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Urinary incontinence affects many

The 40% of middle-aged women who have it often can be helped.

Many women think urinary incontinence is a normal part of aging. According to Michael Zaragoza, MD, a female urologist at Bayhealth Medical Center in Dover, DE, however, “any leakage is not normal.” 

For the approximately 40% of middle-aged women who are sufferers, “It’s important to get the right diagnosis; all urinary incontinence is not the same,” says Adam Holzberg, MD, a urogynecologist with Cooper University Hospital in Camden, NJ.

Stress incontinence

Stress urinary incontinence (SUI) is a loss of urine that occurs with physical

exertion, including coughing, laughing or exercise. In non-sufferers, the pelvic floor muscles support the bladder. Aging, childbirth and menopause can cause these muscles to weaken, sometimes forcing the bladder downward and preventing the urethra from squeezing as tightly as it should.

“Stress incontinence is a mechanical problem” says Heidi Harvie, MD, director of the Women’s Center for Continence and Pelvic Health at the University of Pennsylvania. “Thus, the treatment is more mechanical.”  Here are common treatment options.

Kegel exercises. These strengthen the scaffolding that supports the bladder. The first step is to identify and contract the pelvic floor muscle. For women who can’t isolate the correct muscle, electrical stimulation can be used to do it for them.  Physical therapies have “maybe a 50% success rate. But it needs to be committed to,” says Dr. Holzberg.

Weight loss. “My doctor told me that 20% of patients get better by losing weight,” says Mary Smith of Marlton, NJ, a mother of twins who reported leakage at her six-week post-partum visit. “I found this to be true.”

Surgery. Small incisions place a sling typically made of synthetic material under the mid-urethra. They have success rates as high as 90%. “If the patient believes quality of life is comprised because of leakage, then surgery, versus more conservative therapy, is her decision,” says Dr. Holzberg. 

Urge incontinence

Urge urinary incontinence (UUI) is leakage that occurs after suddenly feeling the need to urinate. A common cause is abnormal nerve signals that result in bladder spasms. While Kegel exercises and physical therapy can help, these other treatments are often prescribed.

Dietary and behavioral changes. This involves avoiding, among other things, caffeine, alcohol, citrus and spicy foods. Timed voids can empty the bladder before a spasm is triggered.

Medications. Meds called anticholinergics work on nerve receptors in the bladder, reducing or preventing spasms. 

Surgery. An outpatient procedure inserts a small electrical wire through the skin into the lower portion of the pelvic bone to stimulate the nerve next to the bladder. “Many patients don’t need to go that way,” says Dr. Holzberg.

Get to a doctor

The right diagnosis is key. “If you have stress incontinence, meds won’t work,” notes Dr. Holzberg.

 “It is common; it should not be something to be embarrassed about,” says Dr. Harvie. “Some women leak during sex, so they cut back, some stop exercising, some won’t go out with grandkids because they are afraid of smelling of urine. It is also one of the main reasons that women get admitted to nursing homes. And it can be fixed.”

Jo Rizzo is a local freelance writer.

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