Last week we talked about the prevalence among menopausal women and some of the causes. This week we will discuss prevention and treatment.
If your doctor diagnoses you with urinary incontinence, there are treatments she can prescribe. Pelvic floor physical therapy is useful for all women, particularly those experiencing incontinence. Medications are available to treat urge incontinence. Vaginal estrogen may be an option for some women. Your doctor may consider inserting an intravaginal pessary to control your stress incontinence. A pessary is a silicone device that comes in multiple shapes and sizes to treat different issues. Once inserted, it presses on your urethra to help when you experience stressors that normally cause urine leakage. In some cases, your doctor may recommend surgery and/or refer you to a urogynecologist for other options. The most common surgery for stress incontinence is a midurethral sling, which uses a synthetic mesh material to replace the damaged muscular support of the urethra. It has a high success rate with a low incidence of complications.
There also are many things you can do at home to reduce your risk of urinary incontinence and/or decrease your symptoms:
Do Kegels every day. If you have incontinence symptoms, it may take 4-6 weeks before you notice any improvement in your symptoms. To do Kegels, squeeze the muscles of your genital area as if you were trying to stop the flow of urine. Be careful not to use the stomach, leg, or buttock muscles when you do it since you want to isolate your pelvic floor muscles. Squeeze for 3 seconds and relax for 3 seconds. Work up to 3 sets of 10 per day. It may be easier when you first start doing Kegels to be lying down. Later, you can do them in any position. Do NOT do Kegels while you are urinating since this will weaken the muscles. The best time to start doing Kegels is when you were in your 20s; the second-best time is now. And do them regularly for the rest of your life
Lose some weight. Being overweight puts more pressure on your bladder and surrounding muscles, which can lead to problems with incontinence. Ask your doctor for a referral to a dietician to help you develop a plan to lose weight that includes healthy foods and physical activity.
Watch what you eat & drink. Caffeine, carbonation (such as sodas), citrus fruits, and alcohol are bladder irritants and may make urinary incontinence worse.
Don't smoke. Smoking can exacerbate urinary incontinence.
Have regular bowel movements. Constipation worsens urinary incontinence, and chronic constipation can be the cause of incontinence due to trauma to the pelvic floor. Eat lots of fiber and talk with your doctor if you are not having soft bowel movements at least 1x/day.
Use your vibrator. Vibrator use has been found to improve urinary incontinence, pelvic floor muscle strength, and chronic unexplained vulvar pain.
Train your bladder. You can help control urgent incontinence by training yourself to go to the bathroom at set times. Increase the time between bathroom visits by 15 minutes every week until you are urinating less than 8x/day. Urinate each time, even if you do not feel like you need to go. By gradually increasing the amount of time between visits, your bladder learns to hold more urine before it signals the need to go again.
Importantly, although incontinence pads and protective underwear can help with the embarrassment of incontinence, they should not be used long-term since chronic wetness will lead to tissue breakdown, infections, and other problems. If you do need to use pads while you are seeking treatment, make sure you choose incontinence products and not menstrual pads. Incontinence pads hold more liquid volume and have technology built-in to convert the urine into a solid which helps with wetness and odor. Finally, incontinence pads are designed to wick moisture away from the skin in a way that menstrual pads are not.
In short, many women over 50 experience urinary incontinence. It is not something you have to live with. It is not a normal part of aging. See your doctor if you experience symptoms of incontinence so that you can rule our more serious conditions and discuss treatment options. The sooner you address the problem, the faster you can get back to your life.
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