Asking for a friend: Is urinary leakage common among women?
While there might be more life-threatening issues for women than incontinence, there are few that are more inconvenient – or perhaps less likely to be discussed.
When more than 1,000 women ages 50 to 80 were surveyed in 2018 by the University of Michigan’s National Poll on Healthy Aging, 43 to 51 percent said they had some experience with urinary leakage, ranging from occasional to daily. Yet two-thirds said they hadn’t talked to their doctors about it. And that’s just one form of incontinence. There are two most common forms of urinary incontinence. One is urinary leakage, which is associated with coughing, sneezing and activities. The other, urinary urgency, is familiar to many women who have to go right now.
Xibei Jia, MD, FACOG, a urogynecologist who recently joined Cape Cod Healthcare’s Urology Associates of Cape Cod, encourages women to speak up about incontinence and other pelvic floor disorders. Although some women accept incontinence as a part of aging, help is available – no matter your age, she said.
“Incontinence can affect women from all ages, but here on the Cape, the majority of the patients I have cared for are slightly older in comparison to other places I’ve worked at,” she said. “But I’ve cared for women ranging from age 20 to 100 year olds.”
Dr. Jia is fellowship trained in urogynecology and is a Board-certified OB-GYN, although she does not take obstetrical patients. Urogynecology is a subspecialty that focuses on urinary incontinence, pelvic organ prolapse and other pelvic floor dysfunctions in women.
Prolapse, for example, happens when the pelvic floor muscles and connective tissues are too weak or damaged to support these organs and organs fall down into the vagina. The biggest risk factors for prolapse is vaginal birth or vaginal deliveries. Other risk factors include age, smoking, heavy lifting, obesity, chronic straining or constipation.
Urinary Urgency
The causes of urinary urgency are unknown, but it affects 15 percent of women across all ages, Dr. Jia said. Women can experience urinary urgency with or without urinary leakage.
Treatments for urinary urgency or urgency incontinence can start with the simple, least invasive methods, such as eliminating bladder irritants like caffeine, soda, artificial sweetener and alcohol; Kegel exercises, which involve strengthening the pelvic floor muscles; and bladder retraining, which focuses on biofeedback in conjunction with pelvic floor muscle exercises.
Urgency can sometimes be treated with medication or with injections of Botox into the bladder muscles, Dr. Jia said. Another treatment, percutaneous tibial nerve stimulation, is similar to acupuncture: A small needle placed behind the ankle area that stimulates a nerve which helps control the bladder. Patients are treated once a week for 12 weeks. There’s also a device called sacral neuromodulator, which Dr. Jia describes as a pacemaker for the bladder. It’s an implantable device that targets the sacral nerves, which in turn controls the bladder function.
The most important thing for women to appreciate is that help is available for incontinence, she said.
“It’s not a well-recognized issue, and because of the taboo and the embarrassment, a lot of women wouldn't want to seek care and talk to people about it. They are not aware there are treatment options – that they don't have to suffer,” she said.
“As a community, we should increase awareness of urinary incontinence, prolapse and other pelvic floor disorders, and provide an environment in which women will feel comfortable discussing these issues. Most importantly, we should provide education so that women know there are treatments for these pelvic floor disorders.”
