Q: I’m going on vacation soon and am worried about leaks from urinary incontinence. What should I do?
Maybe it’s a small dribble after you cough or sneeze, or a larger leak triggered by a sudden urge to go.
Urinary incontinence, or the accidental loss of urine, is a common condition. It affects many more women than men and is more prevalent among older adults, though it can occur at any age, for various reasons, said Dr. Harry Johnson, a urogynecologist at the University of Maryland Medical Center in Baltimore.
If you’re feeling discouraged by the condition, know that there are many effective treatment options available, Dr. Johnson said. And there are helpful products for managing leaks on the go, too.
What causes urinary incontinence?
One of the most common types of urinary incontinence is called stress incontinence, which occurs when pressure (such as from coughing, sneezing, laughing, or jumping) is placed on the bladder, causing urine to leak, said Linda McLean, a physiotherapy professor at the University of Ottawa in Canada. Stress incontinence is usually caused by damage to either the muscles or supportive tissues along the urethra, or the valve between the bladder and the urethra, Dr. Johnson said.
Another common form is urge incontinence, which happens when you feel the need to urinate even when your bladder isn’t full, Dr. Johnson said. This is often a result of nerve injuries that affect the brain’s control over the bladder. With this type of incontinence, the urge can be so strong and sudden that hearing running water, washing your hands or even opening the door of your home can cause a spontaneous loss of urine.
For women and men, the risk of incontinence increases with age. Men tend to experience urge incontinence, often caused by an enlarged prostate, though prostate surgery can lead to stress incontinence. Women experience both types more frequently than men, in part because pregnancy and childbirth can damage nerves and weaken the muscles and connective tissues that support the organs in the pelvis.
People who have mobility difficulties or chronic conditions like stroke, multiple sclerosis or diabetes may also struggle with accidental leaks.
What treatments are available?
According to Dr. Johnson, certain dietary modifications are worth trying first. Cutting back on caffeine and alcohol, which increase urine production, can help, he said. And pay attention to how much water you drink — both too much and too little can exacerbate the condition, Dr. McLean added.
Pelvic floor physical therapy, which includes kegel exercises, is effective for both men and women. Bladder training, which involves gradually increasing the time between bathroom trips by 15 minutes or so until you can last for two or more hours, is also beneficial, Dr. Johnson said.
If these options don’t work, you might consider medication, Dr. Johnson said; anticholinergic drugs — which work by blocking receptors in the bladder to reduce contractions, and thus leaks — are helpful for some people. However, Dr. McLean noted that the drugs have been linked with an increased risk of dementia in older adults, so they should be considered carefully.
For stress incontinence, minimally invasive procedures — such as injecting bulking agents into the urethra or surgically inserting a sling beneath the urethra to help support it — can help prevent leaks.
For urge incontinence, injecting Botox into the bladder stiffens the organ’s muscles so it’s more difficult to contract and cause leaks. And sacral neuromodulation involves surgically implanting a device that delivers electrical impulses to the nerves involved with bladder function.
What works for you won’t work for everyone. But most people will be able to find at least one treatment option that reduces or eliminates their leaking, Dr. Johnson said.
How can I manage my condition when I’m on the go?
Set yourself up so you can reach a bathroom quickly. Identify public restrooms beforehand, such as with a bathroom locator app, said Dr. Paul Pettit, a urogynecologist at the Mayo Clinic. When traveling on a plane, opt for an aisle seat; on long car rides, consider bringing a portable toilet.
Over the past decade, incontinence products have improved immensely and have become much easier to find, Dr. McLean said.
The National Association For Continence maintains a list of effective products, including portable catheters for men that fit like a condom and absorbable pads, liners and underwear. Intravaginal inserts, such as pessaries, can be placed into the vagina to press against the urethra to help decrease leaks. “Not all people like them,” Dr. McLean said. But “when they work, they work really well.”
Finally, have a backup plan in case of an accident. Wear loose, dark clothing to hide wet spots, and bring extra outfits and plastic bags for storing soiled ones.
And remember: Dealing with urinary incontinence doesn’t have to be a lonely or shameful endeavor. There are many resources and options designed to alleviate worry and improve your quality of life, Dr. Pettit said.
