Urinary Incontinence: Questions & Answers

Q: What is urinary incontinence?

Urinary incontinence is the involuntary loss of urine at a time that is neither convenient nor socially acceptable. It may be called “lack of bladder control.” It has happened to almost everyone at one time or another, but when it happens often, it becomes a significant problem. Incontinence can cause embarrassment, poor self-esteem and social isolation. 

Incontinence generally affects women, but men can also have trouble.

Q: Is incontinence a normal part of aging?

Incontinence is not a normal part of aging. Most older women are not incontinent; some young women are incontinent.

The chance of becoming incontinent does increase as we age. That’s because many of the risk factors for incontinence increase with age. These risk factors include the loss of estrogen after menopause, the development of physical and mental disabilities, the use of medications, decreased sensation in the bladder, decreased capacity of the bladder and a loss of muscle tone.

If you often leak urine, please know that it is not normal. You don’t have to accept it as part of growing older. You should seek medical help.

Q: Why do I leak urine when I cough or sneeze?

You have what we call “stress incontinence.” It happens when extra pressure is placed on the abdomen which, in turn, puts pressure on the bladder. Coughing, sneezing, laughing, lifting heavy objects, playing tennis and jumping are examples of activities that can cause stress incontinence.
 
Normally the bladder is held firmly in place by muscles and connective tissue in the pelvis. If these muscles are weak, extra abdominal pressure can push the bladder and urethra (bladder opening) downward, open the urethra, and cause small amounts of urine to spurt out. Stress incontinence can also happen if the sphincter (the muscle surrounding the urethra) is weak or damaged.

Stress incontinence can be cured with exercise, surgery or sometimes a combination of surgery and exercise. No medications are currently approved for treatment of stress incontinence, but several are on the horizon.

Q:  I have to get up to go to the bathroom two or three times every night. Is this normal, or should I be concerned?

Frequent nighttime visits to the bathroom to urinate is called “nocturia.” Several things can cause this condition. 

Some fluids, including coffee and alcohol, increase the need to urinate frequently. If you drink a lot – especially of the fluids that increase urination – you may have to go to the bathroom frequently during the night. Decreasing the amount you drink in the evening may decrease the number of times you need to go to the bathroom at night.

Some people have weak hearts and other conditions that cause fluid to collect in their legs and ankles during the day. When they lie down at night, the fluid from their legs and ankles moves back into their circulation, through the kidneys and into the bladder. This causes them to have to go to the bathroom during the night.
 
Most adults do get up to go to the bathroom once or twice a night. However, getting up more than twice a night on a regular basis is not considered normal. If you usually make more than two trips to the bathroom during the night, you should talk with your doctor about the cause and possible remedies. Nocturia can signal a serious medical condition that needs attention.

Q: Can I do anything to prevent incontinence as I age? 

Research shows that obesity, smoking and weak pelvic muscles are the greatest causes of incontinence. To avoid incontinence, you should maintain a healthy weight, not smoke and strengthen the pelvic floor muscles with correct, frequent exercises.

For women, pregnancy and childbearing are also major causes of incontinence because they weaken the pelvic muscles. Women who have cesarean sections have less risk of incontinence than those who deliver their babies vaginally. Also, women who have big babies, forceps deliveries, episiotomies or tears into the rectum are more likely to develop incontinence. If you are at high risk for these situations, talk with your doctor before your baby is born. It may be appropriate to talk about having an elective cesarean section. Research does not clearly show, however, that a cesarean delivery would prevent incontinence for most women.