What to do when you have to go all the time
You’re stuck in traffic on a Sunday afternoon leaving the Cape, or in the grocery store doing your weekly shopping, when suddenly you feel that familiar and sudden need to find a bathroom. Your bladder is calling and it’s not taking no for answer.
You finally get to a rest room only to realize that some urine has leaked, and you’re left trying to figure out how to continue with your trip or errand.
One quarter to a third of men and women in the United States have urinary incontinence, according to the Urology Care Foundation. The prevalence of urinary incontinence among adult women is 51 percent, according to the American Family Physician Journal.
“Urine incontinence is one of the more common complaints we get from our patients,” said Paul DeMeo, MD, an obstetrician and gynecologist at Cape Obstetrics & Gynecology in Falmouth. “The most common symptoms are leakage of urine with coughing, laughing, sneezing, or exercising, or the sudden urge to go and then leaking before getting to the bathroom. Sometimes we see a combination of both of those or a mix of symptoms. When there is absolutely no sensation, it is what we call imperceptible loss, which is unusual.”
The two most common types of incontinence are stress incontinence (SUI) and urgency urinary incontinence. Stress incontinence is leaking urine when you laugh, sneeze, cough, run, walk, or exercise. Urge incontinence is a sudden and strong urge to urinate and it is difficult to stop.
Diagnosing the Problem
“In younger women, it is more commonly related to pregnancy and the majority of the time, it goes away after delivery,” said Dr. DeMeo. “Sometimes, it depends on the type of delivery, how large the baby was, and how long the patient pushed that may predispose them to urinary incontinence postpartum. Most of the time it can resolve with pelvic floor exercises like Kegel’s or some physical therapy.”
In older women, urine incontinence usually occurs in those who are mostly post-menopausal, according to Dr. DeMeo. “It can be related to their past pregnancies, if they have had several children, or due to a lack of estrogen, which can cause a decrease in laxity of the ligaments that support the bladder. Also, the lack of estrogen can thin out the lining of the urethra, which can increase the risk of developing urinary tract infections and then cause urinary incontinence.”
Diagnosing urine incontinence begins with a good history, a physical exam, a urinalysis and possibly a urine culture to check for a urinary tract infection that can cause symptoms, said Dr. DeMeo. A test that can be performed in the office is to have the patient come to the visit with a full bladder and cough while standing to see if they can demonstrate the leakage of urine from the urethra.
“Basically, at this point, this is all we need to do before we start discussing treatments,” he said.
“Depending on the type of incontinence they have, we can recommend Kegel exercises or bladder re-training, which I would instruct them how to do,” said Dr. DeMeo.
Other treatments include physical therapy, where patients learn pelvic floor exercises, biofeedback, and sometimes electrical stimulation of the pelvic floor muscles.
He also recommends limiting alcohol, caffeine-containing beverages and to stop smoking. Weight loss can also be helpful for obese patients, because they have a higher incidence of urinary incontinence. Cutting back on drinking excessive amounts of liquid greater than 64 ounces per day can also help. Constipation can worsen urine incontinency and treating that will aid in alleviating symptoms.
“Medications for urge incontinence or overactive bladder are available to help inhibit those involuntary bladder contractions that you get with that condition,” said Dr. DeMeo. “Topical estrogen cream vaginally could help thicken the lining of the bladder and urethra and also the attachments, which can be beneficial in treating urinary incontinence.”
Vaginal pessaries, which are soft, flexible devices inserted into the vagina, are an option, particularly for patients who experience leakage related to a particular activity such as running, horseback riding, dancing, and any kind of activity that involves jumping, he said. “They can be fitted with a pessary that they can use prior to the activity that supports the bladder neck, so they don’t leak during the activity. When they are done with the activity, they can take it out and put it back when they resume the activity.”
Dr. DeMeo recommends the following tips to manage urinary incontinence, especially when traveling:
- Wear a pad. While it won’t stop the leakage, it will prevent the urine from getting on your clothes or the car seat.
- Use a vaginal incontinence tampon. If you have stress incontinence, there is a tampon that provides some support for the bladder neck. It will prevent leakage when you laugh, cough, or sneeze.
- Reduce fluid intake.
- Use the bathroom at regular intervals and try not to hold it for too long.
- Watch what you drink. Don’t drink caffeine-containing beverages, alcohol or wine while traveling.