Urinary incontinence in women can be treated

Published Nov 26, 2017 at 9:00am

Commonly older women develop problems with urinary control, called urinary incontinence.

If this is happening to you it is important to understand why and what can be done to prevent embarrassing situations.

Normally, the bladder fills with urine and the person feels a need to urinate. She urinates by loosening the muscles that hold the urethra closed, all the rest of the time. This is a conscious decision, yet one we are hardly aware of until there is a problem.

Incontinence is when the muscles that normally hold the urethra closed become relaxed at an inconvenient time. There is then leakage of urine into the clothing.

Stress incontinence is the common type. In women, risk factors for stress incontinence are previous vaginal childbirth and having entered menopause.

The stress is not mental stress, but physical stress. The woman may cough, laugh or sneeze and this presses against the walls of a full bladder, causing leakage. Lifting heavy objects or exercise may cause this, also.

The other kind of incontinence is sometimes called urgency incontinence or overactive bladder. Classically, this is someone who urinates accidentally at the sound of running water. So, this has a mental cause, but the incontinence is involuntary – meaning that it cannot be controlled.

If you are having trouble with incontinence, you should see your primary doctor. They will order a urinalysis to check for infection and do a physical exam. The history you give will help determine which type of the disorder you have, or you may have both.

Being overweight increases your chance of being incontinent. It is logical that extra weight in the torso, especially in the belly, would cause pressure on the bladder and increase the chance of leakage. Losing weight is very difficult, but it can be done. Begin to exercise regularly. Eat less, give up sweets and between-meal snacks. Gradually you will become thinner. If you lose weight, make sure to monitor your habits — continue to exercise and to eat less. Otherwise the weight will come back.

Diseases that affect the nervous system, such as Parkinson’s disease, multiple sclerosis, spinal cord injury, stroke, and diabetes all may lead to incontinence. This is called a neurogenic bladder and it can be difficult to treat.

If you have one of these conditions and you are having urinary leakage, ask the specialist who is caring for you (such as a neurologist) who to see to help with this situation. Medication and intermittent catheterization may be necessary.

In most cases, for any type of incontinence, you should start by cutting back on caffeine and timing your intake of liquids to fit your schedule.

You may want to train yourself to urinate regularly, at certain times, so the bladder is not too full. Pelvic floor muscle exercises (Kegel exercises) may help strengthen the muscles that control urination. This exercise is done by holding the muscles you use to stop the flow of urine and then releasing. Increase the number or times you do this over time.  

If the problem persists you may want to see a specialist, a urologist who is able to treat incontinence in women. There are some minor surgical procedures that may be helpful. Also, Botox may be injected into the bladder wall.

Although there are some medications that can be used to treat incontinence, there is no single treatment that is always useful. Your doctor may suggest a medication. It will probably need a two-week trial and then if it isn’t effective another medication may be tried. Estrogen in pill form is not effective, but estrogen cream applied to the vaginal area may help.

Adult diapers and incontinence products are now easy to use and acceptable. They may or may not be covered by your insurance.

Between 25-45 percent of women have this problem. The data is not clear, because many women do not discuss this with their provider. Yet it is such a common problem that most family doctors will have helpful advice and find an appropriate specialist, if needed.