By Martin P. Michalewski, MD, FACOG, FPMRS
Urinary incontinence—also known as bladder leakage—affects millions of women. While it becomes more prevalent as you age, it’s not a normal side effect of the aging process and you don’t have to accept its symptoms and live with it.
The Basics of Bladder Leakage
- Most women begin to experience symptoms in their 40s and 50s, after childbearing. In some cases, however, it can start earlier, particularly for those predisposed to urinary conditions.
- There are three types of urinary incontinence:
- Stress incontinence occurs when weakened pelvic floor muscles cause you to leak urine when you cough, sneeze, jump or laugh.
- Urge incontinence typically occurs in older women, when the bladder’s muscles weaken or its urine-holding capacity decreases. Also called overactive bladder, this condition causes uncontrolled bladder contractions, creating an intense urge to urinate or leak.
- Mixed incontinence, as its name suggests, is a combination of both urge and stress incontinence.
- A comprehensive evaluation of urinary incontinence may involve up to five steps:
- A review of your symptoms and medical history
- A physical, pelvic, or urogynecological exam
- An ultrasonogram to evaluate the uterus, bladder, and rectum, their position and size, and to look for any unusual anatomical characteristics of the pelvic organs
- A cystoscopy, or video scope of the bladder, to view the health of the bladder and urethral tissue
- Urodynamic testing to measure nerve and muscle function, pressure in and around the bladder, flow rates, fluid capacities and more
- A common misconception is that bladder leakage is a normal milestone in the aging process. There are several reasons why women experience urinary incontinence and variety of options to treat it.
- Urinary incontinence can be caused by:
- A bladder issue
- Prolapse, when a pelvic organ slips out or down from its position
- A decrease in muscle tone
- Weakened pelvic floor support
- A condition of the body’s connective tissues called hypermobility
More About Urge Incontinence
- One in three women over the age of 40 experience symptoms of urinary incontinence, while it effects one in two women over age 60. For women age 80 and older, it’s rarenot to have some type of incontinence.
- Pelvic floor support issues can create a situation similar to pregnancy, putting pressure on surrounding organs. And, as many pregnant women experience, this increased pressure in the pelvis compresses the bladder, causes pain, and increases frequency and urge to urinate, often interfering with sleep, driving, or other routine activities.
- Surgical treatments can cure 99 percent of stress incontinence situations, but surgery is not designed to fix urge incontinence. First-line treatment options for urge incontinence include diet and behavioral modifications, bladder retraining and timed voiding, oral medications or medications installed into the bladder by catheter, Botox bladder injections, an acupuncture-like treatment called neuromodulation or Urgent PC, and a pacemaker-like implantable nerve stimulator.
Incontinence and Childbirth
- Multiple vaginal births can weaken pelvic floor muscles and lead to urinary incontinence. However, women who haven’t given birth vaginally also can develop incontinence.
- Giving birth vaginally later in life increases the risk of developing urinary incontinence because the amount of collagen in tissues decreases, as does the ability to heal and regenerate healthy tissues. Recovery from vaginal birth for women in their 40s can be more difficult since they may already have bladder-related issues due to the effects of gravity, decreased hormones, or other medical conditions.
- Women who give birth via C-section rarely have incontinence issues. In fact, C-section surgery can help keep bladder and vaginal muscles tight. For instance, in highly developed countries like Italy, France, and Brazil, many women routinely opt to deliver via C-section to preserve their pelvic organs.
Simple Changes to Improve Bladder and Pelvic Health
- Drinking a lot of caffeine or alcohol can worsen incontinence, since these beverages increase the need to urinate. Avoid drinking fluids after 10 p.m. If you’re thirsty, try chewing on ice chips. Limit coffee, soda, strong tea, and alcohol after 6 p.m.
- Healthy sleep and incontinence are inversely related. Incontinence can increase due to stress, anxiety, and lack of rest, and if incontinence wakes you up frequently, you can’t get a good night’s sleep. See a physician who specializes in female pelvic medicine and reconstructive surgery to regain control.
