FAQ: Is urine 'leaking' typical for women?
9/26/2024 by Jennifer Horn, M.D.
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 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 clinician.
Q: How many women experience urine incontinence?
A: More than you may think! As many as 60% of American women have reported urinary incontinence during their reproductive years, 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. Several factors can cause incontinence. Each 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: How is urinary incontinence evaluated?
A: First, your healthcare professional will take a thorough history, including an inventory of your symptoms and consideration of any other health conditions that may be causing the incontinence. Next, they will perform a physical exam, which will include evaluation of the pelvic floor and reproductive organs. Testing should include analysis of the urine and ruling out infection. Specific imaging of pelvic organs and bladder function testing may also be done.
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 firing of 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 adopt 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, or Kegel exercises, strengthen your pelvic floor muscles so they work more effectively and efficiently. You should see results within six weeks to six months. The use of mobile apps, weighted vaginal cones, or supervised pelvic floor physical therapy can augment training.
- 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 clinician in the clinic. Depending on your condition and what is most comfortable, different types, shapes and sizes of pessaries are used for other pelvic floor problems. 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 mid-urethral sling. A synthetic mesh replaces the damaged fibromuscular sling that supports the midsegment of the urethra and reestablishes the continence mechanism. This procedure has a success rate of 80% to 90%; complications related to the mesh are reported at 3%. Other possible complications of surgery include groin pain and trouble urinating. A mid-urethral 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 so much confusing information about mesh and slings, so talking with your healthcare clinician is essential. If you're interested, consult an experienced surgeon who does many 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 (overactive bladder), and what causes it?
A: Have you ever had to "go" so bad, even when your bladder isn't full, that you can't hold it, and when you start to urinate, 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 of 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 caused by 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 contributing to the problem. In addition, your healthcare team can teach and reinforce modifications for voiding, including:
- Fluid management.
- Scheduled voiding.
- Bladder training to gradually increase the time between voiding.
- Double voiding (urinate, wait a couple of minutes, then urinate again).
- 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, and 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 clinician?
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 normal. You can find relief from this condition and resume your active, engaged lifestyle. If you are experiencing blood in the urine, pain or sudden onset of incontinence, you should seek help immediately.
Jennifer Horn, M.D., is a family physician in Primary Care in Rochester and Kasson's Department of Family Medicine. She completed her medical degree at Mayo Clinic Alix School of Medicine and her residency in Family Medicine at Mayo Clinic in Rochester. Her interests include population health, clinical operations and holistic wellness for patients and employees.