Urinary incontinence is something we associate with old age. Yet an overactive bladder (OA) can be a consequence of childbirth, or even constipation. So it’s not uncommon for women in their 30s to 60s to experience urgency, frequency and yes, even urinary incontinence. We do seem to hear more about OA in women than men, so I contacted an expert in the field, Dr. Charles Nager, to ask him about the causes and possible cures for this embarrassing condition, and if there’s anything women can do to prevent light leakage or incontinence from occurring in the first place.
Dr. Nager is a urogynecologist, a specialist in female pelvic medicine and reconstruction, and director of the Women’s Pelvic Medicine Center at the University of California, San Diego.Here’s a transcript of my interview with him:
Is urinary incontinence an inevitable fact of life?
Dr. Nager: It is not inevitable. It increases as we get older. It’s more common in women than in men. Although symptoms of urinary urgency and frequency are as common in men, they just have less incontinence.
Why is that?
Dr. Nager: The urethra in women is just not as strong, or as obstructive as it is in men. So even though they may have a equal likelihood of developing symptoms of what’s called an overactive bladder, which is urgency, frequency, sometimes incontinence, the men are more likely to have just the urgency and frequency. But because their urethra has more obstruction, they’re less likely to have the incontinence. Women, whose urethras are generally weaker, when they get the urgency and frequency of bladder contractions, they’re more likely to have leakage.
Do Kegel exercises help to strengthen the urethra?
Dr. Nager: Yes, the Kegel exercises strengthen the pelvic floor – really all the sphincters for the urinary tract and the anal tract also. They are good exercises to do. Pelvic floor exercises provide improvement in incontinent symptoms.
But can they prevent incontinence?
Dr. Nager: The issue on prevention is less well-studied. There’s not as much evidence that it can actually prevent. I do think they can improve the situation.
What is the typical age of your patients?
Dr. Nager: It’s all ages. Typically, women in their 30s and 40s will present with stress urinary incontinence – which is the type of incontinence due to urethral weakness, which is often related to vaginal birth. Then there’s another group of women, typically in their 50s-80s, who have urgency incontinence, and that’s due to an overactive bladder.
What is light leakage due to?
Dr. Nager: There are two types of leakage. Stress urinary incontinence is due to a weak urethra. It’s a bad name because it’s not due to emotional stress or physical stress. It’s due to anything that increases pressure on your abdomen. Leakage, usually in spurts, is associated with coughing, sneezing, laughing, exercise, and physical exertion. That’s the more common type of incontinence, especially in younger women.
The other type of incontinence is urgency incontinence. A bladder is acting involuntarily. It senses an urge and then there’s not enough ability to suppress that urge, so the bladder contracts and there’s leakage before you get to the toilet. It’s the “got to go” type of symptom. That’s a bladder problem that’s just not being voluntarily suppressed by the brain. We really don’t know what causes that… but that type of incontinence is usually a larger volume loss and can often be more bothersome than stress incontinence.
Women in their 30s, 40s who have post-birth problems – can this be corrected? Or is it the beginning of a continuum of a problem?
Dr. Nager: Yes, this can be corrected. Those are the women that we’ll start on the pelvic floor exercises to improve the strength of their pelvic floor and urethra. That typically will improve the situation. It’s uncommon to get someone completely dry after pelvic floor exercises. If they don’t get a satisfactory response with the conservative therapy like pelvic floor exercises, fortunately we do have some very good minimally invasive surgery that are 85% likely to resolve that symptom.
What does that address?
Dr. Nager: Those surgeries fall into the category of mid-urethra sling. They put a strap of synthetic mesh underneath the urethra, that supports the urethra and keeps it from dropping down or descending and opening up when you have these coughs, sneezes laughs or exertion events.
I’m hearing more about the “sling surgery.”
Dr. Nager: These surgeries are very common. There are more than 260,000 operations a year in the U.S. for stress urinary incontinence. They’re very effective and quite low risk. They cause minimal disruption on daily living activities because they can be done in an outpatient setting and you’re back to daily living activities within a day or two. It’s a pretty quick recovery from these procedures.
Are there common reasons or aggravators of urinary incontinence?
Dr. Nager: The risk factors and the association for stress urinary incontinence seem to be obesity – that’s a big one. There are good studies that show that with weight reduction – either by diet or surgery – you can improve the stress urinary incontinence.
The other risk factor is a vaginal birth. That seems to increase your risk by at least two fold for developing stress incontinence. That’s probably because it disrupts the supportive structures underneath the urethra that now allow it to open up with exertional activities. But that’s not necessarily modifiable.
Then there’s constipation – anything that’s a chronic strain on your lower abdomen can do it. We know that things that put a constant pressure on your abdomen are things like constipation, straining, heavy lifting or a chronic cough would all predispose you to stress urinary incontinence.
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For more information about pelvic floor disorders, such as an overactive bladder, visit the website of the American Urogynecologic Society. It features a directory for finding a specialist near where you live and a chat board where you can participate in discussions and have your questions answered by experts.