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A regular source of embarrassment, urinary incontinence is an under-diagnosed and under-reported problem. Solutions exist. Let's talk about it.
Stress Urinary Incontinence (SUI)
1 in 3 women older than 45 years old are impacted by stress urinary incontinence.
SUI is a loss of urine that occurs at the same time as physical exertion. Activities like sneezing, coughing, or exercise increase the pressure or "stress" on the bladder, which pushes urine out of the body.
Women most commonly develop SUI from changes that happen in pregnancy or childbirth that weaken support to the urethra. Chronic coughing, constipation, obesity, aging, smoking, or extreme weight lifting can also cause SUI. Genetics may also play a role.
Overactive Bladder (OAB)
About 15% of women across all ages are impacted by overactive bladder.
Overactive bladder is a complex condition that can be costly, embarrassing, and result in avoiding social activities for fear of leakage. Women with OAB feel a sudden urge to urinate, sometimes followed by leaking. It is common to feel the frequent urge to go even though your bladder isn't full.
Age increases the risk for overactive bladder as do some bladder conditions such as infection, bladder stones, or abnormal growths. For some women, the cause is unknown.
Frequently Asked Questions (FAQs)
How do I know if I have stress urinary incontinence?
Not every urine leak is because of stress urinary incontinence (SUI). Your doctor will ask questions about when and how often you leak urine. A physical exam helps the doctor identify other conditions that influence the bladder, such as prolapse. Your doctor may ask you to cough with a full bladder to see if you leak.
Additional tests may include:
- Urine analysis to check for a urinary tract infection and blood in your urine.
- Ultrasound to assess how much urine remains in your bladder after urinating.
- Urodynamics to provide information on your bladder and urethra.
- Bladder diary: your doctor may ask you to record what, how much, and how often you drink. You also measure the amount you urinate, which will help your doctor learn more about your bladder symptoms.
What is urodynamics?
Urodynamics is a group of tests performed in the office using a machine to evaluate how well your bladder fills and empties.
What is pelvic organ prolapse?
Pelvic organ prolapse (POP) occurs when the pelvic floor muscles and connective tissue weaken or tear, which causes the pelvic organs (bladder, uterus, vagina, small bowel, rectum) to descend or droop into the vagina, similar to a hernia. These organs are said to prolapse if they descend into or outside of the vaginal canal or anus.
Common complaints with prolapse include:
- Pressure or fullness in the pelvic area, possibly a feeling that something is falling out of the vagina.
- Not being able to wear a tampon.
- Backache low in the back.
- Vaginal dryness or irritation from rubbing on clothing.
- Urinary problems such as leaking of urine or a chronic urge to urinate.
- Trouble urinating or having bowel movements until the prolapse is pushed upward manually.
- Painful intercourse
- Spotting or bleeding from the vagina.
How do you treat incontinence? Will I need surgery?
The ideal treatment depends on your symptoms and the amount that your symptoms impact your daily life. You and your doctor may decide on a combination of these treatments:
- Lifestyle changes: managing your weight, quitting smoking, and adjusting your exercise routines are just a few of the lifestyle changes that may improve incontinence symptoms.
- Physical therapy: pelvic floor exercises can strengthen your pelvic floor muscles and improve your symptoms. It may take 3-6 months of pelvic floor exercises to see the results, and a specialized physical therapist can teach you the techniques. Your doctor can give you a referral.
- Vaginal pessary: a pessary is a silicone device, similar to a diaphragm, that is inserted into the vagina. A pessary helps to push the urethra closed to control urine leakage while still allowing you to urinate normally when you need to. Many women leave a pessary in all the time while others only wear it when they exercise.
- Minimally Invasive Surgery: your doctor will advise you whether minimally invasive surgery is the best option to correct the support around your urethra. Minimally invasive surgery is typically very successful and often low risk. Your doctor will discuss each of the options with you to tailor your treatment for your specific condition and lifestyle.
Will insurance cover the cost of incontinence treatments?
Most insurance plans do include coverage for the cost of urinary incontinence treatments, but it is always best to call your insurance company and ask them to explain your coverage.