By Margaret Hines, MD
Division of Urogynecology and Pelvic Surgery

Have you ever leaked urine when you cough, laugh, sneeze, or exercise? Or felt a strong urge to go and don’t always make it to the bathroom in time? You are not alone. Urinary incontinence is a very common condition that affects millions of women in the U.S., with studies estimating that more than 50% of adult women have issues with urinary incontinence. The good news is that there are many ways it can be managed and treated.

What exactly is urinary incontinence?

Urinary incontinence, also known as UI, is simply the accidental loss of urine. It happens when the muscles that control urine flow do not work as they should. While it can affect anyone, it’s more common in women than men. Understanding the type of incontinence you have is the first step toward finding relief.

The three different types of incontinence are:

Stress incontinence: This happens when physical activity or pressure on your bladder causes urine to leak. Simply laughing, sneezing, coughing, or exercising can cause leakage. It’s often caused by weakened pelvic floor muscles and ligaments that support the bladder and urethra.

Urge incontinence (or overactive bladder): This is usually a sudden, intense need to urinate, followed by an involuntary loss of urine, such as when you can’t hold your urine in long enough to reach the bathroom. Urge incontinence can be caused by nerve damage or by bladder muscles that contract too often.

Mixed Incontinence: This is a combination of stress and urge incontinence. Many women suffer from both types.

Why does this happen to women so often?

Several factors can increase a woman’s risk of developing UI:

• Pregnancy and childbirth:Both can weaken pelvic floor muscles and damage nerves.
• Menopause:Lower estrogen levels after menopause can affect the health of the bladder and urethra.
• Chronic constipation: Constipation is an often overlooked cause of urinary incontinence, especially urge incontinence.
• Aging:Urinary incontinence is not a “normal” part of aging. However, the risk of UI can increase with age.
• Obesity:Extra weight puts more pressure on the bladder and pelvic floor muscles, and may lead to metabolic changes that affect bladder health and function.
• Certain medical conditions:Conditions like diabetes, stroke, or multiple sclerosis can affect nerves that control the bladder.
• Hysterectomy:This surgery can sometimes affect pelvic floor support and increase the risk of UI.

Effective ways to manage and treat UI

The good news is that many effective treatments for UI are available. Your healthcare provider might suggest:

• Dietary changes:Cutting back on drinking caffeine, carbonated beverages, artificial sweeteners, and alcohol can make a big difference.
• Exercise: Kegel exercises can help strengthen your pelvic floor muscles and prevent bladder leakage. Exercise can also be used to reduce tension in the pelvic floor muscles, which can cause urge incontinence and overactive bladder. There is even formal pelvic floor physical therapy to help with this, if needed.
• Bladder training:This treatment involves learning to resist the urge to urinate and gradually increasing the time between trips to the bathroom.
• Medications:Prescription medications can help calm an overactive bladder and improve bladder control.
• Medical devices:For some women, options like vaginal inserts can help support the urethra and prevent leakage.
• Surgery:Surgical procedures can offer long-term relief in some cases, especially for stress incontinence. Most of these are minimally invasive, and patients can go home the same day.

When should you seek help?

If bladder leakage is causing you discomfort or limiting your daily activities, it’s time to talk to your healthcare provider. There’s no reason to feel ashamed or embarrassed. Your medical provider has seen this condition before and is ready to help. They will help you understand the cause of your incontinence and recommend the treatment plan that’s best for you. Women who need more extensive care are often referred to a Urogynecology specialist (men typically see a urologist for their incontinence problems).

At Reliant we have a comprehensive Urogynecology team of board-certified urogynecologists, advanced practitioners and physical therapists that are ready to help. Our urogynecologists also treat women with pelvic prolapse (vaginal bulge), recurrent urinary tract infections, bladder pain, and fecal incontinence.

Our Urogynecology team is located at the Women’s Center for Pelvic Medicine & Surgery in Westborough, and we also see patients in Worcester and Leominster. You can learn more about all our services here.