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Women: How to Take Charge of Urinary Incontinence

It's a common condition, but leaking urine doesn’t have to be life-altering


If you’re a woman suffering from urinary incontinence, you are not alone. You are one of millions: about half of U.S. women over 65 leak urine, according to a study from the Centers for Disease Control and Prevention (CDC). And many younger ones do, too, often after childbirth.

But there are things you can do about it.

“As we get older, gravity takes its toll, aging tissue takes its toll, and ultimately the change of hormones from menopause also takes its toll,” says Dr. Amy Rosenman, health sciences clinical professor in the department of OB-GYN, division of urogynecology at the David Geffen School of Medicine at UCLA.

Different Types of Incontinence

The most common types of urinary incontinence are stress incontinence, urge incontinence and a combination of stress and urge. Stress incontinence is when you leak due to sneezing, coughing or lifting. Urge incontinence is when you have a strong urge to go to the bathroom and cannot hold it, no matter the amount of urine.

Mild to Severe

There is a continuum of how life-altering leaking urine can be. For those with mild incontinence, a few drips here, a few drips there may be merely annoying. For those who leak urine more frequently, they may have to wear pads or adult diapers most of the time, and seek out bathrooms everywhere they go.

For those with severe urinary incontinence, it can be devastating.

“Severe incontinence, women stop traveling, they don’t want to be around other people at night, they’re embarrassed about their absorptive products and how they dispose of them,” says Rosenman. “It becomes unmanageable. You develop leaking all over your home, it smells, it’s difficult to manage.”

Physical, Emotional, Financial Toll

The impact of urinary incontinence can go well beyond the moment of leaking. It can lead to skin rashes, sexual problems and emotional distress.

“Individuals who are incontinent may carry an emotional burden of shame and embarrassment in addition to the physical discomfort and disruption of their lives that occur with episodes of incontinence,” the CDC report notes.

The report cites research that has linked incontinence to depression, an increased likelihood of falling, increased burden on caregivers, and a risk factor for nursing home placement and hospitalization.

It is physically, emotionally and financially taxing to suffer from urinary incontinence, but there are ways to deal with it. Here are six tips:

Tip No. 1: Talk about it.

Exact numbers of people who suffer from urinary incontinence are tough to find because not everyone reports the condition. Studies suggest that people with urinary incontinence don’t always seek care. The first step is to talk to your doctor.

“Talking about incontinence is still one of those frontiers that’s not really comfortable for many women, and certainly the older patients are uncomfortable enough that they don’t even bring it up to their doctor,” says Rosenman. “So, if their doctor doesn’t specifically ask, ‘Do you leak urine?’ most of them won’t even tell.”

Rosenman hopes primary care physicians will start by asking their patients if they leak urine, and if they do, asking if it bothers them. The doctor can then refer patients to a specialist, such as a urogynecologist like Rosenman, or a pelvic floor physical therapist.

Tip No. 2: Eat healthy.

Some foods can worsen urge incontinence, and make people feel like they need to use the bathroom more frequently.

“There are foods that are bladder irritants,” says pelvic floor physical therapist Liz Miracle, founder and owner of Miracle Physical Therapy in San Francisco. “Things like coffee, caffeine, tea, wine, alcohol or red spaghetti sauces.”

Tip No. 3: Get to a healthy weight and exercise.

“If you are overweight, losing five pounds can reduce the stress on the pelvic floor and reduce your incontinence significantly,” says Miracle. “It’s harder for women to lose weight as they age, especially once you’re de-estrogenized. Fat produces phytoestrogens, so your body wants to hold onto the fat because that is its only source of estrogen. So, then it makes it really hard to lose fatty weight.”

Miracle also recommends exercising to bring blood flow to the pelvic area, which can help with muscle strengthening.

Tip No. 4: Try pelvic floor physical therapy.

