Afraid to laugh too hard, go for a run or have a coughing fit? If you're worried about leaking urine, you're not alone – it's more common than you might think. Urinary incontinence, or the uncontrolled loss of urine, is a frequent complaint among women and especially among moms. About 30 to 40 percent of middle-aged women experience it, says Dr. Hsin Wang, M.D., an OB-GYN with the DMC Medical Group. "As we get older, age 55 and older, about 30 to 50 percent have it," Dr. Wang says. "It's pretty common."
Another surprise? Incontinence is also incredibly treatable. But many women aren't aware of that because they're hesitant to discuss the problem with their healthcare providers. "The most unfortunate thing is women don't like to talk about it. They don't talk about it with their family doctor or their OB," Dr. Wang says. "They think, 'Oh, this is just too embarrassing to talk about' or, 'It's just a normal part of aging and there's nothing that can be done, so I'm not going to talk about it."
Women can be affected by different types of urinary incontinence, all ranging from mild to severe. Stress incontinence means leaking urine with exercise, coughing, laughing or sneezing – "some type of activity that makes a person lose urine uncontrollably," Dr. Wang explains. It could be a slight dribble or enough to warrant wearing a pad. Urge incontinence, on the other hand, is not induced by activity and is due to an overactive bladder or the muscle around the bladder being irritated or spasming. "A person can be watching TV and she doesn't even have to move and she can just wet herself," Dr. Wang says.
Other women experience both stress and urge incontinence. While the causes of urge incontinence are less understood, risk factors for stress incontinence include heavy lifting, vaginal childbirth, older age and smoking. And having a bigger baby equals a bigger risk. "If you push out a 9-pound baby, then that's a lot more stretching and weakening of those muscles," she says. While many women assume the only fix for incontinence is surgery, Dr. Wang says it's usually not necessary and is only considered when other treatments aren't successful. "They're afraid it's going to be surgery," Dr. Wang says, and that's another reason patients avoid the conversation. "The first line therapy is always physical therapy and exercises."
The DMC has specialized physical therapists who are trained to help women overcome urinary incontinence through pelvic muscle strengthening and Kegel exercises. Therapists also teach women how to walk, bend and lift with pelvic strengthening in mind. "These dedicated physical therapists know how to teach them and train them how to do these exercises properly," Dr. Wang says. For urge incontinence, medications and diet modifications may be considered for treatment. When those options don't work, cutting-edge techniques such as Percutaneous Tibial Nerve Stimulation (PTNS), which helps the nerves in the bladder communicate better, could be the next choice. "PTNS is really exciting," she says, since many patients are able to stop taking medications for incontinence after the procedure. Other surgical options are available, too.
With multiple proven treatment options available, women should feel confident asking for help. After all, urinary incontinence can affect multiple aspects of a woman's life and lead to isolation. "It has a huge social impact," Dr. Wang says, pointing out that people dealing with the problem sometimes avoid social activities for fear of embarrassment if leaking occurs. "It affects quality of life, it affects their interpersonal relationships, their mental well-being. When you're not with people, you become more depressed."
So it's time to start talking about urinary incontinence, Dr. Wang believes. The sooner women get help, the more likely they'll be able to avoid more invasive treatments. "In my practice I know 74-year-olds who've had four babies, who play tennis and run around and don't leak," she says. So if a patient like that doesn't have to leak, "then why can't you? All women have that potential." With family, careers and busy lifestyles, it's common for adults to push their own health aside -but they shouldn't. "My health is no big deal," women often think, Dr. Wang says. "I don't want them to dismiss themselves."