There’s No Need to Live With Urinary Incontinence

It’s a common problem in women, one few care to discuss, even with their physicians — urinary incontinence. It can develop for a variety of reasons at various stages in life. But whatever the root cause in any particular case, Nabila Noor, MD, with LVPG Female Pelvic Medicine and Reconstructive Surgery, wants women to know that the problem can be addressed, and that there are many treatment options to consider.

“A lot of women, especially as they age, think ‘Oh, a little bit of urinary leakage is a normal thing. My mom had it. My grandmother had it. It’s not a big deal.’ Someone who’s had a baby and is leaking a little bit will hear from her girlfriends that it’s common and it’s fine,” says Dr. Noor, who specializes in female pelvic medicine and reconstructive surgery.

“The problem is that while it might start as a small thing, before you know it, it’s controlling your life. Your day is built around bathroom breaks. You’re avoiding things you used to enjoy. You’re afraid to go on social outings because you think you might smell of urine, or you’re reluctant to go on long drives because every half hour you need to stop at a bathroom.”

As Dr. Noor will be quick to tell you, if this sounds familiar to you, it’s time to seek professional help.

The most common cause of urinary incontinence is pregnancy or childbirth, but menopause is also a major player. Other risk factors are conditions that put pressure on the pelvic floor, including obesity, a chronic cough or chronic constipation. Neurological conditions can also result in incontinence as they might damage the nerves that control the pelvic floor muscles, the bladder or the urethra. These conditions include spinal cord injuries and stroke. Diabetes places a woman at risk as it, too, can affect the nerves. The same goes for multiple sclerosis.

Not all cases of incontinence are the same, Dr. Noor says. There are three major categories she tells her patients about:

• Stress urinary incontinence is characterized by the leakage of urine with laughing, coughing, sneezing or physical exertion. It is the most common type of incontinence, affecting almost 50 percent of women.
• Urge urinary incontinence is characterized by an inability to hold one’s urine when the urge to go arises. Women with this type of incontinence will have an accident if they can’t get to the bathroom immediately. Or, they go to the bathroom more frequently, as often as every hour.
• Mixed incontinence is a combination of the first two.

Treatment for incontinence depends largely on how bothered you are or how aggressively you want to treat your condition, Dr. Noor says.

“Some treatments are more conservative, but we also have surgical options. I always encourage people to start with lifestyle changes. These could be dietary changes, such as avoiding things we eat or drink that affect how much we urinate. Avoiding caffeine, for example. And if you’re drinking gallons of water in a day, you are going to be urinating a lot.”

Pelvic floor exercises such as Kegels also can help, but be patient, Dr. Noor says.

“Remember that strengthening muscles takes time and patience. Give it at least three months of good, consistent Kegel exercises done properly before expecting to see change,” she says.

It’s also possible to train your bladder to better resist the urge to urinate.

“Don’t run to the bathroom immediately when you feel the urge,” Dr. Noor says. “See if you can do some Kegels and try to increase the time you can wait before going to the bathroom.”

There are also medications that might help, depending on the type of incontinence. And, there are procedures.

“We can to things like sling surgery, in which we insert a tiny piece of mesh to help support the urethra. This is a great treatment option for stress incontinence,” Dr. Noor says. “We can also do bulking injections, which sort of shore up the walls of the urethra. These can help with stress incontinence.”

An injection of Botox into the bladder can help with urgency, and there are more advanced therapies, as well, including a sort of pacemaker that can be implanted to regulate bladder control.

“What is best for you is a discussion you need to have with your physician, preferably a specialist who is focused on female urology and can thoroughly assess you and explain what kind of urinary incontinence you have,” Dr. Noor says.

Urinary incontinence is not a life-threatening disease, but that doesn’t mean a woman should dismiss it.

“Sometimes women tend to minimize their symptoms and convince themselves that it’s not a big deal,” Dr. Noor says. “These women will never learn that there are amazing treatment options. In other cases, women may have heard horrible stories about treatments from 20 years ago. Everyone should understand that a lot has changed in the last two decades. There is a whole specialty — urogynecology and pelvic reconstructive surgery. What we can do for women has improved so much.”

Dr. Noor notes that even women who have been living with incontinence for decades can get help.

“There’s no right or wrong treatment and there’s no timeframe. It all depends on the patient,” she says. “I have treated patients with urinary incontinence ranging from 20 years old to over 90 years old. It all starts with a simple conversation. Talk to your physician.”