As many as one out of three — or more than 19 million American women — experience uncontrollable loss of urine. Many more women are troubled by the condition than men.
Urinary incontinence affects a woman’s emotional, psychological, and social well-being. Many curtail recreational activities and are reluctant to do things they used to in case a restroom is not nearby.
For most, incontinence is a highly treatable condition, though many women wait years before seeking the help they need.
Urinary incontinence is a symptom, not a disease. It is a common condition that can result from an infection in the urinary tract, weakened muscles, certain medications, or medical problems that interfere with thinking or movement.
While incontinence affects older women more frequently than younger women, experts say incontinence should not be thought of as a consequence of aging.
There is more than one type of incontinence. Stress incontinence is one of the most common and may be the result of childbirth or menopause.
"Stress incontinence is a common condition in which urine leakage occurs when a woman coughs, sneezes, or laughs," says physical therapist Mary Russell, who teaches classes on incontinence at John Muir Health.
Other forms of incontinence include:
- Urge incontinence: Happens when you have a sudden need to urinate and you lose urine for no reason. A common cause of this type of incontinence is nerve damage due to a health condition or injury.
- Overactive Bladder: Occurs when abnormal nerves signal the bladder to empty without warning.
- Functional incontinence: Happens when a person has a medical or physical problem that interferes with thinking, moving, or communicating. Alzheimer’s or being in a wheelchair can lead to functional incontinence.
- Overflow incontinence: Occurs when the bladder doesn’t empty, causing it to spill over. Weak bladder muscles are often the culprit.
- Transient incontinence: A result of a temporary situation such as an infection, medication, or a cold with coughing.
"Women shouldn't hesitate to seek treatment. There is a lot to learn about physiology, and much can be done to improve the condition,” says Russell. “About 75 percent of women with this problem who follow some simple steps can get better without surgical intervention."
Treatment depends on the type of incontinence you have. Treatment strategies may include pelvic floor (Kegel) exercises, timed voiding, dietary changes, surgery or medication.
Judson Brandeis, MD, a urologist on staff at John Muir Health, emphasizes the importance of beginning Kegel exercises early in a woman's life. These are the muscles you squeeze to stop the flow of urine.
Performing these exercises several times a day, especially beginning after vaginal childbirth, can improve urinary, vaginal, and rectal tone. You can do them without being noticed, while stopped at a traffic signal or during a TV commercial break, he suggests.
Women can learn to use their pelvic floor muscles functionally throughout the day to re-establish effective muscle tone, and exercises can be tailored to individuals, Russell adds.
"Just as you've learned to cover your mouth when you sneeze, you can learn to have your pelvic muscles work fast enough and strong enough to prevent leaking."
Sometimes a woman's incontinence progresses beyond the scope of the interventions that Russell teaches.
"One in every nine women has a surgical procedure for incontinence during her lifetime," reports Dr. Brandeis.
"Reasons for surgery can include a prolapsed uterus, or a condition in which another organ or internal structure sags into the vaginal passage and must be repositioned,” he says.
"The most effective procedure when Kegels don't work anymore is positioning of a pubo-vaginal sling," Dr. Brandeis says. "This bladder neck suspension is an outpatient procedure with minimal pain and side effects that is highly successful and takes half an hour to perform.."
Dr. Brandeis and others agree that the good news is that incontinence is highly correctable — and possibly preventable with the use of Kegel exercises to start training the pelvic floor before problems occur.