Many factors that weaken pelvic floor muscles, including childbirth, menopause, obesity, and constipation, can increase the risk of bladder leakage. Neurological disorders such as multiple sclerosis and Parkinson’s disease can also interfere with bladder function, says Arthur Louis Burnett, professor of urology at Johns Hopkins School of Medicine in Baltimore. Conditions that affect the prostate can also lead to incontinence.
But leaks are not part of normal aging. “There’s always something that can be done,” says Jason M. Kim, clinical assistant professor of urology at the Renaissance School of Medicine at Stony Brook University in New York.
You may be hesitant to broach the subject, but talking about it can improve your quality of life. Here’s what you need to know to find a solution that will work for you.
Before recommending treatment, your health care provider will determine the type of incontinence you have. The most common form is stress urinary incontinence, or leakage when you sneeze, cough or laugh. “Anything that adds abdominal pressure can force the bladder to leak urine,” says Brian J. Linder, urogynecologist at Mayo Clinic in Rochester, Minnesota.
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Overactive bladder, or urge incontinence, makes people feel like they have a strong and frequent need to go to the bathroom – and if they don’t get there in time, they could have an accident. “Some people have to go every 20 minutes, which limits what they can do,” says Kim.
Evidence-based treatments for urinary incontinence range from lifestyle modifications to surgery, and your provider should start with the least invasive options. If your regular doctor doesn’t show you a variety of strategies to try, a specialist like a urologist or urogynecologist can help you find what works. “You don’t have to deal with it just because you’ve learned to live with it,” Kim says.
Lifestyle changes are usually the first line of treatment. If you are overweight, losing a few pounds can reduce the pressure on your bladder. Relieving constipation with dietary changes such as increasing your fiber intake or with medication, if needed, can have the same effect. Alcohol and caffeine can irritate the bladder and promote leakage, so limiting the use of these can also help.
Pelvic floor physiotherapy, which helps strengthen the muscles involved in urination, is another non-invasive treatment. Known as Kegel exercises, these exercises can help with both stress incontinence and an overactive bladder. They can take multiple sessions to work in, Kim says, and you can practice at home.
Medication could be the next option, says Linder. Anticholinergic drugs such as oxybutynin (Ditropan and Ditropan XL) can help calm an overactive bladder, but research has linked them to symptoms of dementia in older adults, especially at higher doses. A beta-3 agonist such as mirabegron (Myrbetriq) could offer some of the same effects without the cognitive risks, Kim says.
More invasive procedures are often a last resort. Of these, the gold standard for stress incontinence, Kim says, is a sling procedure, which typically uses a mesh to help support the urethra and prevent leaks. Most people find that this operation alleviates their symptoms, but complications can sometimes be serious. Doctors may also inject bulking agents into the bladder. It’s less invasive, but there’s little long-term data, according to American Urological Association guidelines. For overactive bladder, Botox injections into the bladder muscle can help. “It will last about six months,” Linder says, so repeat treatments are needed — and some side effects can be serious.
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