Urinary incontinence, the involuntary leakage of urine, is a major health problem that affects approximately thirteen million people in the United States. Though 10–30 percent of women age 15 to 64 experience urinary incontinence at least some of the time, the condition tends to increase in frequency with age. It often makes itself known during perimenopause, when a great deal can be done to make sure it doesn’t progress. By the time women reach age 65, the overall rate of incontinence increases to about 15–35 percent.
Several types of incontinence exist, the most common being stress urinary incontinence (SUI). SUI occurs whenever you increase your intra-abdominal pressure so much (by coughing, sneezing, laughing, lifting or exercise) that your urethral sphincter, the muscle that holds the urethra closed, can’t hold back the urine that’s in the bladder. Urge incontinence (an overactive bladder) is the next most common form of incontinence. Women with this condition often find themselves missing out on normal activities because they have to go to the bathroom so often and worry whether or not one will be available.
The hallmark of stress incontinence is leaking urine (in small or not-so-small amounts) when you cough, sneeze, laugh, lift something or exercise (including running)—anything that puts pressure on your abdomen. The hallmark of urge incontinence is strong, sudden urges to urinate and the feeling that you might be about to wet yourself—which sometimes happens.
Stress urinary incontinence may result from problems with the sphincter muscle itself or from the fact that the angle of the urethral tube has changed, becoming too mobile to function properly—a condition known as urethral hypermobility. Urge incontinence is caused by involuntary contractions of the bladder muscle.
Contributing factors include:
Surgical approaches to stress urinary incontinence are often very successful. Sutures are placed in the tissue near the urethra to elevate the bladder neck so that it functions properly. The disadvantage of these approaches is that they require an abdominal incision and a fairly long recovery period. Find a surgeon specially trained in urogynecology.
A whole host of new surgical techniques have recently been developed to help permanently reposition the bladder neck so that urethral function is restored. They are done laparoscopically on an outpatient basis. Short-term results with the new techniques are also favorable, with a cure rate of about 82 percent. Long-term results are not yet available. In addition, several surgical techniques suspend the uterus thus "curing" prolapse without removing the uterus.
Another excellent option for some women involves injections of Teﬂon, body fat or bovine collagen around the urethra under local anesthesia. These injections increase the volume of urethral tissue, allowing it to close properly and prevent the leakage caused by stress urinary incontinence. It usually takes two or three injections over time to get the desired result, and they may eventually have to be repeated.
Urge incontinence is commonly treated with drugs such as tolterodine (Detrol) that inhibit detrusor contractions. Side effects include headache, dry mouth, dry eyes, constipation, and indigestion.
Keeping a record of when you leak to determine which substances and situations may be contributing to your incontinence. Record how often you experience the problem, any activity that precedes it, how much urine actually leaks, whether or not you experience a warning beforehand, if it wakes you up at night, and whether it follows the ingestion of certain foods, drinks, or medications.
Strengthening your pelvic floor is one of the best ways to prevent or cure urinary stress incontinence because when your pelvic muscles are strong, they can better support the urethra so that it doesn’t give out when you do anything that increases intra-abdominal pressure. It also increases the blood supply to your pelvis, making you more resistant to diseases such as urinary tract infections, and it enhances the ability to reach orgasm and improves vaginal lubrication during sex. I strongly recommend working with a physical therapist fully trained in pelvic ﬂoor rehabilitation. Though strengthening the pelvic ﬂoor won’t cure every type of urinary incontinence, it is always worth a try before resorting to surgery or drugs.
Kegel exercises are one effective way to do this. Some studies report that up to 75 percent of women are able to overcome stress incontinence with Kegels alone. You can do these exercises anytime and anyplace if you’re doing them properly, and not a soul will know. Unfortunately, the vast majority of women who are told to do Kegel exercises are not instructed in how to do them properly and they also give up too soon. Vaginal weights are another means of strengthening the pelvic floor.
Biofeedback-assisted behavioral treatment is another excellent way to strengthen your pelvic floor muscles. Studies show it gives better results than medication: from 50 to 89 percent improvement after six to eight weeks. The disadvantage is that it requires the use of rectal or vaginal probes.
Extracorporeal magnetic resonance therapy (EMRT) is yet another therapy option. This device, known as Neocontrol, uses a magnet built into a special chair. Magnetic energy is targeted on the pelvic floor muscles and increased slowly to create a magnetic field. The resonating magnetic flux will, in turn, induce electrical depolarization of nerves and muscles, resulting in contraction and exercise of exactly the right muscles.
For women whose incontinence is related to the changes in hormones during perimenopause and menopause, estrogen cream (such as estriol vaginal cream) can help. This cream is applied to the top surface of the outer third of the vagina enhances nerve function and blood supply to the urethra, which in turn increases muscle size and strength. It is available by prescription from any formulary pharmacy that carries natural hormones. The usual strength is 0.5 mg/g.
For mild stress incontinence, simply wearing a menstrual tampon is often helpful because they push on the vaginal wall, compressing the urethra. If you use tampons for this purpose, remember that they must be changed regularly to avoid toxic shock; don’t leave the same tampon in all day long. For more serious stress incontinence caused by urethral hypermobility, urethral prosthetic devices are very useful and are especially good for those women who have incontinence only during specific activities such as golf or aerobics. Examples include the Impress Softpatch (a single-use soft foam patch you can stick over the urethral opening to create a seal that stops mild to moderate leakage), the Reliance Urinary Control Insert (a small, soft balloon-tipped catheter-like insert that is fitted inside the urethra and is inflated with a small amount of air to keep it in place), the Fem-Assist and CapSure Shield (silicone devices that fit over the urethral opening like a suction cup), and the FemSoft Insert by Rochester Medical Products (a silicone tube inserted into the urethra and surrounded by a liquid-ﬁlled sleeve that creates a seal at the neck of the bladder, preventing leakage).
Several other devices work by reestablishing a normal angle between the bladder and urethra. These devices include the Incontinence Ring, the Incontinence Dish, the Incontinence Dish with Support (from Milex), and Introl’s Bladder Neck Support Prosthesis.
Reducing or eliminating caffeinated drinks (including coffee, tea and some soft drinks) can also help. Even decaf coffee is a diuretic—and so is cold weather. Coffee is also a known bladder irritant. It is also helpful to lose excess body fat.