Medical Column: Do You Wet Your Pants?

By: Dr. Stephen Yarbrough

Many women would answer that question as yes! Urinary incontinence is defined as the accidental leakage or loss of urine.  According to the American Urological Association, urinary incontinence is very common, with a prevalence of 51% among adult women in the United States.

There are several types of urinary incontinence. The first is known as stress incontinence, which is leakage that occurs with activities such as coughing, sneezing, laughing, or running. Stress incontinence, the most common cause of urine leakage in women ages 45-49, occurs more commonly in patients who are obese or have given birth by vaginal delivery. The second type, known as urge incontinence or “overactive bladder”, is most common in older women. With this type, women may have a sudden, uncontrollable urge to urinate and may leak when trying to rush to the restroom. Many people with urge incontinence also have to go to the restroom more often than most people during the day and/or night. Common triggers include unlocking the door when returning home, going out in the cold, turning on the faucet, or washing your hands. The third type is known as mixed incontinence, which is when there are symptoms of both stress and urge incontinence.

How is urinary incontinence diagnosed? Your doctor can use several tests to determine which type you have. This may include a questionnaire or physical exam with a special test called a “cough test”, which is where you are asked to cough with a full bladder while your doctor watches for urine leakage. Another common test uses ultrasound to evaluate how much urine remains in your bladder after you empty your bladder. After a complete evaluation, your doctor can diagnosis and treat you appropriately.

How is urinary incontinence treated? Treatment options differ for each type of incontinence. Some things you can do on your own to help symptoms can include weight loss if you are overweight, decreasing your fluid intake, avoiding constipation, and pelvic floor exercises (kegel exercises). For stress incontinence, treatment can include the use of a pessary, which is removable device inserted into the vagina that helps support the vaginal tissues. Another option for stress incontinence is surgery, which has the highest cure rate. For urge incontinence, treatment may include medications that help reduce the bladder urgency such as Botox injections into the bladder or a surgical option where a nerve stimulator is placed.

Will I ever be “normal” again? With the treatments mentioned above, many people are able to regain bladder control or at least improve the symptoms of leakage. Untreated, this can result in a decreased quality of life, increased anxiety and depression, increased urinary tract and skin infections, increased risk for falls and fractures in older women, and increased caregiver burden, according to American Family Physician (AFP). So if you believe that you may be experiencing symptoms of urinary incontinence, talk to your Family Physician. Relief may be easier than you think.