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Female Urinary Incontinence—See Your Doctor for Treatment

separator When you’re jogging, do you have difficulty controlling your urine? How about when you’re laughing hard, or sneezing? Do you ever run into your office building after your first coffee of the day and hope and pray you’ll make it to the bathroom in time?

Maybe the most important question here is: did you think that having trouble controlling your urine is something you’ll simply have to learn to live with? The truth is there are many treatments for this problem, also called female urinary incontinence. So many women think that incontinence is something you have to put up with as you get older, but it’s not.

According to a recent article in the Journal of the American Medical Association, between 12 and 55 percent of women have experienced incontinence, but only 13 to 55 percent of them talk to their doctors about it. Those who do discuss it tend to be the ones whose symptoms are most severe and have a strong impact on their quality of life. But many women are simply too embarrassed to bring the subject up, which is too bad, because treatment can be quite effective.

Risk factors for incontinence
There are many factors that can increase the risk of incontinence. Some of the more common ones include:

  • Age—the older you are, the more common it is
  • Caucasian race
  • A relatively high level of education
  • Pelvic floor muscles that don’t contract well
  • Frequent urinary tract infections
  • Constipation and other bowel problems
  • Neurological problems, such as Parkinson’s and stroke
  • Diabetes
  • Smoking
  • High caffeine consumption
  • Higher body mass index
  • Childbirth
  • Some medications—diuretics, laxatives and antidepressants, among others

Three basic types of incontinence
The three most common types of incontinence include:

Stress incontinence: involuntary leakage of urine that occurs during exertion, coughing, sneezing etc.
Urge incontinence: involuntary leakage or urine that accompanies a strong urge to urinate
Mixed incontinence: symptoms of both stress and urge incontinence

When you visit your doctor to find out what type of incontinency you have and what your treatment options are, you can expect to have a thorough physical examination, which typically will include neurological, mental status, and abdominal, pelvic and rectal examinations. Your doctor may also ask you to cough, to find out whether you have stress incontinence. Additionally, it’s common for your doctor to want to find out how much urine is left in your bladder after you urinate. This can be done either by catheterization or by bladder ultrasound.

Your doctor will probably also discuss your risk factors with you, and perhaps help you identify ways you can address the risk factors that are under your control, such as smoking, high body mass index, high caffeine consumption, etc.

After that, you and your doctor will discuss treatment options that are most appropriate for you.

Treatment options
Treatment for urinary incontinence can range from doing exercises every day to strengthen your pelvic floor muscles to taking medication to having surgery. Here are some of the most common treatments:

Kegel exercise: this involves contracting the pelvic floor muscles and then holding the contractions for several seconds. It’s important to do this several times per session, several sessions per day.

Bladder training: this involves urinating according to a timetable rather than according to an urge, and increasing the time between urination gradually.

Electrical stimulation: brief electrical impulses can help to control muscles.

Medication: there are several available, and which one to use depends on the type of incontinence and other health conditions present.

Surgery: There are two main procedures for incontinence—open retropubic colposuspension and suburethral sling procedure. These procedures both help with bladder control, although the surgical techniques are different. Your doctor will discuss the operations with you and explain which is most likely to be successful for your particular situation. 

Your doctor may refer you to a specialist for more workups if your diagnosis is uncertain, if you have had previous pelvic surgery or if you continue to have frequent urinary tract infections, among other reasons.

The main message is that urinary incontinence has many treatments, and one of them is likely to offer you great relief. Freeing yourself from the worry of urinary leakage can give you highly improved quality of life.

Journal of the American Medical Association, 25 February 2004.
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