Primary Care in Rochester and Kasson

FAQs: Is urine 'leaking' normal for women?

9/27/2018 by Dr. Jennifer Horn


Urine "leaking" or incontinence isn't normal, but it is common — and treatable. Urine incontinence can adversely affect your physical, social and psychological well-being, and even your quality of life at home and at work. Answers to these frequently asked questions about this condition will help dispel some myths, and if you experience urine leakage, I encourage you to talk it over with your provider. 

Q: How many women experience urine incontinence?

A: More than you may think! One in four women experience it, and incontinence gets more common with age — up to 75% of women over 65 report involuntary leakage. 

Q: Isn't it just a normal result of childbirth and aging?

A: Childbirth and aging can play a role, but urine leaking isn't a given for women. Incontinence can be caused by several factors, and sometimes more than one. Each additional cause makes your symptoms more severe and the treatment more complex. There are two main types: stress and urge incontinence. If you have both, it's called mixed incontinence. 

Q: What is stress incontinence and what causes it?

A: This is the leaking brought on by physical activities such as coughing, laughing, sneezing, jumping or even walking. Increased abdominal muscles from these actions exerts stress or pressure on your bladder and bladder neck. If your incontinence mechanisms are weakened, this increased stress causes leakage, typically spurts or drops of urine. Unfortunately, women affected by stress incontinence tend to stop doing their favorite sports or recreational activities and adapt a less-active lifestyle. 

Q: How is this type of incontinence treated?

A: If you have stress incontinence, there are several options for treating it: 

  • Pelvic floor muscle training. A member of your care team or physical therapist trained in women's health will coach you on how to do Kegel exercises. These exercises strengthen the muscles of the your pelvic floor so they work more effectively and efficiently. You should see results within six months. 
  • Treatment for conditions that may contribute to incontinence. Obesity, chronic cough, constipation, diabetes, limited mobility and genitourinary symptoms of menopause all can contribute if not addressed or treated. 
  • Intravaginal pessary. A pessary is a device made out of silicone; it's fitted to your vagina and inserted by a provider in the clinic. Different types, shapes and sizes of pessaries are used for different pelvic floor problems, depending on your condition and what is most comfortable. A ring pessary has a knob that exerts external pressure on your urethra to overcome the pressure caused by daily activities. The effect of a pessary is immediate — and reversible once the device is removed. 
  • Surgery. When other options fail, surgery can be a solution. The most common procedure is the midurethral sling. A synthetic mesh is used to replace the damaged fibromuscular sling that supports the midsegment of the urethra and reestablishes the continence mechanism. This procedure has a success rate of 85-95%; complications related to the mesh are reported at 3%. A midurethral sling is considered minor surgery, and you'll probably be sent home the same day, with some limitations on your activity.

These options are safe, but there are risks.  There's a lot of confusing information about mesh and slings, so it's important to talk with your health care provider.  If you're interested, consult an experienced surgeon who does a lot of these procedures.

A less invasive option for some cases is an injection of bulking agents into the internal sphincter of the bladder, but this is less effective. 

Q: What is urge incontinence and what causes it? 

A: Have you ever had to "go" so bad, even when your bladder isn't full, that you just can't hold it, it starts and you can't stop it? That's urge incontinence, and women who have it say it's more distressing than stress incontinence because it's unpredictable and restricts their lifestyle more. You may find yourself mapping out where toilets are located and limiting outings and social activities because you don't want to be embarrassed. Urge incontinence is usually caused by involuntary bladder contractions or "spasms", creating the strong urge to go to the bathroom and producing a larger volume urine leakage. 

This can be a common condition as you get older and most of the time there's no underlying condition causing it.  Risk factors for this condition can include neuropathy, such as diabetes or multiple sclerosis, menopausal symptoms or some types of brain injury that alter the bladder's inhibitory pathways. 

Q: How is it treated?

A: As with stress incontinence, the first lines of therapy are pelvic floor muscle training and treatment of conditions that contribute to the problem. In addition, your health care team can teach and reinforce modifications for voiding, including: 

  • Fluid management
  • Scheduled voiding
  • Bladder training to gradually increase the time between voiding
  • Double voiding
  • Avoiding bladder irritants, such as caffeine (coffee, tea, chocolate, certain medications, artificial sweeteners like aspartame and saccharin), alcoholic beverages, carbonated beverages (including sparkling water), chili pepper, citrus fruits and juices (grapefruits, lemons, limes, oranges, tangerines, kiwi, Vitamin C supplements)
  • Self-monitoring with a bladder/voiding diary

Unlike stress incontinence, medications can be very effective in treating urinary urgency, frequency and urge incontinence. First-line options are medications that relax the muscles of your bladder. The most common side effects include dry mouth, constipation and low blood pressure. Recently, Botox (yes, the wrinkle-fixing drug) injections have been used in patients who don't respond to, or tolerate, the medicines. Injections provide reasonable improvement for about six months. Possible side effects include temporary urine retention. 

Surgery is used for this type of incontinence only in very rare cases. 

Q: If I'm experiencing leakage, should I talk it over with my provider?

A: Absolutely! Only 45% of women who experience weekly episodes of urine leakage talk with their providers about it. Some find it too embarrassing to discuss, while others may think it's just normal. You can find relief from this condition and resume your active, engaged lifestyle!

Dr. Jennifer Horn is a family physician in Employee and Community Health's (ECH) Department of Family Medicine. She completed her MD at Mayo Medical School and her residency in Family Medicine at Mayo Clinic Rochester. Her interests include population health, clinical operations and holistic wellness for both patients and employees.