That was a quote from a sign I saw on vacation last summer. While we read it and laugh, we all know what it means. “How’s your bladder working?” is a common question that I ask patients in the office. The responses I get include, “fine, except when I ____”, or, “I’m fine as long as I know where the bathrooms are.” And while some patients may think this is normal, the fact is, it’s not.
The incidence of urinary incontinence does increase with age, but it isn’t something that you should, “learn to live with.” Once you’re potty trained, you should stay so. Unfortunately, childbirth is a big cause of the problem. One study found that for women who’ve had a vaginal birth, the incidence of urinary incontinence was 31 percent in the first three months after the delivery. Another survey found the overall incidence of urinary incontinence to be about 53 percent in women ages 20 to 80. In fact, I heard once at conference that we spend more money in this country on “Depends” than we do on diapers.
Not all leaking is the same. Loss of urine can be due to:
• Stress-incontinence, is when the leakage occurs in response to an increase in abdominal pressure like coughing, sneezing or laughing
• Urge incontinence is when the bladder empties without warning.
• Overflow incontinence is caused by a bladder not emptying completely and basically, “overflows.”
• Some woman have an almost constant leakage of urine which may be due to a problem with the urethra staying open all the time, like a drainpipe.
• Mixed incontinence is generally thought of as a combination of stress and urge incontinence.
And while there are many categories we can use to classify the type of incontinence, there are many reasons within each category as to why it occurs. Taking a thorough history is an important part of the evaluation process, as is performing a pelvic exam and oftentimes performing a urodynamic evaluation. Urodynamics is an office-based test whereby the physician can evaluate the function of the bladder, urethra and pelvic muscles to determine the cause(s) of the incontinence.
Once the cause(s) of the incontinence are determined, treatment options can be discussed. These can include one or more of the following: physical therapy, medication, behavioral modification or surgery.
The first step is to tell your doctor what is going on. If the treatment of incontinence isn’t their thing, they can send you to someone who can help. It saddens me to hear a patient say that they haven’t been able to do the things they love to do because they’re afraid of having an accident. You don’t have to “live with it.” I can think of many instances of patients who were embarrassed to talk about their problem, but after they did and we worked together to fix it, they were overjoyed and felt like they were able to reclaim their lives.
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