Female incontinence: what you should know and why you should tell your doctor

FOR many women, urinary incontinence can be a secret shame--an embarrassment that happens frequently or every once in a while. It can be a confidence-busting inconvenience. But what these same women might not know is that urinary incontinence, or the accidental or involuntary leakage of urine, is often a treatable, preventable condition.

There are two types of incontinence, says Dr. Wendy Wilcox, assistant professor at Albert Einstein College of Medicine/Montefiore Medical Center in New York and a board-certified obstetrician/gynecologist.

Stress incontinence occurs when the pelvic muscles don't support the bladder well enough. This can happen during pregnancy, during menopause, or when you do anything that puts pressure on the abdomen, such as laughing, sneezing, coughing, lifting something heavy, exercising or even walking.

Urge incontinence is a urine leak that is preceded by a sudden desire to urinate, and may result in the loss of large amounts of urine. Experts say there's a feeling of not being able to reach the bathroom fast enough. Many women experience urge incontinence because of infections that irritate the urethra or bladder, or because of muscle spasms, which force the urine out of the bladder. Other causes include constipation, stroke, spinal cord injury, dementia or diseases that affect the nervous system. Many women experience both stress incontinence and urge incontinence at different times and for different reasons. But both forms should be diagnosed and treated separately. Statistics show that incontinence affects more than 15 million Americans, and, contrary to popular thought, it's not just limited to older people. Incontinence affects up to a third of the female population in the United States, and stress incontinence accounts for half of those cases, Dr. Wilcox says. Many of those who suffer from leakage are younger women, particularly women who engage in high-impact exercises, including running, aerobics and gymnastics. African-Americans are more predisposed to urge incontinence because of the health conditions that disproportionately affect them.

Risk factors include hysterectomy, labor (as the pelvic floor expands to accommodate childbirth), obesity, any condition that can lead to a chronic cough (such as smoking or bronchitis), bladder stones, chronic bladder infections or surgical procedures, neurological diseases and certain medications.

Often, incontinence goes undiagnosed, experts say, especially in the younger population because of the myth that it's a condition that should only affect older people. Additionally, because it can be embarrassing, many people choose to live with it--finding driving routes with public restrooms, or avoiding going out altogether. A patient may even find herself avoiding intimacy.

"With incontinence, it really is based on your lifestyle--when it affects you enough to impinge on your lifestyle," Dr. Wilcox says. "Oftentimes, the patient will not volunteer the information. If it goes untreated, many patients lose self-esteem and get depressed."

But there is help, specialists say. The most common treatment is a simple exercise known as Kegels. Kegels strengthen the pelvic floor muscles by contracting and relaxing the pelvic muscles. Imagine that you're trying to stop a flow of urine. You should feel a small lifting motion. If your abdomen, legs, or buttocks tighten, you're squeezing in the wrong place. Exercise the pelvic floor muscles by squeezing and holding them tightly for 5 seconds, working up to 10 seconds. Do these contractions 10 to 20 times, allowing a 10-second rest between each one.

Dr. Wilcox also recommends behavioral changes and keeping a voiding diary to track your bathroom use. Additionally, avoid caffeine and excessive amounts of alcohol, and don't drink too much water, which can put pressure on your bladder. Change your schedule and re-train the bladder.

Your doctor can also prescribe certain medications to treat urge incontinence, but make sure that you're aware of all side effects. New, minimally invasive surgical options, such as re-tightening the pelvic muscles and inner wall, can have quick recovery times, and have the highest cure rates for stress incontinence. Consult your physician to determine the best option for you.

What You Can Do Right Now About Female Incontinence

1. Establish a schedule of urinating every three to four hours, regardless of whether you feel the need.

2. Talk with your doctor about all prescription and nonprescription medications you take to see if any of them are making your condition worse, and to understand what type of incontinence you're experiencing.

3. If you have trouble reaching the bathroom before you urinate, consider making a clearer, quicker path to the bathroom and wearing clothes that are easily removed (such as those with elastic waistbands or Velcro closures), or keep a bedpan close to your bed or chair. For small leaks, consider purchasing a consumer product that can line the panty and protect your clothes from leaks.