Don’t make me laugh

Millions of women, of all ages, are affected by urinary incontinence. And yet, more than half of us suffer silently. Healthcare providers aren’t asking, and we’re not telling.

Urinary incontinence, the involuntary leakage of urine, remains undetected and undertreated despite its substantial impact on affected individuals. The incidence of urinary incontinence in women is considered high, but varies considerably among age groups and the real number of affected women remains largely unknown. However, one study of women between the ages of 20 to 80 years, reported an overall prevalence for urinary incontinence of 53 percent. In postmenopausal women, 56 percent reported urinary incontinence at least weekly. While incontinence tends to become more problematic as we age, it’s not just older women who suffer. In women between 20 to 49 years of age, the prevalence was 47 percent. In fact, a study among high school and collegiate female athletes showed more than 25 percent had symptoms of urinary incontinence while participating in high-impact sports.

There are many causes of urinary incontinence, but the most common type of urinary incontinence in women is stress incontinence. It happens when there is an increase of intra-abdominal pressure produced from activities such as laughing, coughing, sneezing, or exercising. The underlying abnormality is typically related to where the bladder and urethra are located within the pelvis. Normally, the pelvic musculature and connective tissue keep the bladder “up” and the urethra “down” at a straight angle. However, when this usual anatomical support of the bladder is lost, the lower part of the bladder may be displaced downward and therefore outside the abdominal cavity. When pressure is increased in the abdomen (e.g. laugh, jump, run, cough, etc.), the lower part of the bladder that is supposed to be protected and supported by the pelvic floor is now subjected to higher pressures. This rise in bladder pressure overcomes the ability of the urethral sphincter muscle (which you normally voluntarily control), and thus results in urine loss.

The most common risk factors for developing stress incontinence include pregnancy, vaginal delivery, obesity, chronic cough, or previous injury or surgery to the pelvic area. Pregnancy obviously causes increased abdominal pressure as the fetus grows. And during delivery you push everything out, and sometimes more than just a baby. Obesity causes adipose (fat) tissue to accumulate both inside your body as well as the outside, increasing the pressure on the pelvic floor. Despite the cause, there are several treat options available. Initial treatment begins with lifestyle changes such as weight loss, smoking cessation, and dietary changes. Bladder training, pelvic muscle exercises (i.e. kegels), and pelvic floor muscle rehabilitation are helpful for many women. Until you are able to seek treatment or complete appropriate therapy, there are things out there to keep you dry. Absorbents like pads and undergarments are the standard options for dealing with urinary incontinence. However, the less well-known options are insertion devices, like pessaries or urethral inserts.  Pessaries are relatively safe and effective devices that are inserted vaginally and aid in supporting the pelvic floor and bladder. Available by prescription, urethral inserts are small, tampon-like plugs are are put directly into the urethra to prevent urine from escaping. If these conservative treatments are ineffective, then referral to a specialist and surgery may be indicated.

Urinary incontinence often has profound effects on quality of life and is associated with depression and anxiety, work impairment, activity aversion, and social isolation. Some women suffer from sexual dysfunction because of the anxiety that sexual activity would cause urine loss, and may even avoid intercourse altogether. And while urinary incontinence is clearly quite common and can have major psychosocial impacts on the quality of life, most women do not seek treatment. In a 2007 survey, only 45 percent of women who reported urinary incontinence occurring at least once a week sought care for their incontinence symptoms. In younger populations, this number approaches 90 percent. But why? Are we embarrassed? Do we think this it is a normal “part of being a woman?” The reasons why women do not get help are unclear. But treatment options for urinary incontinence are plentiful, and the outlook is far from dismal. About 80 percent of those who are affected by urinary incontinence improve or are cured with appropriate treatment. Take the 3IQ quiz, keep a bladder diary, do your own research, and get the help you need.



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