The Leak of Which We Don’t Speak: Causes of Bladder Leaks and Tips for Strengthening

For generations, too many women have believed that urinary leakage was something they simply had to live with, an inevitable consequence of getting older or having children. And they felt embarrassed about discussing it, so they kept quiet and often ended up isolating themselves socially to avoid accidents. What is a woman to do?

Thankfully, this is changing, due in part to the barrage of ads we see about treatments for urinary incontinence (UI). As annoying as the ads may be to some people, they’re causing more women to seek medical help to deal with this condition, which is good news. And women are learning that they’re not alone.

In fact, according to the Agency for Healthcare Research and Quality, more than 13 million Americans have incontinence, and women are twice as likely to have it as men. About 25 to 45% of women suffer from urinary incontinence, defined as leakage at least once in the past year.

It’s important to know there are two basic types of urinary incontinence (and some women can have both):

• Overactive bladder (OAB), also referred to as urge UI, is the sudden urge to urinate that you can’t control. It occurs because the bladder muscles start to contract involuntarily even when the amount of urine in the bladder is low; this contraction triggers an urgent need to go.
• Stress UI is the unintentional loss of urine that occurs when physical activity or movement, such as sneezing, coughing, lifting, or exercise, puts pressure (stress) on your bladder. Common causes are pregnancy and childbirth, older age, and conditions that cause a chronic cough, which can cause the pelvic muscles to stretch and weaken.

Treatment depends on the type of UI you have, but the good news is that today there’s a range of effective treatment options, including some steps you can take on your own. Here’s an overview:

Ways to Treat OAB

• Pelvic floor exercises (often referred to as Kegels). We find that 50% of women who do these regularly see a 75% improvement in their leakage. If you don’t know how to do these exercises, we can refer you to a physical therapist who specializes in teaching them.
• Behavioral therapies. These include timed voiding (emptying the bladder on a regular basis, whether or not you feel the urge to go), bladder-holding techniques and consuming fluids on a specific schedule.
• Lifestyle changes. This includes avoiding or cutting down on triggers such as caffeine, alcohol or artificial sweeteners.
• Medications. Currently, there are seven different medications available (in oral and skin patch forms) specifically prescribed for bladder control.
• Botox. Injected into the bladder muscles via a cystoscope, Botox works by partially blocking the nerves that overstimulate the bladder muscles.
• Electrical nerve stimulation. There are two ways to modulate electrical impulses to the nerves to calm the bladder: percutaneous tibial nerve stimulation, which is similar to acupuncture treatments, or sacral nerve stimulation, which works more like a pacemaker for the bladder.

Ways to Treat Stress UI

• Pelvic floor exercises. Same as above, these are effective for this form of UI.
• Pessary placement. A pessary is a support device placed in the vagina (nonsurgically).
• Surgery. This includes minimally invasive vaginal sling procedures that help close your urethra and bladder neck (the part of the bladder that connects to the urethra.

Even if you’ve tried one medication or approach and it didn’t work, there are so many treatment options today that I urge you not to give up. Find a doctor who is willing to work with you to come up with the right solution for you.

As a doctor who specializes in these conditions, I want to reassure you that while urinary incontinence is exceedingly common, it’s NOT normal, and you shouldn’t feel you have to live with it, especially if it interferes with your quality of life.

And know that insurance does cover these treatments!

Guest blogger: Cynthia Hall, MD, Obstetrics and Gynecology – Female Pelvic Medicine and Reconstructive Surgery