Millions of women let urinary incontinence limit their lives. Over 13 million Americans have leaky bladders, and at least four out of five are women, according to the National Association for Continence (NAFC).
Many women do not seek help for their bladder problems, because they mistakenly believe that this is a normal part of the aging process. Women in the prime of life may give up traveling, exercise, and other everyday activities as a result of their fear of accidental loss of urine.
Although urinary incontinence is possible at any age, it often starts between 30 and 50. There are several different types of urinary incontinence, also called a “leaky bladder.”
Stress incontinence—the most common form—arises when urinary muscles that support the bladder become weak from pregnancy, childbirth, too much weight, or loss of estrogen at menopause, which causes weakening of the support structures. Dribbling may take place during laughing, sneezing, coughing, jogging, lifting a child, or other acts that stress the abdomen.
Urge incontinence—also called overactive bladder—is the sudden, overwhelming urge to urinate several times day and night because the muscle that controls urination contracts abnormally when the bladder is filling. Leakage may occur while attempting to get to the bathroom.
Overflow incontinence, or a constant dripping of urine, occurs when small amounts of urine leak from a full bladder. This kind of incontinence affects men more than women, because an enlarged prostate can block the urethra.
Functional incontinence happens to older people, or those with other problems that prevent them from getting to the bathroom in time. Arthritis, for instance, can make it difficult to move quickly. A person with functional incontinence has normal bladder control.
Women may leak urine—a little or a lot—while rushing for the toilet. They may "map out" bathrooms at every stop, make sure they get the aisle seats, or wear absorbent pads. They may even become housebound.
By menopause, many women have some degree of incontinence. The urethra carries urine from the bladder. Estrogen loss makes the urethra more sensitive to the "gotta go" spasms, and lax pelvic muscles fail to slow the flow.
Six ways to stay dry
Treatment depends on the type and severity of incontinence. Your health care provider can help you decide on a course of action, but treatment usually begins with one or more of these methods:
Kegel exercises. You can tighten pelvic floor muscles, the muscles you use to stop urinating, by tightening the rectum as if holding back gas and contracting the vagina as if stopping urine flow. Kegel exercises can help mild to moderate urge and stress incontinence in two to three months. Do 30 to 40 Kegels in a day, gradually holding contractions up to 10 seconds. Tighten pelvic muscles before you cough or sneeze.
Bladder retraining. One way to do this is to keep a chart of your urination and leakage to figure out if there is a pattern, the National Institute on Aging (NIA) suggests. Once you determine the pattern, you can plan to empty your bladder before you might leak. Gradually increase the time between the urge and urination by 10-minute intervals until you reach three or four hours. With this method, along with biofeedback and Kegel exercises, you may be able to control urge and overflow incontinence.
Fewer bladder irritants. Caffeine, citrus juices, very spicy foods, and nicotine can cause bladder spasms. Caffeine and alcohol raise urine output. Keep fluid intake, including water, to eight glasses a day. But don't skimp on water, either. Urine concentrated in the bladder can make things worse.
Weight loss. Losing weight can decrease pressure on the abdomen, which can decrease the severity of a leaky bladder.
Medical options. Gynecologists and urologists have special expertise in the management of incontinence. They may prescribe a diaphragm-like pessary to prop up the bladder and close the urethra when inserted before exercise. They may also prescribe drugs that decrease bladder urges, or vaginal estrogen creams after menopause.
Surgical solutions. For severe stress incontinence, collagen or synthetic implants can plump up urethral tissue to stem urine flow. In tough cases, "sling" surgery helps re-suspend the bladder neck to adjust urine flow. Less-invasive versions use natural or synthetic tape to tighten the tissues around the urethra to slow the flow.