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Health Matters: You Don’t Have to Live with Urinary Incontinence

By Emily Marshall, PA-C

From small leaks to sudden accidents, urinary incontinence can feel embarrassing and have a negative impact on your quality of life.

However, you don’t have to live with urinary incontinence, and with the right diagnosis and treatment approach, you can regain control.

Penn Medicine Princeton Urogynecology and the Center for Pelvic Wellness at Penn Medicine Princeton Medical Center (PMC) offer highly specialized, progressive treatment for a wide range of pelvic disorders, including urinary incontinence.

Not a Normal Part of Aging

Urinary incontinence, the loss of bladder control that causes accidental urine leakage, is a common condition, especially among women.

According to the U.S. Department of Health and Human Services Office on Women’s Health, urinary incontinence affects twice as many women as men. This is because health events unique to women — such as pregnancy, childbirth and menopause — affect the bladder, urethra, and pelvic floor which includes the muscles that support these organs.

Although urinary incontinence is more common in older women — more than 4 in 10 women 65 and older have symptoms — it is not a normal part of aging.

Stress and Urge

While there are several types of urinary incontinence, the two most common are:

Stress incontinence — Urine leaks when movements, such as laughing, coughing, sneezing, or exercising put pressure on your bladder and supporting structures. Stress incontinence is the most common type of urinary incontinence and is also the most common type that affects younger women, according to the Office of Women’s Health.

Urge incontinence — Characterized by the strong, sudden urge to urinate. Often, women with urge incontinence are unable to get to the bathroom in time. Some women with urge incontinence feel the need to urinate more than eight times a day. Urge incontinence is often a symptom of overactive bladder.

Often, women will experience both stress incontinence and urge incontinence together.

Variety of Factors

A variety of factors can lead to urinary incontinence, including:

• Pregnancy and childbirth, which put strain and pressure on the bladder, urethra, and pelvic floor.

• Menopause. Lower levels of estrogen can cause irritation to the bladder, urethra, and vagina.

• Overweight and obesity. Extra weight puts pressure on the bladder and can weaken the pelvic muscles over time.

• Constipation. Increased stool burden can irritate the bladder and straining can weaken the pelvic muscles.

• Hysterectomy or other surgery that affects the female reproductive organs.

• Neurological disorders or injuries that affect the central nervous system, such as multiple sclerosis, Parkinson’s disease, stroke, or tumor.

• Some medications, such as diuretics, certain antidepressants, antihistamines, and cold medications.

• Beverages and foods that increase urine production and stimulate the bladder, such as caffeinated drinks, alcohol, spicy foods, and acidic foods like tomatoes and citrus fruit.

Options for Treatment

If you are experiencing urinary incontinence, don’t wait to seek medical help. There are several safe and effective treatment options, including:

• Dietary changes, such as avoiding foods and beverages that stimulate the bladder and eating more fiber to relieve constipation.

• Pelvic floor exercises. Physical therapy can help strengthen your pelvic floor muscles to better support your bladder and other pelvic organs. Additionally, pilates and yoga are effective for strengthening the pelvic floor.

• Training the bladder to hold more urine and completely empty each time so you can better control the urge to urinate.

• Injections. For urge incontinence, botulinum toxin injections in the bladder can help relax the bladder wall muscles. Injections of bulking agents in tissues surrounding the urethra help prevent bladder leaks associated with stress incontinence.

• Medications. A variety of medications can relax the bladder, help prevent muscle spasms, and increase bladder capacity.

• Percutaneous tibial nerve stimulation (PTNS). This nonsurgical technique involves placing a thin needle under the skin of your ankle near the tibial nerve. A stimulator sends mild electrical pulses through the needle to the tibial nerve and then to other nerves that control bladder function.

• Vaginal pessary. A vaginal pessary is a small, removable device that is inserted into the vagina to help support the pelvic floor muscles. It is a nonsurgical treatment for stress incontinence.

• Sling procedures. These surgical procedures use your own tissue, donor tissue, or synthetic material to support the urethra and help it stay closed to prevent leaks.

• Neuromodulation device. With this surgical procedure, the doctor inserts a small stimulator device under the skin of your buttock. It sends mild electrical pulses to the nerves that control bladder function.

With so many treatment options available, it is important to work with your doctor and treatment team to identify an approach that is best for you.

Whether you leak a few drops or totally empty your bladder, accidental urine leakage is not something you have to live with. Talk to your doctor and take control of urinary incontinence so it no longer controls you.

To find a physician affiliated with Penn Medicine Princeton Urogynecology, please call 888-742-7496. For more information about the Center for Pelvic Wellness at Princeton Medical Center, visit www.princetonhcs.org/pelvicwellness.

Emily Marshall, PA-C, is a certified physician assistant at Penn Medicine Princeton Urogynecology.

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