Urinary Incontinence–When your kids aren’t the only ones wetting their pants!

We have all seen the commercials, we have all joked about it with our girlfriends, and we have all secretly worried about the day it would happen to us.  Then one day, when we least expect it, something happens:  as we laugh a little too hard when our girlfriend recounts a familiar work story while we are on maternity leave; when we push ourselves to get in those extra few burpees at the gym;  when we bend down to pick up that dreaded basket of laundry…our body betrays us.  More specifically, our bladder lets out a little gush of urine that sets us down a huge road of despair about “peeing” on ourselves and becoming “one of those women”.
There are a few different types of incontinence depending on how and when the leakage of urine occurs.  Theses are the most common types.
STRESS INCONTINENCE occurs when you leak urine after laughing, lifting, coughing, or sneezing.  Stress incontinence is caused by weakening of the muscles and supporting tissues of the bladder. Increases in abdominal pressure against the bladder or the sphincter muscles (like when coughing or sneezing) result in leakage of urine. The muscles can weaken for several reasons, including pregnancy, childbirth, nerve damage, or weight gain.
URGE INCONTINENCE occurs when you leak urine after having strong sensations of needing to urinate and not being able to reach the bathroom on time.
Urge incontinence is also referred to as overactive bladder.  Which is similar to the commercials “Gotta go, gotta go!”  People with overactive bladder may not have incontinence but have more frequent and uncontrollable trips to the bathroom.
Urge incontinence is believed to be a result of spasms of the bladder muscles. Spasms may arise due to damage to the muscles themselves or to the nerves that supply them.  Reasons for nerve and muscle damage may include a stroke, infection, or inflammation.
MIXED INCONTINENCE some women have a combination of both stress and urge symptoms.
Certain medications can exacerbate your incontinence.
-Antihypertensives: some can relax your bladder muscles and exacerbate symptoms.
-Diuretics: increase the amount of urine produced and worsen the severity of incontinence.
Bladder irritants:
Caffeine, alcohol, sweet beverages, carbonated drinks can irritate the bladder as well as cause it to fill quickly and then leak.
Vaginal deliveries, the process of pushing a baby through the vaginal canal for up to 1-4 hours, stretch out the nerves that innervate and pelvic floor musculature that support the bladder.  Women who have delivered large babies or who pushed for longer then 2 hours, are at greater risk for urinary incontinence.
The vaginal tissue as well as the bladder and urethra are invigorated by estrogen.  After menopause, the levels of estrogen drop dramatically and these tissues thin out and weaken.  This process increases the risk for incontinence.
If you smoke you cough.  Coughing increases pressure on the abdomen that is transferred to the bladder and places stress on the urethral sphincter that holds your urine inside your bladder.  Chronic coughers eventually stress out their sphincter to the point of leaking urine every time they cough or put extra pressure on their bladder (lifting, laughing, sneezing).
Being overweight can also place excess pressure on the bladder and make symptoms worse.
Always talk to your doctor even if the symptoms are mild.  It’s often a difficult topic to bring up, but a necessary one.  This way your doctor can track any changes and see if your symptoms are progressing or worsening and therefore time for more medical or surgical interventions.
For now here are a few things to do at home before your doctor’s visit:
1. Keep your vagina tight!...Kegels are to your vagina what crunches are to your abs.  The urethra is surrounded by the vaginal musculature and strengthening it provides support for the bladder.  Tighten the same muscles you use to stop the flow of urine.  Hold for 10 seconds and relax, do sets of 5 then 10  and repeat throughout the day–especially while lifting or right before coughing/laughing/sneezing to prevent leaks!
2. “Don’t wait to go!”:  We are all guilty of holding in our urine and waiting until the very last minute to run to the bathroom.   Eventually, our bladder looses its ability to make us aware when it reaches its “normal” full and instead doesn’t let us know it needs to be emptied until it reaches the “emergency” full level when in some cases it might be too late!
Try to retrain your bladder and start going to the bathroom every 3hrs even if you don’t have the urge to go. This will hopefully avoid some leakage that may occur from a full bladder.
3. Timing your voids is also a way to retrain your bladder for those who have the problem of URINATING ALL THE TIME.  It can help relax the bladder, allow it to fill more, and decrease your urges to urinate.
-Start by urinating every hour for the first 1-3 days, then increase the time interval by an hour for the next 3 days until you reach the goal of being able to hold your urine for 3-4 hours.   If you have a strong urge to urinate then do a few kegels to get you through.
4. Limit your fluid intake.  I always encourage plenty of water hydration but with urinary incontinence you don’t want to over do it.  Avoid bladder irritants like caffeine and sweet, carbonated beverages and don’t drink fluids 3 hours prior to going to sleep.
You need to see your doctor.  Help is available and incontinence is not a natural and acceptable part of aging.
Scheduling an appointment with your gynecologist is a good start.  It’s also a good idea to keep a bladder diary and keep track of how much fluids you take in and when/how you leak.
Some tests to expect at your visit or that your doctor may order include: 
-vaginal exam: to check for bladder prolapse and examine the strength of your kegels and vitality of your vaginal and urethral tissue
-bladder stress test: your doctor will ask you to cough while she observes to see if there is any leakage of urine.
-post-void residual: you may be asked to urinate and afterwards your doctor will place a small tube through your urethra to see if there is any urine left that was not emptied from the bladder.
-urine analysis: to check for infection
-cystoscopy: a test that looks with a camera to evaluate for any abnormalities inside the bladder
-urodynamics: a thin tube is placed through the urethra and the bladder is filled with water to measure filling, urge, and leakage pressures
Urge incontinence: 
If your symptoms are more consistent with urge incontinence, meaning you “gotta go, gotta go!”, then treatment is with medication.  The medication relaxes your bladder to prevent bladder spasms and allowing it to fill for longer periods of time before you get the urge to  urinate.
However the medication can cause side effects such as dry mouth and dry eyes.
There is also an option for implantation of a device that sends nerve signals to control bladder spasms.
Stress incontinence:
For women with stress incontinence, the treatment is usually surgical.  Placement of a mesh sling beneath the urethra provides support and helps prevent leakage.
Other non-surgical treatments include:
-Collagen injections are used to bulk up the tissue around the urethra and increases the resistance to the flow of urine from the bladder.  However these injections are only temporary and are usually repeated every 12-18 months.
-Physical therapy can be used to strengthen the muscles in the vagina and around the urethra to provide more support
-A pessary is a device placed inside the vagina that may help for women who also have bladder prolapse and may not be good surgical candidates.
Urinary incontinence effects many women.  It is a physical symptom that can take an emotional and psychological toll on its victims.  Women are often embarrassed to tell even their loved ones about their symptoms.
Its important to educate women on the symptoms of urinary incontinence and let them know there are effective treatments, and they don’t have to include adult diapers!
If you suffer from urinary incontinence, see your doctor and find a treatment option that is right for you!
Remember prevention is always key!
Staying fit, preventing obesity, no smoking, drink plenty of water not bladder irritants, timing your voids, and don’t forget your kegels!!