From Leaking Urine to Sudden Urges to Go: An Ob-Gyn Talks Bladder Control Problems

Whether it’s a few drops of leaking urine or a complete emptying of the bladder, incontinence is a bladder control issue that women are twice as likely to have as men. And by the time a woman has made an appointment to talk about what she’s dealing with, she has had enough.

Incontinence can be embarrassing, super annoying, and costly. But you don’t have to suffer in silence – there are many treatment options available.

When you should see a health care professional

You shouldn’t have to wear a pad to soak up urine every day. Also ask yourself these questions:

• Is the urge to urinate interfering with your work because of leaking or frequent bathroom breaks?

• Do you map out where bathrooms are when you run errands?

• Is incontinence interfering with your sex life or intimacy with your partner?

These are all signs of a problem, and that it may be time for you to talk with a gynecologist.

Identifying the problem

When I first meet with a patient, we determine what kind of incontinence she has. The two most common types are stress incontinence and urgency incontinence.

Stress incontinence is triggered by a cough, sneeze, or physical exercise, and the result is leaking urine. Urgency incontinence is leaking after a sudden, strong urge to urinate that you cannot stop. If the patient has a combination of the two, we first target the one that’s bothering her the most.

Treatments for stress incontinence

Stress incontinence occurs when weakened pelvic floor muscles can’t hold up to the pressure on the bladder and urethra. These muscles may have weakened due to age, vaginal birth, or obesity.

If the issue may be related to weight, we’ll talk about weight loss. As little as an 8 percent weight loss can decrease incontinence by half. I also recommend that patients work with a physical therapist who specializes in pelvic floor exercises. These exercises strengthen the muscles that control urination.

Another option is a pessary, which is a device that supports the walls of your vagina and lifts the bladder and urethra. It’s a non-surgical fix. If we’re still not finding relief after trying a pessary, the surgical option is a urethral sling, which is a type of mesh that’s placed under the urethra.

When you cough, for example, and the urethra moves, the mesh provides extra support for the muscles that aren’t doing their job.

Treatments for urgency incontinence

Urgency incontinence is when you get the urge to go, and if you don’t make it to a bathroom, your bladder will empty. It can have serious effects on your life and your work.

Experts don’t know what causes urgency incontinence, but there are different ways to approach it. First we start with behavioral changes, which vary based on your situation. Steps could include:

• Weight loss – again, losing even a small amount of weight can help.

• Avoiding excess fluids. If you’re having trouble sleeping, we talk about limiting fluids before bedtime so sleep is less interrupted.

• “Time voiding,” which is retraining the bladder. If the patient is in the bathroom every hour, we’ll slowly lengthen that interval so they’re in the bathroom less often.

• Pelvic floor exercises, with help from a physical therapist.

• Changing your diet. I review a list of bladder irritants: coffee, chocolate, alcohol, spicy foods, and other things. We have patients skip those foods and drinks for a week or two and see what their urgency or frequency is like.

If behavioral changes don’t help, there are other options to explore. We can try certain medications that relax your bladder muscles and prevent leakage. Botox, injected into the muscles of the bladder, can help some patients temporarily. And there are several medications we can try, including anticholinergics, which block the impulse to urinate. This can help you get more sleep at night.

We also can talk about two different procedures that might help. In one technique, a thin wire is placed under the skin of the lower back. In the other treatment, a thin needle is inserted near a nerve in the ankle. Mild electrical signals are sent through the wire or needle to the nerves that affect your bladder. This nerve stimulation may help improve bladder control.

In this together

My patients and I talk about all of these solutions together and see what helps.

Just remember: It’s OK to talk about these issues. There are a lot of women going through this – and a lot of gynecologists who can help. Read Urinary Incontinence to learn more.

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This information is designed as an educational aid for the public. It offers current information and opinions related to women's health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer.