If you have urinary incontinence, you don’t necessarily have to resign yourself to wearing pads and carrying extra changes of clothing. Whether you’re experiencing leaking because you were pregnant, have prostate issues, do high-impact sports or are getting older, ongoing incontinence isn’t a given.
With effective medications, surgical procedures or physical therapy that extends beyond routine Kegels, many people have their urinary incontinence cured or significantly reduced. Learn about the types of incontinence and treatments that can improve your quality of life by keeping you active and dry.
What Incontinence Means
Incontinence doesn’t necessarily involve large quantities of pee. “Incontinence means the involuntary loss of urine — when you’ve lost control,” says Dr. Harry Johnson, who specializes in female pelvic medicine and reconstructive surgery at the University of Maryland Medical Center. “There’s not an amount. It just means you leak urine when you don’t want to.”
Urinary incontinence is a “huge” and underreported problem, says Johnson, who is also the associate chairman of the department of obstetrics, gynecology and reproductive sciences at the University of Maryland School of Medicine.
“Probably more than 60% of women have some sort of urinary incontinence, maybe less severe in some patients than others,” he says. “It’s very common. The problem is that a lot of people don’t report it to their doctor or think there are treatments available for them. So, it sometimes tends to be a silent problem.”
Women are more likely to have urinary incontinence than men for several reasons including pregnancy and childbirth, hormonal changes from menopause and anatomical differences like women’s shorter urethras.
Stress incontinence and urge incontinence are the primary categories. Women are more likely to experience stress incontinence, whereas men tend to have urge incontinence.
This is the most common type of incontinence overall, and the most likely to affect younger women. Weakened pelvic floor muscles from stressors such as pregnancy, vaginal delivery or impact sports put pressure on the bladder and urethra (the tube through which urine leaves the body when the bladder empties), forcing them to work harder.
Routine actions such as laughing, coughing or sneezing that involve the pelvic floor muscles can make urine leak. Intense physical activity and movements like weight lifting can also cause leakage.
For women, pregnancy and vaginal birth can contribute to stress incontinence. “The pregnancy itself can upset the balance of forces and pressures on the pelvic floor that can then create incontinence,” says Julie Wiebe, a physical therapist and a clinical assistant professor of physical therapy at the University of Michigan – Flint. “And the delivery can add to the reasons why you might be experiencing incontinence.”
However, young women who’ve never been pregnant may still deal with leaking urine. “Incontinence can occur across the age span and can occur even if you’ve never had children,” says Wiebe, who treats women of all ages but specializes in those who experience incontinence because they participate in athletics.
Also known as ‘overactive bladder,’ the sudden, strong urge to pee typically leads to leakage before someone can make it to the bathroom. In other cases, people feel a frequent urge to urinate throughout the day, although the amount of urine is relatively small. It’s more likely to affect older women, likely because of age-related hormonal and physical changes, and men. It can happen unexpectedly when triggered by drinking water, hearing or feeling running water, or even during sleep.
For men, urinary incontinence is often related to prostate problems. “They have urinary retention due to an enlarged prostate and that can also contribute to urgency, frequency and urge incontinence, which means it’s a little more difficult to control your urine, so you get involuntary loss,” Johnson says.
Incontinence Treatment Options
Incontinence treatments include behavior modification, pelvic floor exercises and physical therapy, medications, surgery, injections and implants, depending on whether stress or urge incontinence is the problem, the patients’ gender, athletic activities and other habits.
Restricting fluid intake to about six to eight glasses, spread throughout the day, limiting caffeine and doing bladder training to gradually space out your bathroom breaks can reduce incontinence. Caffeine has a diuretic effect, so people pee more, and it may also cause bladder irritation.
Contracting your pelvic floor muscles, doing up to 10 reps for up to 10 seconds, three times a day, can help tighten these muscles to improve bladder control. Both men and women can benefit from Kegels.
Pelvic floor physical therapists who specialize in urinary incontinence and pelvic organ prolapse, or problems with pelvic support, can help patients with a variety of techniques including exercises and biofeedback, which uses sensors to demonstrate how your muscles are being used during pelvic floor exercises. These specialists help create a customized exercise plan for patients to work on independently.
Prescription anticholinergic drugs such as Ditropan and Enablex can treat overactive bladders. Oxytrol for Women is available over the counter. “The medication blocks the receptors to the bladder that cause (it) to contract and expel urine,” Johnson explains.
Other medications like mirabegron (Myrbetriq) help relax the bladder muscles, allowing it to fill more. “The bladder decides when it’s going to empty by volume,” he says. “This medication will increase the volume that you can hold before you get the urge to go to the bathroom, and help you control the urge so you can make it to the bathroom.”
Botox bladder injections
Botox can help some people with overactive bladders who don’t respond to other medications. While patients are lightly sedated, multiple Botox injections are given through a cystoscope, a small tube that’s inserted into the bladder for the procedure. The treatment is typically covered by insurance.
“Botox works pretty well,” Johnson says. “The problem is it wears off, and you have to repeat it in six months.”
