Urinary Incontinence

What to Ask the Doctor

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

Are you one of more than 26 million Americans living with incontinence?

Are you embarrassed to ask your doctor about it?

Why?

Even if you answered a simple “yes” to the first two questions, you might have several answers to the last question. Certainly leakage problems can be embarrassing; it’s not an easy subject to bring up. Time is often short in the doctor’s office. You may be afraid that your doctor will dismiss your concerns.

Fortunately, health professionals are more prepared to listen and help than ever before. Organizations dedicated to supporting people with incontinence have raised public awareness, and many medical associations, governmental organizations, and even insurance companies are pushing doctors to be more attentive.

Still, it’s up to you to bring it up. “It can be difficult for a young woman, for example, to talk to a strange male physician about this problem,” said Roger Dmochowski, M.D., a professor of urologic surgery at Vanderbilt University in Nashville, Tennessee. “But my experience is that once it’s brought up, doctors will hear it and are willing to try something, or consider a referral. What works is to say something like, ‘I have something and it’s really bothering me, and disrupting my quality of life.’”

The best way to get past your embarrassment? Be prepared. One of the best ways is to keep a “continence diary.” No, this isn’t a place to write your deepest thoughts regarding urination. It’s a record you keep of when you go, how much you go, and how often you have leakage problems. Just get a small notebook and mark columns for date, time, amount of urine, and a note of whether you had any leakage. Record what, when and how much you drink as well. Keep the diary for 3 to 4 days before your appointment.

“Over the course of the last week, when did you have an accident?” asks Nancy Muller, executive director of the National Association for Continence. Write that down, she suggests. “How often does it happen? Did you leak a little, or suddenly have an overwhelming need to go to the bathroom when you got out of the car at home—and couldn’t make it?” These descriptions, she notes, point to different types of problems that need to be treated in very different ways. “The least helpful thing your doctor can hear is something like, ‘I have that same problem my grandmother had.’”

Preparing a list of questions about incontinence for your doctor before you go will also help you to have a better discussion with your doctor. For example, you may want to ask:

• What is causing my incontinence?

• What type of incontinence is it?

• Are there lifestyle changes I can make?

• What other treatment options are available?

• How long will it take for me to notice results?

If you can’t fit all your questions into one 15-minute session, make another appointment just to discuss incontinence. If you present your concerns and questions to your doctor and he or she doesn’t seem responsive, then maybe it’s time to look for a new physician. Or if you like working with your doctor overall, it may make sense to seek out a specialist, such as a urologist or a gynecologist trained in urological issues, just for this problem.

Talking about incontinence with your doctor for the first time isn’t easy. But it may open the door to a much better quality of life.