There are 333 board-certified clinical specialists in women’s health, according to Erin Wendel-Ritter, a spokesperson for the American Physical Therapy Association. Wendel-Ritter also noted that physical therapists can specialize in women’s health without being board-certified.

A physical therapist can help assess the pelvic floor, the network of muscles that holds up the bladder, uterus and intestines and helps control the flow of urine. Both a weakened pelvic floor and an overly active pelvic floor can contribute to leaking. To find a physical therapist in your area, try the American Physical Therapy Association zip code search tool.

Tip No. 5: Sign up for a mobile app.

To complement your physical therapy, try out a mobile app that helps coach users in pelvic floor exercises. There are the free apps such as Kegel Trainer, KegelTunes and Kegel Nation. For 99 cents, you can get the Kegel Kat app that features a workout headband wearing cartoon cat that will coach you through your exercises. Tread carefully here, however: Miracle says 30 percent of women do exercises incorrectly. So, the tools may be best used in conjunction with professional help.

There are also insertable devices that have corresponding mobile apps, such as the kGoal, a $149 handheld device that you insert into your vagina to help with pelvic floor strengthening. It buzzes when you do the exercises, so you get internal feedback, and the device sends data back to your phone via Bluetooth, so you can track your strengthening.

“The reason why we’re trying to develop things, like the kGoal, is because if you’re in the middle of Kansas you may not have a pelvic floor physical therapist or your gynecologist within a two-hour drive of you,” says Miracle, who helped develop the device. “(We are) trying to empower women to be able to try to figure things out for themselves. And we do know that the Internet has a lot more information out there and it can be confusing. But if you know you have some [pelvic organ] prolapse happening, you had a baby, you’re older, or you’re leaking some urine when you cough, it’s pretty safe to say that pelvic floor strengthening is an appropriate intervention for you.”

Another similar device is the $199 Elvie, made popular by its inclusion in the Academy Award goodie bag in 2017. Like the kGoal, it is a handheld insertable tool, and helps users tighten and contract the pelvic floor muscles. And, for $249, you can purchase the PeriCoach device, whose makers guarantee progress after completing their eight-week exercise program.

Tip No. 6: Get support from a pessary.

For something a bit more analog, try a pessary. That’s a medical device inserted into the vagina to provide structural support. And while people have been using them since the 13th century, they have evolved since then.

There are different shapes, different sizes, different configurations: some have knobs to keep them in place, some have a little suction that keeps them in place. Some even inflate. You can be fitted by your doctor for one you keep in for hours at a time or one you only use during exercise. You can also try a disposable pessary that looks like a tampon and comes in three sizes (the Poise Impressa) and can be found alongside adult diapers at most grocery stores.

Other Potential Solutions

If the above interventions don’t work, talk with your doctor about other ideas, such as:

  • Logging how often you use the bathroom. Or setting an alarm to use the bathroom on a set schedule. Work with your doctor on a schedule that could also build up your muscle control.
  • Trying antidepressants. Studies show that certain antidepressants, such as Cymbalta, have been effective in reducing the number of incontinence episodes.
  • Vaginal estrogen cream. Note: Studies are inconclusive about its efficacy for incontinence.
  • Bulking injections. This is an outpatient procedure with minimal sedation where the physician will inject some material at the opening of the bladder to gently close it. It will open when you urinate.
  • A pacemaker for your bladder. This may help your brain-bladder connection so you know when you need to empty your bladder.
  • Inserting surgical mesh or another procedure to support or hitch up your organs and muscles. This can improve your pelvic support system.
By Lauren M. Whaley
Multimedia journalist Lauren M. Whaley is a 2016-17 Knight Science Journalism Fellow at MIT and specializes in topics related to reproductive health care, mental illness and health disparities. She is a past president of the national organization Journalism and Women Symposium (JAWS) and spent her early 20s leading canoe expeditions in Canada for high school women. She's currently based in Somerville, Mass.
@laurenwhaley

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