While experiencing an involuntary release of urine may feel far from normal when it’s happening, the truth is it’s a lot more common than you may think.
According to Dr. Katelyn Kopcsay, urogynecologist, Baystate Urogynecology, “A recent survey of women found that 25-50% of the respondents reported they had a bladder control issue in the past year. That’s at least one in four women experiencing a leak, a dribble or full-on accident. And, yes, while it’s happening, that uncontrolled loss of urine—on any scale—can feel very isolating, the numbers prove it’s happening to a lot of women all the time.
In other words, if you’re having bladder control issues, you’re far from alone. But, more importantly, there’s a very good chance you’re closer to regaining control than you think.”
Understanding and treating common types of bladder incontinence
Frequently experienced by women who have given birth or gone through menopause, urinary incontinence is often very treatable. As Kopcsay notes, the first step in treating the issue is getting an accurate diagnosis. “There actually are several different types of incontinence; the most common being stress incontinence and urge incontinence, often called overactive bladder.
Each type has different causes, characteristics, and triggers for leaking urine. Diagnosing the type of incontinence is an important first step in choosing a treatment option.” Here’s a closer look at each:
The loss of small amounts of urine when a person coughs, laughs, exercises, or is startled is called stress urinary incontinence (SUI). It results from the weakening of the muscles in the pelvic floor that occurs over time. The biggest risk factor for SUI is childbirth, particularly vaginal delivery. Obesity, which can increase pressure on the pelvic floor, is also known to contribute to SUI.
How to Stop Stress Incontinence
“SUI is often successfully treated with simple lifestyle changes,” says Kopcsay. “For individuals with obesity, losing 8% of body weight can lead to a 50% reduction of SUI symptoms.”
Regardless of weight, Kopcsay adds that pelvic floor exercises can reduce symptoms. “Actively engaging the specific muscles of the pelvic floor with Kegel exercises—squeezing your muscles as if you’re trying to stop urine flow or not pass gas—can give you back some of the control lost to aging.”
Kopcsay advises patients to perform exercises 30-50 times a day. “It may sound like a lot but given you can do them seated or standing and you can see a 60% reduction in leakage, it’s really not that much.”
She also recommends patients look to keep fluid intake under 64 ounces per day and practice ‘timed voiding’—going to the bathroom every two hours.
If these approaches don’t offer the desired degree of relief, there are surgical options that can be considered, the most common being the midurethral sling.
Kopcsay explains, “The procedure is very low-risk and basically involves implanting a synthetic mesh under the urethra to recreate the lost support. It’s a same-day surgery that offers immediate results and is over 90% successful.”
While it’s most often referred to as overactive bladder (OAB), urge incontinence is probably best described as “I gotta’ go RIGHT NOW” syndrome.
Why Do I Have a Constant Urge to Pee?
Characterized by a sudden and compelling urge to pee, OAB often leads to urine leakage. The unexpected urgency often leads women to limit socializing or outings for fear of having an accident.
Causes and Treatments for Urge Incontinence
If you have an overactive bladder, you're probably wondering "Why can't I hold my pee?" — and "What can I do about it?"
Kopcsay explains, “The core of the problem with OAB is that the brain has lost control over the bladder.” She continues, “Normally, the muscles of the bladder stay relaxed as it fills with urine. Nerve signals from the bladder tell the brain that the bladder is filling, and the brain decides if it’s appropriate to empty the bladder. With OAB, the messaging is out of whack and the bladder contracts without permission from the brain. The urge to urinate can be quite frequent and strong, often disrupting sleep, and leakage is quite common.”
Treatment of OAB often begins with a bladder diary. “I advise patients to maintain a bladder diary,” says Kopcsay, “noting how often they have an urge, how much they drink, and what they are doing when they have leakage. This gives us a better picture of exactly what’s happening.”
She also recommends patients engage in active fluid and diet management. “Certain foods, like caffeine, artificial sweeteners, and sodas, can increase bladder sensitivity and contribute to OAB. I also suggest they limit fluid intake 4-6 hours before bed if they are having bothersome urination overnight.”
Strengthening Your Pelvic Floor
Because a weakened pelvic floor is also a contributing factor in OAB, Kegel exercises are also recommended.
Once you've learned to do them correctly, Kegel exercises are simple — and you can do them anywhere, anytime.
Medical Treatments for Overactive Bladder
If those measures don’t bring relief, the next step is often medication. A number of prescription medications in both generic and brand name form have been shown to be effective. However, potential side effects include dry eyes, increased blood pressure, and even cognitive impairment in older adults.
Another treatment option is percutaneous tibial nerve stimulation (PTNS). “This is an effective with no side effects,” says Kopcsay.
PTNS works by stimulating nerves and improving the communication between the brain and bladder. An acupuncture needle is inserted near the posterior tibial nerve in the ankle area and connected to a TENS unit. Treatments are performed weekly for 12 weeks in the doctor’s office and approximately 30 minutes. After the initial 12 treatments, your provider will evaluate your response to treatment and determine if treatments should continue on an every 4-6 week basis.
Kopcsay adds, “In addition to PTNS, another treatment option that aims to improve brain-bladder communication is Interstim. Best described as a pacemaker for the bladder, the treatment involves implanting a small device in the buttock area near a nerve to the bladder. In addition to the fact that this approach is very effective, another nice aspect is that we can actually do a trial run with it outside your body for two weeks before doing the actual implant.”
Botox for Bladder
A final option for OAB is Botox for the bladder. “One of the most potent muscle relaxants,” says Kopcsay, “Botox is effective at preventing inappropriate bladder contractions, and thereby preventing OAB-related leakage. Treatments typically last for 6-9 months and can be performed in the doctor’s office.”
True relief from bladder issues is possible
Bladder control issues can be frustrating and embarrassing. But regaining control may be possible—and easier than you think. To discuss your issues with a Baystate health professional, contact Baystate Urogynecology.