Is Incontinence Inevitable?

Dr. Gunter, I am a postmenopausal 63-year-old woman. I am wondering if the fate of all women my age and older is to wear pads for leakage. I understand your specialty is gynecology and not urology but thought you could weigh in on any advances in this area as the two specialties are related.

— Gail Barraco, Saratoga Springs, N.Y.

[Have a question about women’s health? Ask Dr. Gunter yourself.]

Urinary incontinence is a common and distressing problem for many women. While the rate of incontinence increases with age, there are many therapies available to reduce leakage and improve your quality of life.

Urinary incontinence, the involuntary leakage of urine, affects women of all ages. Approximately 25 percent of young women, 50 percent of middle-aged women and 75 percent of older women have some degree of urinary incontinence.

There are two main types of urinary incontinence:

Stress urinary incontinence The loss of urine with physical activity, coughing or sneezing

Overactive bladder Also known as urgency incontinence, this is the strong, sudden urge to empty the bladder with or without leaking urine. (Basically, when you have to go you have to go. Now.) Many women with overactive bladder have to get up multiple times each night to empty their bladder.

Women can also have mixed incontinence, which is both stress urinary incontinence and overactive bladder.

Women with urinary incontinence often do not seek medical care. Some women are not bothered by their symptoms, others feel ashamed, some have been brushed off by health care providers, led to believe there are no therapies, or they have been offered only a limited range of treatment options.

There are many therapies for incontinence, from bladder training, pelvic floor exercises, pessaries, medications, injections and surgeries. Making a recommendation for specific therapy without a medical history isn’t possible. However, there are some incontinence basics that everyone should know to help them get started.

  • Rule out a bladder infection as this can be a cause of incontinence. See a medical provider to arrange a urine test and rule out an infection.

  • Be mindful of how much water you drink — the need to drink eight glasses a day is a myth! The more you drink the more you have to empty.

  • Wear incontinence pads, not menstrual pads. Choosing the right protection matters. A menstrual pad (or period underwear) is likely to keep urine next to the skin, which can cause irritation, itching and even skin breakdown.

  • Try pelvic floor muscle exercises, also known as Kegel exercises. Some women can learn to do them on their own and others may need help from a pelvic floor physical therapist. These exercises can help both stress urinary incontinence and overactive bladder. Kegel exercises include: sustained contractions (holding the squeeze or contraction with a goal of working up to 10 seconds) and quick flicks, which are a simple contraction and release taking 1 to 2 seconds. For women with overactive bladder, doing a set of five quick flicks as soon as the urge to empty is felt can relax the bladder, giving time to get to the toilet without leaking.

  • Weight loss can help reduce leaking for women who are overweight.

  • See a provider and get a diagnosis. Many gynecologists, urologists and primary care providers are very knowledgeable about urinary incontinence, but a urogynocologist may be needed for anyone having difficulty getting help and for those with more challenging incontinence issues.

Women have told me that when they brought up their incontinence to previous providers, they were told it was a “normal” part of aging and the conversation ended quickly with the implication that it was something to be tolerated. It isn’t just medicine that treats incontinence as shameful; our society does as well. Imagine if we treated everyone who needed glasses with shame and told them their visual impairment was something they had to live with.

Dr. Jen Gunter, often called Twitter’s resident gynecologist, is teaming up with our editors to answer your questions about all things women’s health. From what’s normal for your anatomy to healthy sex and clearing up the truth behind strange wellness claims, Dr. Gunter, who also writes a column called The Cycle, promises to handle your questions with respect, forthrightness and honesty.

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