Bladder Matters: Urinary Incontinence in Women

Date:
4/23/2009 | 12:00 pm

This may be a topic you are uncomfortable talking about. 

Women experience loss of bladder control - or incontinence  - twice as often as men. It is a common and embarrassing problem. Pregnancy, childbirth and menopause, as well as the structure of the female urinary tract, can contribute to this condition. However, it should not be considered as a natural part of aging, but a medical condition which can be treated. Dr. Holzberg will answer your questions about pelvic organ prolapse - which affect many women – and urinary incontinence, including evaluation and treatment options. 

Dr. Holzberg is the Co-Division Head, Division of Female Pelvic Medicine & Reconstructive Surgery at Cooper University Hospital.  He is board certified in Obstetrics & Gynecology.  He earned his medical degree from New York College of Osteopathic Medicine and was an intern at Lutheran Medical Center.  He also completed his residency and a fellowship at Cooper University Hospital.  He sees patients at offices in Voorhees and Hamilton.

Will the occasional bladder incontinence just get worse as I grow older, or can I expect an improvement or status quo? Betsy from Collingswood

4/23/2009 12:00:59 PM

Adam Holzberg, D.O.: To be honest with you, Betsy, any of those things can happen. It is unlikely that you will see improvement, though. Typically as women get older these problems can worsen. The best thing to do is seek treatment even if it is just some simple behavioral changes to fit your situation or dietary modifications such as decreasing caffeine, carbonated beverages, citrus juices and fruit, artificial sweeteners and tomato-based products.

I would like to know if there is something that I can do to prevent myself from peeing when I cough or sneeze? Loretta from Woodlynne

4/23/2009 12:02:52 PM

Adam Holzberg, D.O.: There are a few different options for this problem. The easiest is to perform Kegel exercises on a regular basis and often you will see a response in a few months. You can also explore more in depth treatment with physical therapy and then there are also some minor surgical options. The best thing to do is obtain a full evaluation of your complaints and obtain all the risks and benefits of different treatment modalities.

I had a complete hysterectomy at Cooper in October of 07.  Since then I am experiencing dripping after I urinate when I stand up. Is this common? I have no other problems. I am 65 years of age. Suzanne from Burlington

4/23/2009 12:04:10 PM

Adam Holzberg, D.O.: This is a very common problem in women and not only after a hysterectomy.  Sometimes doing Kegel exercises or more in depth physical therapy can help this problem or a simply standing for a moment over the toilet following urination can help.  You need to be the judge as to how much of a problem this is for you and decide if you might want to pursue further options.

Ever since I gave birth five months ago, I have leakage when my bladder becomes full or whenever I feel the urge to go to the bathroom. Is there any treatment for this? Michelle from Deptford

4/23/2009 12:06:10 PM

Adam Holzberg, D.O.: Many women have urinary complaints after giving birth. Some of these complaints will resolve on their own and others can persist.  We encourage women to do their Kegel exercises after giving birth in order to bring their pelvic muscles back to shape.  This can be very helpful for you.  More intense therapy can be done with a physical therapist in the way of biofeedback and functional electrical stimulation.

I have intermittant problems, a few weeks of frequent urination with no infection, a few days of stress incontinence, and last month I had 3 days of leakage. Then it simply went away. I am 54, had two vaginal deliveries, and am, for the most part, in good health. The symptoms then go away for months at a time. What might be causing this? Linda from Sicklerville

4/23/2009 12:08:15 PM

Adam Holzberg, D.O.: It's difficult to say.  I would need more information.  It is possible that diet can have an affect on your bladder symptoms.  Many things we eat and drink can be bladder irritants that can lead to some of these symptoms.  Items like caffeine, carbonated beverages, citrus juices and fruit, artificial sweeteners and tomato-based products are just a few things that can irritate our bladder.  These items can certainly effect frequency and urgency and if the bladder or urethra is irritated can cause intermittent stress incontinence.

I have had the surgery to fix this problem. But I now experience, at times, leakage when coughing or when I can not hold until I reach a bathroom. Is this problem reoccurring even though I had the repair done several years ago? Headdy from Maple Shade

4/23/2009 12:10:09 PM

Adam Holzberg, D.O.: Any surgery for incontinence has an inherent failure rate. Many factors account for decreased efficacy over time. It often depends on the type of surgery you had. Not being able to make it to the bathroom is often a problem that is not fixed with surgery so it is possible this is a different problem that could be helped with medication or behavioral modification. My best advice would be to come in for a consultation to explore your options.

