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Aug 10,2007
Women’s Health: You don’t have to live with urine loss
by Kenneth L. Noller, MD

Urine leakage can be a debilitating problem that many women unfortunately accept as a natural part of aging.  Although an estimated 13 million Americans, both men and women, suffer from some type of urinary incontinence, only about half of women who experience urinary incontinence report it to their doctors.  Some women are ashamed about their problem or they decide to use absorbent pads or change their behavior to deal with it.  But in most cases, urinary incontinence can be greatly improved with treatment, so there’s no need to suffer.

The bladder (which stores urine) and the urethra (which carries urine outside of the body) control urination.  Under normal circumstances, the muscles around the urethra relax and then the bladder contracts, causing urination to begin.  The flow of urine stops when the muscles around the urethra contract and the bladder relaxes.  Urinary tract infections, weakened muscles and ligaments that hold the pelvic organs in place, abnormalities in the urinary tract, neuromuscular disorders, and medications such as diuretics can interfere with urinary tract function and lead to incontinence.

There are several types of urinary incontinence.  Urine loss that occurs when a woman coughs, laughs, sneezes, walks, runs, or exercises is called stress incontinence.  Stress incontinence is the most common form of urinary control problem.  Women who have urge incontinence, or a condition called “overactive bladder,” may feel a strong sudden urge to urinate and may leak urine before reaching the bathroom.   

Women can also experience incontinence related to an underactive bladder, a blockage or other problem in the urethra, or an unrelated medical condition that prevents them from getting to the bathroom in time, such as arthritis, stroke, or nervous system or mobility problems.

The symptoms of urinary incontinence can include a strong urge to urinate whether the bladder is full or not, urinating more often than usual, needing to use the bathroom in the middle of the night, painful urination, and bed-wetting or leaking during sleep.  If you have urine loss that affects your daily life, it is important to seek help from your doctor.

Your ob-gyn may suggest that you lose weight, avoid heavy lifting, drink less caffeine, get treatment for lung diseases that make you cough, or stop smoking. Your doctor might also recommend special pelvic muscle exercises (“Kegel” exercises) to help strengthen the muscles around the bladder and the urethra, or suggest going to the bathroom on a schedule. Surgery is an option if other treatments have been unsuccessful, and collagen injections around the urethra may be an effective therapy for women who cannot have surgery. 

For more information, the ACOG Patient Education Pamphlet “Urinary Incon-tinence” is available at www.acog.org/publications/patient_education/bp081.cfm
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