A small, implanted device sends mild electrical impulses to the nerves of the sacrum, which is located right above the tailbone. It’s surgically inserted into the buttock, Johnson explains, and works by stimulating the nerve that leads to the bladder, to decrease urgency and frequency in urge incontinence.
Percutaneous tibial nerve stimulation
This in-office treatment uses a thin needle electrode that’s inserted near the tibial nerve in the lower leg. The electrode is connected to a battery-powered stimulator that sends an impulse to the tibial nerve and then the sacral nerve to reduce urgency. Treatment may consist of weekly, 30-minute sessions for about 12 weeks.
Placing a sling under the urethra is the most common surgery for stress incontinence. This sling, made of synthetic mesh or the patient’s own tissue, supports the urethra and helps keep the bladder in place.
Procedures using synthetic mesh have caused complications such as infection and pain. Instead, using fascia, or tissue, taken from the patient’s abdominal wall avoids complications from synthetic mesh. Sling procedures are available for men and women.
This recently developed treatment involves injecting bulking agents around the urethra.
“We inject into the muscle between the bladder and the urethra,” Johnson says. “This increases the bulk of the muscle to reduce incontinence. It slows down the urine flow and increases the resistance to urine coming through the urethra.” The brief, outpatient procedure is done with local anesthesia and offers quicker recovery than surgery.
Prostatic artery embolization
This minimally invasive procedure treats benign prostatic hyperplasia, or an enlarged prostate, which can cause urinary urgency, frequency and incontinence in men. The interventional radiologist, a doctor who uses imaging techniques to visualize inside the body, guides a tube into blood vessels that feed the prostate. Tiny particles are then injected into those vessels to reduce blood supply to the prostate, allowing it to shrink to improve urinary symptoms.
With any incontinence treatment, your health care team should explain the risks and benefits, describe possible side effects or complications and discuss outcomes, which could range from no effect to reduced episodes or freedom from incontinence altogether.
Sports, Impact and Incontinence
Sports and incontinence can be connected. Depending on how it’s measured and the type of exercise, women’s incontinence related to sports and fitness ranges anywhere from 30% to 80%, Wiebe says. Activities that include impact forces, such as running and jumping, tend to have higher rates of incontinence, and trampoline-related activities would land in the higher range for impact-related incontinence.
“We do see much higher rates, above the general population, in women who participate in impact activities,” Wiebe says. In research on women, sports and incontinence, findings include:
— In a study of European women athletes in track and field events, long-distance runners reported the highest rates of incontinence, which affected 44% of those surveyed overall in results published in the June 2021 issue of the International Journal of Environmental Research and Public Health.
— A study of Portuguese elite women athletes found triple the rate of incontinence compared to age-matched control participants, in results published in December 2018 in the British Journal of Sports Medicine. Most of the women had never given birth.
— In a study of competitive women powerlifters, nearly 44% of women had experienced incontinence within the previous three months, according to results published in December 2021 in the journal Sports Medicine–Open.
Incontinence can have a chilling effect or simply be accepted as par for the course. “We know in the literature that about 10% to 20% of women will leave fitness because they’re experiencing incontinence,” Wiebe notes. “But there is the other end of the spectrum with other athletes and athletic women who ignore it, who think, ‘Well, everyone in my running club leaks.’ So, it doesn’t affect them at all in terms of their fitness.”
Pelvic Floor Training and More
Kegel exercises to strengthen pelvic floor muscles have been around for nearly 75 years. Although Kegels still play a big role in incontinence prevention, they’re not the end-all and be-all, Wiebe says. Other variables contribute when women have incontinence from activities as disparate as tennis and CrossFit.
“It’s not just that your pelvic floor is weak,” Wiebe says. “So we can’t just say, ‘Do your Kegels.’ If you’re lifting loads and running 10 miles, Kegels will not help you.” Instead, she says, “It’s understanding whatever the sport is they’re experiencing incontinence and modifying or taking components of that sport, breaking it down and then building it back up with the pelvic floor included in that conversation with the patient.”
For example, doing squats or lunges can help, depending on the sport. “Let’s talk about a lunge with a runner,” Wiebe says. “The pelvic floor, the abdomen and the diaphragm work together when you take an inhale. On inhale, the pelvic floor and tummy sort of open and give a bit. On exhale, they rise back up and in. So, using that rhythm of diaphragm-abs-pelvic-floor working together inside a lunge, and going up and down into a lunge, I would say, ‘Let the pelvic floor lower a bit as you lower into the lunge. And then exhale and let the pelvic floor and abs rise as you come up out of the lunge.'”
The patient continues these motions as they lunge repeatedly. “That looks like running and now I’m integrating the pelvic floor with the abs and diaphragm, with the glutes, hips, knees and quads,” Wiebe says. Next, the progression moves to jumping and teaching the body new movement patterns, like making changes in how hard someone lands.
Typically, women are “thrilled” to see how such training can change their lives, Wiebe says. “The message I hope to get out there is: You can run and be dry. You can lift and be dry.”
When it comes to incontinence, Johnson says, this is what patients should realize: “There are treatments. While they’re not 100% — they don’t work for everybody — they work for most people. Incontinence is not normal. There are treatments and everyone should be evaluated to see if they can help improve their quality of life.”
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