- Eating a diet rich in fresh, organic foods can improve the condition, as can limiting processed foods and those containing pesticides, dyes, antibiotics, stabilizers, preservatives, and hormones. Avoid acidic and other bladder-irritating foods.
- Incontinence becomes more prevalent in women with higher BMI, and the condition is common in women who weigh between 170 and 220 pounds. Losing weight can significantly improve bladder leakage. In fact, studies show that losing just 10 percent of your body weight can improve urinary conditions by up to 60 percent.
Options to Treat the Tinkle
- The vagina and bladder are estrogen-dependent organs, so as the level of estrogen declines in women after menopause, both organs suffer. Estrogen-containing vaginal creams can greatly improve bladder function and other symptoms of menopause like vaginal dryness without the risk of causing breast cancer. Over-the-counter edible yam extract and soy isoflavones also can help.
- If you’re not sexually active, the muscles in the vagina and pelvis will weaken and eventually shrink. Dilators can help restore the vaginal opening, and proper pelvic floor exercises can strengthen the muscles. Kegel exercises won’t restore prolapsed pelvic organs, but pelvic floor muscle therapy under the direction of a trained therapist can teach you how to squeeze the correct muscles to improve symptoms and at least slow progress of the disorder.
- There are several treatment options, including:
- Lifestyle modifications, like changing your diet, getting more sleep, and losing weight
- Oral medications to stabilize the bladder
- Acupuncture via a neuromodulator machine in the ankle, which sends impulses to the bladder
- Botox injections, which can eliminate bladder spasms and increase urine-holding capacity. Treatments take about five minutes and lasts up to three months.
- Medications that are fed into the bladder with a tube and then urinated out
- An implantable bladder stimulator, an advanced option if the above treatments don’t provide relief
- Injectable collagen
- Radiofrequency treatment
- Laser vaginal rejuvenation
- Computer-controlled pelvic floor muscle therapy
- Surgery, as a last (but not least effective) option
- Uterine or bladder prolapse are types of pelvic floor hernias, and like any other hernia, once it happens, it won’t reverse on its own. It not only leads to bulge, incontinence, pressure, pain, and discomfort, but also can cause an obstruction by kinking pelvic organs. Prolapse also may result in kidney issues or a life-threatening infection. Outpatient surgical procedures can correct the condition and alleviate symptoms.
- It’s vitally important to get the right treatment the first time. Every patient’s situation is unique and it’s important that treatment is tailored to your needs, expectations, lifestyle, and age. If you have surgery to reverse incontinence and it fails, you may develop scar tissue or alter your anatomy in a way that limits your future treatment options. Surgery, when indicated, should be performed by a highly skilled, experienced surgeon who specializes in the field. Research shows that surgeons with the highest volumes have better outcomes.
- Surgical treatments include vaginal, laparoscopic, and robot-assisted outpatient reconstructive treatments options, including the suburethral sling (not vaginal mesh). All restore pelvic floor support, improve bladder function, and reverse incontinence. Surgical treatments involving vaginal mesh are not recommended for sexually active women.
- While your doctor may recommend a total hysterectomy, it’s important to note that prolapse or incontinence are not a “fault” of the uterus, but rather the surrounding connective tissue and ligaments. Therefore, only removing the uterus won’t fix the problem and you will likely need to undergo more complex procedures in the future. There are many other less-invasive options to treat prolapse.
You shouldn’t “tolerate” urinary incontinence or prolapse issues by wearing pads, diapers, or changing your lifestyle. As detailed above, there are a variety of options to cure, treat, or prevent the condition from getting worse—and improve your quality of life. Many patients say that they didn’t realize how much incontinence was affecting their lives until they treated it. The sooner you see a doctor, the more options you’ll have to consider. A simple 15-minute treatment can help you get back to travelling, playing sports, and running after your kids or grandkids.
Dr. Martin P. Michalewski is medical director of the new Urogynecology and Pelvic Medicine Program at CentraState Medical Center. He is board-certified in obstetrics-gynecology and FPMRS. He can be reached by calling 866-CENTRA7.