
However, once the cause of the problem is diagnosed, urinary incontinence is often treatable.
More Prevalent in Women
Urinary incontinence is defined as the involuntarily leaking of urine, whether just a few drops or a bladderful.
Incontinence occurs when the pelvic floor — the muscles, tissues and ligaments that hold the pelvic organs (vagina, uterus, bladder, urethra, and rectum) in place — weakens over time.
A common condition, it affects both men and women, although it is more prevalent in women.
For women, weakening of the pelvic floor is typically caused by pregnancy, childbirth, age, or obesity. In men, prostate cancer surgery, bladder or bowel problems, and heavy lifting or high-impact exercising may weaken pelvic floor muscles.
Three Main Types
As the American College of Obstetrics and Gynecology (ACOG) notes, urinary incontinence in women can be divided into three main types:
- Stress urinary incontinence: Leaking urine when coughing, laughing or sneezing. Leaks also can happen when a woman walks, runs or exercises.
- Urgency urinary incontinence: A sudden strong urge to urinate that is hard to stop. Women with this type of urinary incontinence may leak urine on the way to the bathroom. If you have an “overactive bladder,” it means that you have symptoms of urgency and frequency that may or may not include incontinence.
- Mixed incontinence: Combines symptoms of both stress urinary incontinence and urgency urinary incontinence.
Several Treatment Options
The first step in treating urinary incontinence is usually a medical history and physical exam to help determine the cause of the condition.
Often urinary incontinence can be managed with certain lifestyle changes and exercises to strengthen the pelvic floor. It’s important to seek treatment, as professional education and tools can help ensure you successfully manage the condition. The Center for Pelvic Wellness at Penn Medicine Princeton Medical Center offers specialized physical therapy for the pelvic floor.
Certain medications may also be prescribed to help relax bladder muscles, which helps decrease urgency and frequency and increase warning time when you need to urinate, so you have more time to make it to the bathroom without a leak.
When medication does not work or is not a good fit for the patient, Botox or a synthetic bulking material may be administered as injections in a doctor’s office to treat incontinence. Botox helps relax the bladder to decrease urgency and frequency and the bulking substance acts to plump up and narrow the opening of the urethra to decrease leakage.
Women may also be fitted for an internal medical device that is designed to be inserted into the urethra as needed to help prevent urinary leakage.
For those whose problems persist, there is a tiny device that works like a pacemaker, providing gentle stimulation to help restore proper bladder function. The device is inserted just under the skin in the upper part of the buttock in a brief outpatient procedure.
There also are minimally invasive surgical options, including an implantable support for the urethra called a pubovaginal sling to treat stress incontinence. Another option is pelvic reconstructive surgery if the bladder is out of place, or the pelvic organs have dropped from their normal position because of prolapse.
Decrease Your Risk
You can decrease your risk for incontinence with certain lifestyle changes:
- Maintain a healthy weight. In overweight women, losing even a small amount of weight (less than 10% of total body weight) may decrease urine leakage, according to ACOG.
- Avoid bladder irritants such as caffeine, alcohol, and high-acid foods.
- Eat a diet high in fiber.
- Don’t smoke.
- Train your bladder to increase the time span between urinating to normal intervals — every three to four hours during the day and every four to eight hours at night, according to ACOG.
If you suffer from urinary incontinence, keep in mind that with so many options for treatment available, there is no reason to limit your activities or plan your life around the bathroom.
To find a physician affiliated with Penn Medicine Princeton Health or for more information about the Center for Pelvic Wellness at Penn Medicine Princeton Medical Center, call 888-742-7496 or visit www.princetonhcs.org.
Heather M. van Raalte, MD is double board certified in obstetrics and gynecology as well as female pelvic medicine and reconstructive surgery. She is the chairperson of the Department of Obstetrics and Gynecology at Penn Medicine Princeton Health and medical director of the Center for Pelvic Wellness at Princeton Medical Center.