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Urinary incontinence is a condition women have traditionally been hesitant to talk about, although it can have a major effect on the quality of their lives. Unfortunately, many women feel they just have to live with incontinence, especially as they grow older.

Peter Rosenblatt, M.D., Director of Urogynecology, at Mount Auburn Hospital, a teaching hospital of Harvard Medical School in Cambridge, says, “Women need to talk with their physicians about urinary incontinence because there are a number of very effective treatment options that can help them return to their normal lives.”

The most common type of urinary incontinence is stress incontinence, which is the involuntary loss of urine that may occur while coughing, sneezing, laughing, jumping, or exercising. The second most common type of incontinence is urge incontinence, which is more common as women age. Urge incontinence involves a leakage of urine and that is usually associated with a strong urge to immediately go to the bathroom. This urge may occur, for instance, with certain triggers, such as when you put the key in your front door or are taking a shower.

Another condition called overactive bladder is associated with urge incontinence. Actual leakage may not occur, but you may still feel urgency and have to go to the bathroom much more frequently, perhaps several times in the middle of the night.

Stress incontinence is more common in women for several reasons. Childbirth, especially if you’ve had big babies with prolonged labor and vaginal deliveries, may injure the structures holding up the bladder. The more children a woman has had, the higher the risk for developing incontinence. Other factors contributing to incontinence are menopause, asthma, chronic cough, smoking or an occupation that requires a lot of lifting. In addition, overweight women tend to have more incontinence than women of ideal body weight. Losing just 5 to 10 percent of your weight can help reduce the incidence of incontinence.

Dr. Rosenblatt says, “There are steps a woman can take in her own home to address incontinence issues before even going to the doctor’s office.” He suggests that one of the most useful and overlooked steps is keeping a diary of your voiding habits (or number of bathroom visits). By writing down everything you drink and each time you go to the bathroom, you may be able to see a pattern you can control.

You can also do Kegel exercises. This means contracting and releasing the pelvic floor muscles. These are the muscles you use to hold back urine. Kegel exercises can be incorporated into your normal activities. For instance, you may do them while you’re driving or each time you stop at a red light or while you’re watching TV, perhaps during each commercial. Generally, four sets of ten exercises each day are recommended. Dr. Rosenblatt says that about 70 percent of women will see an improvement in both stress and urge incontinence as a result of doing regular Kegel exercises.

What you eat and drink can also have an impact on incontinence. Caffeine is not only a diuretic that causes you to urinate more often, but it is also an irritant to the bladder that can result in an urge to urinate before the bladder is very full. Besides avoiding caffeine, you may also find that avoiding alcohol, citrus juices, and spicy foods may make a difference.

Establishing a regular voiding schedule can also be very helpful for both stress and urge incontinence.

Dr. Rosenblatt recommends bladder retraining drills that have women urinating at specific times each day and then slowly increasing the intervals between these times.

The point at which you seek medical attention depends on your threshold of tolerance. A small amount of leakage may bother one woman but not another. If you feel incontinence is having a social or hygienic effect on your life or is disrupting your quality of life, then you should see your doctor.

“Women should not just assume that some incontinence as they age is normal, since no amount of incontinence is considered normal,” says Dr. Rosenblatt.

Diagnosis of incontinence starts in the doctor’s office with a complete medical history. The patient describes her symptoms, which may suggest a diagnosis of the type of incontinence going on. This is important since each type responds to a different treatment. A physical examination can also be helpful since a prolapse, or dropping of the uterus or bladder, can be associated with leakage. The vaginal walls may also be examined for their hormonal status because after menopause there can be a significant thinning of the vaginal walls that can be reversed with the use of locally applied estrogen creams.

Additional testing is sometimes necessary to confirm a diagnosis. One group of helpful tests is called urodynamics. This involves filling the bladder with fluid through a catheter and measuring the resulting pressure in the bladder and urethra, which is the tube that leads from the bladder to outside the body. During this process, conditions that can lead to stress urinary incontinence, such as bladder contractions (urge incontinence) or weaknesses in the urethra’s sphincter muscle (stress incontinence), may be detected.

Doctors may recommend many of the techniques already mentioned but may also prescribe medications. There are some medications that are particularly helpful for overactive bladder and urge incontinence or for women who have a combination of both kinds of incontinence. These medications may result in some minor side effects such as dry mouth and occasionally constipation, but overall they are very well tolerated and women can stay on them indefinitely with good urgency control.

If lifestyle changes aren’t working for stress incontinence, then surgery is frequently the next best step. Surgical procedures have become much less invasive in recent years. Now minimally invasive procedures done on an outpatient basis have a 90 to 95 percent success rates. Dr. Rosenblatt says that the most common procedure he currently performs is called the tension free vaginal tape procedure or TVT. This involves putting a synthetic fabric of mesh or a “sling” under the urethra. The patient has a local anesthesia with a small amount of sedation and goes home the same day. Most procedures today are performed through the vagina: however, laparoscopic procedures, which are performed through lighted instruments inserted in the abdomen, can also be very effective in reducing stress incontinence.

Dr. Rosenblatt emphasizes, “Proper diagnosis is the first step toward finding a treatment that will address urinary incontinence. I would like to urge all women whose lives are disrupted by incontinence to see their physicians. You don’t have to live with this condition.”