I have constant leakage, but I do not have any prolapse. Is that considered stress incontinence? I also continue to get UTIs. I have heard that D-Mannose may help is resolving these infections. Sandy from Stratford

4/23/2009 12:13:04 PM

Adam Holzberg, D.O.: If your leakage is occuring mostly with activity like cough, sneeze, laugh or even walking, then it is likely stress incontinence.  Leaking with the urge to go and not being able to make it is urge incontinence.  In regards to your frequent UTI's, I am not familiar with using D-Mannose but like any herbal supplement you should be careful.

When standing or walking I often feel the urge to urinate and can't wait to find a bathroom. I often think I will not make it to the bathroom, even when my bladder is not that full. While sitting, or even during the night, I am fine. I never get up during the night to urinate. I am 62 yrs old,had a hysterectomy at age 47 and think this has something to do with my problem. What is your opinion? Rosemary from Maple Shade

4/23/2009 12:16:25 PM

Adam Holzberg, D.O.: Hysterectomy can be a risk factor for urinary incontinence but there are many women who have not had one and have similar complaints. Often times this can be helped with medication and/or some easy behavioral or dietary modifications, such as decreasing caffeine, carbonated beverages, citrus juices and fruit, artificial sweeteners and tomato-based products.

I don't have urinary incontinence; however, I have another concern. For about the past two months, on average of twice in a 24-hour period, something strange happens when I urinate. After the flow is completed, I expel "air" through my urethra, which feels strange and sounds almost like the sound of passing gas - but this is air from the urethra. I have no other symptoms - everything else is normal. Is this a normal occurrence, and if so, what causes it? Loretta from Westmont

4/23/2009 12:18:10 PM

Adam Holzberg, D.O.: I would not consider this a normal occurrence.  Air would have to somehow get into the urinary tract to then be ultimately expelled.  Air can be produced by bacteria which can be a sign of other abnormalities.  I would suggest evaluation by a physician if this problem persisits.

What are Kegel exercises and can that help me when I really need to urinate and can't hold it in time to get to a bathroonm? Sarah from Allentown

4/23/2009 12:19:59 PM

Adam Holzberg, D.O.: Kegel exercises are exercises that squeeze your pelvic muscles.  You can test out whether you do them correctly by trying to stop your urine mid-stream.  I don't suggest you do this regularly when performing these exercises but it's a good way to make sure you are doing them correctly.  They certainly can be of help in controlling the urge to urinate,  If you need further training you can seek help from a physical therapist who specializes in this problem.

Dr. Holzberg, I had an operation to straighten out my urethra many years ago. The Dr who performed the operation said this would solve my urinary problems. It worked for about two (2) months and then all my urinary problems came back. I have such bad incontinence that, whenever I do dishes I wind up having to stop and go to the bathroom and most of the time I don't make it in time. Very often I sleep with an adult (pull-up)diaper on. I get up several times during the night to urinate. In the morning when I awake I rarely make it to the bathroom without wetting myself. I never leave the house without a pad or Pull-up on. I loose my urine when I laugh or cough. I am 9yrs post menopausal, have Fibromyalgia and IBS. Also, Asthmatic, Diabetic and had a heart attack 10/19/2007, I was 57yrs old. Dr. Rosenbloom performed my double bypass at Cooper. Heart-wise I'm fine. What can be done for my severe incontinence. Thank you for your time concerning my problem.  Ellen from Southampton

4/23/2009 12:22:31 PM

Adam Holzberg, D.O.: I am not sure exactly what surgery you had based on your description.  Your problem sounds complex and would require further discussion in addition to a further workup.  Based on your complaints, it sounds like your incontinence is varied, occuring with both urge and activity.  Treatment is often multifactorial and could include medicine, physical therapy and other behavioral modifications and even further surgical options.  A full evaluation would be needed for specific options. Best wishes.

At what age do women usually experience loss of bladder control? Sara from San Diego

4/23/2009 12:24:11 PM

Adam Holzberg, D.O.: It can occur at any age.  Most typically it can occur after childbirth and worsen after menopause.  Many factors come into play, so a typical age cannot be defined.

