Peeing in Public: Female Incontinence

When you are afraid that your friend will make you laugh and both you and your bladder will lose it, it’s not a good situation. The inability to hold your urine (medically termed incontinence) is not anyone’s idea of a funny situation. It can be incredibly embarrassing and isolating. While you certainly won’t kick the can because of incontinence, it may kick the quality of your life. Women often report depression, anxiety, and isolation because of it. Admitting it out loud can be difficult; but once you say the words, you will probably see several of your friends nodding in agreement. You are certainly not alone.

You may be asking yourself: how the heck did I find myself leaving the pharmacy with Depends? I used to buy tampons and pregnancy tests, and now I am buying Depends! How did this happen? Well, despite your love for your little ones, they are usually somewhat to blame. And the larger your brood, the better the chance that you will experience incontinence. Furthermore, if you avoided a C-Section and pushed those kids out, you are even at greater risk. Wow, being a woman is so much fun!

While pregnancy and delivery are big players in the incontinence game, obesity is also one of the biggest risk factors for urinary incontinence. Believe it or not, obese women are three times more likely to suffer from incontinence. It’s a real risk factor. And not surprisingly, rounding out the top four is age; age is the A-number-one risk factor for incontinence. While about 4% of women age 20 to 29 report incontinence, this number jumps to 40% in women older than 80 (getting old is not easy!)

Incontinence comes in many shapes and sizes (as do the women that it affects). Close your eyes, and imagine four drawers—one that holds your bras, one that holds your T shirts, one that holds your tanks, and one that holds your long-sleeved shirts. Now, if you live in New York City, you may be thinking: I only have space for one drawer, and all that stuff is mixed together. However, the rest of the country is digging the metaphor. Each drawer is a part of a dresser that holds something that you wear on your top. Incontinence is similar; there are four main types of incontinence, all which hold their own “drawer.” There is stress, urgency, overflow, and mixed. It is important to identify which type you have so that you can get the right treatment.

Ah, stress…the big S impacts us on a daily basis, from morning to night, from work to home, from friends to spouse. And much like the pressure it causes in our daily lives, stress incontinence results from increases in intra-abdominal pressure. Think cough, sneeze, laugh, push—all of these actions increase pressure in your abdomen and can lead to the leakage of urine. It is more common in younger women (40s) and generally occurs because the urethra (that’s the hole from which your urine comes out of) changes position. It becomes hypermobile (or uber flexible); this change results from poor support in the pelvic floor (pregnancy, deliveries, obesity, chronic coughing, high-impact activity).

Moving right along from the T- shirts to the tank tops, we have urge incontinence. Think gotta go, gotta go, gotta go right now…and that’s urge. The need to go right now is called urge. This usually happens as we age and often occurs alongside other medical conditions. The urge to urinate comes whether the bladder is full or basically empty. Due to bladder contractions, you are always on the go, searching for a bathroom.

The next drawer down is overflow incontinence. In an overflow situation, the urine is always flowing; whether it is a stream or a dribble, it never stops coming. In general, it results from an inability to completely empty the bladder, and it can be a real bummer.

Putting it all together, or choice A + B (stress and overactive), you get mixed incontinence. The combination effect makes treatment slightly more difficult and diagnosis definitely more clouded. You will likely need a specialist to help you solve this problem. To figure out if you have it and what you have, we need to do some tests. After a thorough history and exam (focused on the pelvis and pelvic organs), we will likely check your urine for infection. Believe it or not, bugs in the urinary system can lead to incontinence, so this is one of the first places we look.

Usually, we will ask you to keep a diary (Dear John…I think I may be in love with Tom…no, not that kind of diary) documenting when you urinate, how much you urinate, and what you drank before you urinated. It is also likely that we will schedule you to undergo something called urodynamic testing. While totally different than any test you have ever gone through (think sitting in a chair with catheters coming out of all orifices below your belly button), it will shed a lot more light on why your urine is making unsolicited appearances throughout the day. Furthermore, if surgery is in your future (and we are not saying that is where you are headed), this is super helpful in planning the procedure.

Before any medical treatment is initiated, be it pills or surgery, we ask you to look at your life and see what, if any, changes need to be made (and to get a second opinion!). If you are smoking, you need to quit. If you are overweight, you need to lose weight. If you are suffering from constipation (chronic pushing is not good), you need to take a stool softener and eat more fiber, and if you are drinking tons of caffeine, you need to cut back. While basic, these can be the biggest beasts to tackle (we know; we have some habits that would be nearly impossible to break).

We will also suggest learning and implementing daily Kegel exercises. No, we’re not kidding. Strengthening your pelvic floor muscles can help reduce incontinence. We also take you back to those magical days of potty training your toddler (“Sammy, do you have to go pee-pee?”) over and over again until they finally get it! Retraining your bladder to void frequently and keep bladder volumes low can be quite helpful. Despite our best efforts, many times, lifestyle changes ≠dry underwear. We may need medication and/or surgery to get us there. It’s not a bad thing; it’s just a slightly bigger deal. But with new advancements in medicine and surgery, we can find the right treatment to tame your bladder.

Whatever you call it, the ladies room, the bathroom, the loo, or the potty, the bathroom is a pretty essential part of all of our days. You stumble in bleary eyed in the middle of the night without giving it much thought. However, when you start to experience incontinence, everything to do with it—the bathroom, where it is, how long it will take you to get there, and what you will do if it is full—becomes a big, big deal.

Unfortunately, it is not an uncommon problem. Millions of women experience it, and most do it in silence. While we don’t suggest updating your Facebook status to reflect “incontinent,” we do recommend sharing it with your doctor and those who are near and dear to you. Their support will make a difficult situation easier and will guide you to get the treatment you need. Don’t suffer in shame; it’s so not worth it!