Urinary Incontinence

Catherine E. DuBeau, MD

Can urinary incontinence be prevented? Or is it just a natural part of life after having a baby? Or a normal part of aging?

Although urinary incontinence occurs most commonly in women of childbearing age and older women, it should never be considered "normal" or "expected." We are learning more about methods to prevent urinary incontinence for women at all stages of life. Obesity is a risk factor, and it is now clear that weight loss will markedly improve any incontinence that exists, and may also decrease the chance that incontinence will develop. For women smokers who have a "smoker’s cough" and are prone to leakage when they cough, quitting cigarettes can decrease the cough and therefore incontinence.

Pelvic floor muscle exercises (also known as "Kegel exercises") started before delivery can decrease the chance of post-partum incontinence. There is also some evidence that doing these exercises before pelvic surgery may decrease the chance of postoperative incontinence. Episiotomy during delivery is associated with postpartum incontinence; women should talk with their obstetricians about their potential need for episiotomy and what can be done to avoid it. Experts strongly feel that vaginal delivery should not be avoided in favor of C-section because of any potential incontinence.

Incontinence risk may also be reduced by ensuring effective management and treatment of certain medical problems. These include diabetes, depression, neurological diseases, any condition that decreases the ability to walk, and memory impairment. All of these conditions have the potential to be well controlled by working with one’s health care provider. Older women should never accept being told that their arthritis or trouble walking is just part of old age; find a provider who will take your complaints seriously and help with treatment.

Many medications may exacerbate or cause problems with incontinence, particularly among older women. These include several types of medication for high blood pressure (angiotension converting enzyme inhibitors, calcium channel blockers, alpha-blockers), diabetes (rosiglitazone and pioglitazone), sleep or agitation (sedative hypnotics, e.g., lorazepam), pain (narcotics, non-steroidal antiinflammatory agents, gabapentin, and pregabalin), congestive heart failure (diuretics), nasal congestion and "colds" (antihistamines), and psychosis/agitation (e.g., risperdal).

The majority of women who take these medications will not develop incontinence from them. However, women with other risk factors for or who already have some incontinence should talk with their health care provider whether their medications might be contributing and can be changed.

Catherine E. DuBeau, MD
Director, Geriatric Continence Clinic
University of Chicago
National Association for Continence
American Geriatric Association