I am 61 years old and struggling with urgency and frequent urination and have no structural or neurologic problems based on tests. I have found that omission of caffeine has helped my problems somewhat. I need better control; what do you recommend? Judith from Philadelphia

4/23/2009 12:26:07 PM

Adam Holzberg, D.O.: You are on the right track with your dietary changes.  Other treatment modalities could include regular Kegel exercises or more in depth physical therapy including biofeedback and electrical stimulation.  There are a number of medications to improve this problem in addition to some surgical modalities.  Full evaluation is warranted if this is affecting your quality of life.

What causes the loss of bladder control  in so many women as we age? Is there a particular point in a woman's life (or particular cause-related activities, behaviors, etc.) when bladder control begins to fail or weaken? How might it be prevented? What might younger women do to protect themselves against losing bladder control in the future? Thank you. Lucinda from Lawnside

4/23/2009 12:28:34 PM

Adam Holzberg, D.O.: Unfortunately, we don't know this answer for sure.  There are many factors that influence urinary incontinence depending on the type.  Childbirth, age, weight, previous surgery and genetics are just a few factors. Regular Kegel exercises and being aware of dietary triggers are some of the easy things to help slow the progression of these problems.

I'm not so much concerned about urinary incontinence -- leaking, etc. -- as I am about frequency and urgency. What about having to urinate often and urgently, but each time only a small amount? What does that say about my bladder? Is that considered "incontinence"? Can anything be done about that? Thank you. Ava from Haddon Heights

4/23/2009 12:31:14 PM

Adam Holzberg, D.O.: It is not considered incontinence unless you experiencing the loss of urine with this urge prior to getting to the bathroom, but frequency and urgency can be a serious impairment to a woman's quality of life.  There are many things that can be done.  Kegel exercises, physical therapy, medication, behavioral and dietary modification and even surgery can all help this problem that affect millions of women.

I have Urge Incontinence (I don't leak when sneezing or coughing but I have to go RIGHT NOW). Is this something that can be helped with hypnosis, since it seems to be a brain/nerve disconnect? I don't want to take yet more pills and put yet more drugs into my system. Molly from Edgewater Park

4/23/2009 12:32:19 PM

Adam Holzberg, D.O.: I am not aware of hypnosis being of help in this situation, but a little research may bring new information to light. There are ways of improving this problem other than taking medication.  Strengthening the pelvic muscles with Kegel exercises or biofeedback and electrical stimulation with a therapist can help.  In addition, as I've mentioned above, other lifestyle and behavioral changes like diet modification can also help. Good Luck.

Can a woman have incontinence as a symptom related to Interstitial Cystitis ("IC")? I have IC and I also have incontinence. I have leakage after my bladder starts to fill a little bit. Also it seems like my leakage is worse when I'm tired or at the end of the day. Is that possible for the incontinence to be worse when your muscles are tired? Sue from Sicklerville

4/23/2009 12:34:24 PM

Adam Holzberg, D.O.: Interstitial cystitis, as I'm sure you're aware, is a bladder syndrome which consisis of urinary frequence, urgency and/or pelvic pain.  The urgency component can certainly have some urge incontinence associated with it.  It certainly is reasonable, that when you are tired your muscle control is diminished.

I recently had bladder repair,(urethral sling) stress incontinence, in November 2008, it helped but not completely. Now i seem to have no muscle control, is this normal? I have an appointment in May with my urologist. Betty from Mount Laurel

4/23/2009 12:36:23 PM

Adam Holzberg, D.O.: If you are saying you now have difficulty holding your urine, then this can be an adverse affect of a sling.  Many times this will resolve by 3-6 months after surgery, but it can persist.  It could require additional treatment if it is affecting your quality of life.  I strongly suggest you discuss this with your urologist and ask about your options.

After a visit with my gyn regarding pelvic organ prolaspe, he recommended a hysterectomy and to tuck my bladder back in place. I am 54 yrs old. Please advise if a hysterectomy is the best treatment option. Monica from Marlton

4/23/2009 12:38:06 PM

Adam Holzberg, D.O.: There are many factors that come into play when deciding to do a hysterectomy.  We do not have concrete medical evidence as to whether hysterectomy is a necessary part of the surgical treatment for pelvic organ prolapse.  It is difficult for me to give you a definitive answer without further evaluation.  I would suggest you explore this question further with your gynecologist or consider seeking an additional opinion.

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