If you often need to “go” right away or leak urine (pee) accidentally during normal activities, you may have a bladder control problem. Bladder control problems affect the way a person holds or releases pee and are also known as urinary incontinence (UI). UI is common, affecting 15 to 35 percent of those age 60 and twice as many women as men. Younger, active women also commonly report experiencing UI.
Because UI may be embarrassing and a nuisance, it can greatly reduce quality of life and is linked to depression. People with UI may decide not to get together with family or friends, limit physical activity and not enjoy fun things they used to do. Getting help for UI can be important for improving and maintaining emotional health.
“Physically, for the urinary system to do its job,” says Susan Dong, MD, a urologist at Valley’s Urology Clinic, “muscles and nerves must work together to hold urine in the bladder and then release it at the right time when you’re ready to go to the bathroom. The coordination of messages from the nerves between the bladder and brain are complex and that’s why it takes a long time for children to learn to be potty trained.”
There are two kinds of incontinence:
- Urge incontinence (also known as “overactive bladder”) is when the bladder squeezes on its own without you or your brain telling it to squeeze. The bladder can become overly sensitive to holding urine and the feeling that you need to pee comes more frequently and/or you are unable to reach the bathroom in time. Aging can cause this kind of leakage, as well as some neurological conditions such as multiple sclerosis, Parkinson’s disease or spinal cord injuries.
- Stress incontinence is when coughing, sneezing or exercise puts pressure on the bladder and causes leakage through the urethral sphincter (the muscles in the bladder that open and close to control release of urine).
Most common in women, stress incontinence is also more likely for those who have been pregnant, especially if the birth was vaginal. Even if you’ve never been pregnant, aging causes the ligaments holding the bladder to stretch and become more relaxed with less support. Also, the pelvic floor muscles (muscles that support your bladder, uterus and bowel) can weaken.
For men, stress incontinence is typically caused by surgery, such as a prostate removal.
Talking with your primary care provider is the first step in dealing with a bladder control problem
If you have symptoms of overactive bladder or stress incontinence, please talk with your primary care provider first to rule out the possibility of a urinary tract infection (UTI) or constipation that can put pressure on your bladder. “Your provider can also help figure out whether something you’re eating or drinking is irritating your bladder—coffee, tea, acidic foods, or certain medications are often culprits,” says Dr. Dong. Both men and women may benefit from strengthening weak pelvic muscles through Kegel exercises, a process of squeezing and holding. Learn how to do Kegel exercises the right way here. Weight loss may also be suggested to reduce pressure on the bladder.
No relief? See a urologist for help
“If you aren’t finding relief through initial steps,” says Dr. Dong, “ask for a referral to a urologist who can review your symptoms and explore treatment options. The urologist may prescribe a medication for overactive bladder and for stress incontinence, medication and/or pelvic floor physical therapy.”
For patients experiencing long-term incontinence severe enough to affect their daily lives, one of these common urologic procedures may be the solution
Sling procedure (men and women): To prevent leaks, the urologist surgically implants synthetic mesh or the body’s own tissue to create a sling around the urethra (the opening from the bladder).
Artificial sphincter (men): For extreme cases of incontinence, a donut-like, self-controlled device that inflates and deflates, is implanted. It keeps the urethra closed when inflated and when the bladder is ready to be emptied, it is deflated.
Bladder BOTOX® (men and women): This simple procedure helps reduce the spasms of an overactive bladder. A tiny camera is inserted into the urethra to view the bladder and a small amount of BOTOX® is injected in multiple areas and if successful, the treatment is repeated every 4 – 12 months.
Bladder pacemaker (men and women): To treat an overactive bladder, the urologist will locate the sacral nerve which travels from the base of the spine to the bladder. Using nerve stimulation to restore bladder function, a small electrode connected to a pacemaker is placed near the sacral nerve, implanted in a tiny incision above the buttocks.
Other treatment options are available
“Depending on your condition and other health and lifestyle factors, we can discuss additional treatment options like percutaneous tibial nerve stimulation,” says Dr. Dong. “And if in addition to bladder control problems, you also have trouble with bowel control, we can work collaboratively with a gastroenterologist to help solve the conditions.”