A common, frustrating problem for millions of Americans is urinary incontinence, the loss of voluntary bladder control. Although it can affect anyone, it is 50 percent more common in women than men, and might be troublesome for more than 40 percent of women over 40.
Not being able to predict when or where urine loss might occur can interfere with work, exercise, or even being able to enjoy social activities.
There are different types of incontinence. The most common is stress incontinence, which occurs when abdominal pressure suddenly increases, as with laughing, coughing, sneezing, or lifting something heavy.
This problem is caused by weakening of the muscles supporting the bladder and bladder opening. Pressure from a laugh or a cough may be all it takes to cause a leak. These supportive muscles can lose strength for different reasons, such as pregnancy and childbirth, weight gain, or sports injuries.
Those who often feel the need to urinate but can't get to the bathroom in time might have urge incontinence. Sometimes the urge can come from the sound of running water or from sipping a drink, but there could also be no trigger for the leak.
Urge incontinence can make sufferers feel like they must empty their bladder when it isn't full, or cause several trips to the bathroom at night, interrupting sleep.
This sudden, uncontrollable need to urinate is caused by spasms in the bladder muscles, which can be caused by nerve or muscle damage, injuries, certain medications, or caffeine intake.
Overactive bladder (OAB) might cause a sudden, frequent need to urinate, but might not always cause leaking. Even if people can "hold it" until they make it to the bathroom, they can still be bothered by constantly having to interrupt activities to go.
Although incontinence isn't dangerous, it can certainly affect one's quality of life. But there are many treatments that can improve or even reverse incontinence.
The first step is to diagnose the type of incontinence. The doctor will ask about medical history, get a urine sample to check for infection, and do a physical exam. The patient might be asked to keep a diary of drinks, urination, and how often leaks occur. Other tests might be necessary to pinpoint the exact cause of incontinence.
Treatment is then tailored to the type of incontinence. This might be as easy as modifying caffeine intake, or regularly scheduled emptying of the bladder, even when there is no feeling of the need to go.
Home exercises for bladder support (Kegel exercises) can increase the strength of the pelvic muscles and improve bladder control. Pelvic floor physical therapy might help further. Medications can be helpful for urge incontinence and OAB, especially when combined with bladder training.
For both stress incontinence and urge incontinence, different types of surgeries can help.
Bottom line: There is no need to suffer in silence. If incontinence is an issue, talk to your health care provider.
Gregory Glover, MD, FACOG, FPMRS, is a board-certified urogynecologist, specializing in female pelvic medicine and reconstructive surgery, with Werner & Glover Women's Health in Beaufort.