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Urinary Incontinence
There Is Help!

Urinary incontinence is the involuntary loss of urine. It affects up to 70% of women living in the community and about half of women living in nursing homes. Most women affected by urinary incontinence never seek medical assistance, yet the cost of urinary incontinence is high, about $12.4 billion dollars.

There are two major kinds of urinary incontinence: Stress Incontinence and Urge Incontinence. Between 29% and 75% of women have stress incontinence, while between 7% and 33% of women have urge incontinence, also called overactive bladder. Some women experience both kinds of incontinence. Urinary incontinence has many causes. Menopause, childbirth, some medical conditions, heavy lifting, smoking, obesity, prior surgery, and some medications are all thought to contribute to urinary incontinence. Urinary tract infections can also cause or worsen urinary incontinence. In addition, pelvic organ prolapse, a condition in which the uterus and/or vagina descend or bulge, can lead to urinary frequency, urgency and urinary incontinence.

Stress incontinence occurs with a sudden increase in intra-abdominal pressure, such as with a cough that causes an increase in pressure around the bladder that overcomes the pressure in the urethra, forcing the urethra open and resulting in urine leakage. Urge incontinence is thought to occur by uncontrolled the bladder spasms that create a feeling of needing to urinate and urine leakage which often occurs on the way to the bathroom.
You should see your doctor to evaluate incontinence. Your doctor may examine you and begin treatment for urinary incontinence. Your doctor may also suggest that you see a bladder specialist such as a urogynecologist. At these appointments, the physician will do a comprehensive physical exam. The physician will determine whether you have any signs of pelvic organ prolapse. You may be asked to strain or cough to simulate a situation that might cause stress incontinence. Your urine will be checked to make sure you do not have an infection, and you may be asked to keep a voiding diary. Additional bladder tests may be performed. The physician may place a catheter in your bladder to measure how much urine you have left in your bladder after you urinate. She may also fill your bladder with sterile water to better understand how much fluid your bladder can hold and how your bladder feels things.

If you are asked to complete a voiding diary, you will keep track of how much fluid you take in as well as how much and how often you urinate in a 24 hour period. You will be asked to record the number of episodes of incontinence you have each day. This diary will help your doctor better understand how much you drink and the type of leakage you are experiencing. This information can help your physician suggest some ways to begin treating your leakage.

You can take a few first steps to help improve your incontinence. Try to avoid fluids that contain bladder irritants, such as caffeine, artificial sweeteners, and citrus juices. These can cause bladder spasms and may cause you to urinate more frequently. Caffeine is also a diuretic, which means it encourages your kidneys to filter more liquid causing you to go to the bathroom more frequently.

Sometimes, you can help prevent leaking episodes by voiding on a regular schedule. Often, women only feel an urge to urinate once their bladder is very full or they delay voiding too long only to lose urine on the way to the bathroom. By voiding at regular intervals, you may be able to prevent some accidents. A bladder diary may also help you identify how long you wait between voiding, the times that you leak urine and a reasonable time between voiding. You should be trying to void at least every 2-3 hours. Your physician may talk to you about urge suppression techniques. Briefly, when you feel an urge, contract your pelvic floor muscles (Kegel muscles) and then walk calmly, instead of running, to the bathroom. You may only be able to postpone voiding by 1 minute at first but will be able to work up to delaying voiding longer periods. Finally, don't underestimate the importance of weight loss. Being overweight can make incontinence worse.

Your physician may talk to you about physical therapy. Physical therapy can help control both urge incontinence and stress incontinence. Physical therapists use a variety of techniques including improving Kegel exercises to strengthen your pelvic floor and biofeedback. Using biofeedback, you can learn to control your pelvic floor muscles to help prevent urine leakage.
Medications may also help to improve incontinence. If you have gone through menopause, increasing estrogen in the vagina by using vaginal cream may help treat vaginal atrophy and improve symptoms of incontinence. Oral medications can be used to treat urge incontinence. These medications allow the bladder muscles to relax and increase the amount of urine that the bladder can hold. These medications can cause dry mouth, constipation, headaches, blurred vision, dry eyes, and drowsiness.

Women with stress incontinence may benefit from the use of a pessary. A pessary is a device that is worn in the vagina and can help provide support to the vagina and bladder and decrease urinary leakage related to coughing, sneezing, lifting, exercise. Surgery can also be used to treat stress incontinence. A minimally invasive, outpatient surgery called a midurethral sling is 80-90% effective in treating women with stress incontinence.

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