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“Every time I cough or sneeze, I wet my underwear. I have to wear a pad every day.”

“I hate that when I need to use the bathroom, I wet myself before I get there.”

“Ever since I had my baby, I find that I cannot hold my urine.”

“I do not like going out or exercising anymore because I feel like there is an odor.”

“Everywhere I go, I have to locate the nearest bathroom.”

I have been asked by some of the blog readers to talk about urinary incontinence. I realized it has been years since I wrote about urinary incontinence. Urinary incontinence is when you involuntarily leak urine. It is when we have no control over urinating. It is a common condition in women that can occur at any age. In a survey done in the United States, only 45 % of women who were having a problem sought care. Unfortunately, many women are embarrassed to talk about it and would rather suffer in silence. I always tell women if their quality of life is not suitable due to an ailment and they have reached a point where it is affecting their life and limiting their activity, it is time to get help. TALK WITH YOUR HEALTHCARE PROVIDER. 

Urinary incontinence can be divided into three broad categories, and depending on the cause, the treatment options are different.

1. Stress urinary incontinence – losing urine when coughing, sneezing, laughing, or exercising.
2. Urge incontinence – when you cannot hold your urine in time to get to the bathroom.
3. Mixed incontinence – a combination of both.

The workup for urinary incontinence often starts with a thorough history. Your doctor will want to know when the problem started and how it affects your life. They will want to know about your medical history, especially all the medications that you are taking. Some types of medicines can cause urinary incontinence. For example, if you are on a diuretic for high blood pressure, you might notice that you are urinating a lot. Your physician might need to adjust the dosage or the time you take the medication.

After a history, a physical exam will be done. Sometimes the condition may be related to the tone of your vagina, especially after a vaginal delivery. If so, your doctor may recommend pelvic floor physical therapy. Your doctor might have you do a voiding diary for 2 -3 days to get an idea of what you are drinking and how that may play a role in your symptoms. After reviewing your diary, the doctor may suggest that you stop drinking after a particular hour. Your doctor may even suggest timed voiding, where you are encouraged to void every few hours whether you feel like urinating or not. Losing weight may also be a treatment option. Your doctor will send your urine for analysis to ensure you do not have an infection.

If conservative methods do not help, you will be referred to a urogynecologist. A urogynecologist is a physician who has finished an OB/GYN residency and has done additional training to care for women with urinary problems. For some women, they may need complex testing called urodynamic testing, they may need medication, or they may require surgery.

If medication is prescribed, ask your physician about the side effects. Dry mouth is a common side effect of some of the drugs. For some of the drugs, long-term use has been associated with dementia. It would be best to ask your physicians about the drug they prescribe and its long-term effects. Never stop taking a medication without discussing it with your provider. Generally, medication is used for those who have urge or mixed incontinence.

Surgery is usually offered to those with stress or mixed incontinence. I know surgery can be scary, but when it works, it can change one’s life, especially in the case of urinary incontinence. If you do choose to have surgery, it is best to get it done by a urogynecologist. They are most likely to have a better success rate than a general OB/GYN. You always have a right to ask to see a urogynecologist if your general OB/GYN is considering doing the surgery.

Other options that may be discussed are an implant placed in the buttock or a Botox injection. Both options are typically used for overactive bladder, which is under the broad category of urge incontinence.

If you are having bothersome symptoms due to urinary incontinence, please seek help. There are many treatment options. DO NOT BE SILENT. You are not alone. 

These blog posts are for all of us. I want it to be meaningful to you. If there are topics you want to address, you can always email me at drngozi@ngoziosuagwumd.com.