Urinary Incontinence

A Medical Problem? Don’t Just Get By, Get Better

Reviewed by: Joanne Poje Tomasulo, M.D., ACOG

Maybe you’ve noticed a spot of urine on your underwear, or more mad dashes to get to the bathroom on time, or “leaks” when you lift a box, or simply that you’re going more and more frequently. These are all signs of urinary incontinence. You may think it is only a problem for elderly people, but up to 19 percent of women under age 45 are dealing with it at any one time, so there’s a good chance that at least one of your girlfriends is going through the same thing.

You know it’s a problem, but what do you do about it? If you’re like many Americans, you’ve learned to live with your condition without asking your doctor for help. You probably feel a bit of embarrassment or shame. You may feel like it’s a sign that you are getting old and can’t control your body. These feelings and fears are all completely natural, but it doesn’t have to be this way. Incontinence isn’t your fault.

“There’s a tendency for people with a problem with leakage of any kind to talk about it to a friend but not to a healthcare provider,” said Jane Frahm, PT, supervisor of women's physical therapy services at Detroit Medical Center’s Rehabilitation Institute of Michigan. “Or you may have mentioned it to a caregiver, and been brushed off, or told that you’re getting up in years and that’s what to expect.” Her message: Don’t stand for it. “You don’t need to accept leakage of any kind as an inevitable passage,” she said.

“It’s not a life-threatening event, but it is a quality-of-life threatening event,” said Roger Dmochowski, M.D., a professor of urologic surgery at Vanderbilt University in Nashville, Tennessee. “If you’ve had to adapt, if you’re no longer doing exercise, or other social things, it’s time to seek help.” Nancy Muller, executive director of the National Association for Continence, suggested “it’s a problem if it’s bothersome, worrisome, messy, smelly or embarrassing.”

Your doctor can help you. “It’s treatable,” said Dr. Dmochowski. “There are usually a variety of options, including behavioral therapies, such as controlling your fluid intake. The condition can’t always be cured, but it can be improved.” Talking to your doctor doesn’t mean you’ll have to sign up for surgery; that’s one of the last options. The first therapies will likely be pelvic floor exercises (Kegels) and possibly behavioral and lifestyle changes. If they don’t work as well as you’d like, your doctor may suggest prescription medicines or devices to help you regain your continence.

Remember, too, that incontinence isn’t a disease. It’s a symptom. Talking to your doctor is a first step to diagnosing the underlying cause. For example, urinary tract infection might be the cause, so antibiotics could clear up your problem. More rarely, incontinence is a sign of a serious disease, so talking to your doctor about bladder control could save your life.

More likely, it will simply be liberating. Effective treatments are available that can help you regain bladder control instead of trying to live around the problem. The message is neatly summed up in a panel report from the National Institutes of Health on incontinence:

• You are not alone.

• Some medical conditions that cause fecal and urinary incontinence can be treated.

• Incontinence does not have to be a part of aging.

• Lifestyle changes, behavioral interventions, medical treatment, and surgery can provide benefits in many cases.

• You should tell your care provider.

Imagine the ability to go through your day without worrying about where the nearest bathroom is, no longer wearing protective undergarments, or being able to go out without the fear of leakage. If that isn’t worth a conversation with your doctor, what is?