Regaining control

There are many likely causes of urinary incontinence; including childbirth and aging so don't be embarrassed to consult your doctor.

It's important to tell your doctor that you are incontinent because he or she may be able to help.

Even in our tell-all age, women don't like to talk about problems with bladder control. But urinary incontinence may affect up to 75% of women at some point in their lives.

When urine leaks become frequent or severe enough to be a problem, it is called urinary incontinence, or loss of bladder control. It may be triggered by laughing, coughing, lifting or running. In some cases, the sound of flowing water may trigger a leak. Incontinence does not always mean that leaks happen often. But for an active woman or one who loses a large amount of urine each time, even once a week may be too often.

Bladder function can also be affected by pelvic prolapse. That is when the tissues supporting the pelvic organs–urethra, bladder, uterus and rectum–sag out of place. The muscles at the openings of these organs can get weak. Or, the nerves that send signals that the bladder is full don't work correctly.

Why does incontinence occur?

There are many likely causes of urinary incontinence, including childbirth and aging. Infection, damage to organs and nerve and muscle disorders can also cause incontinence. The side effects of some drugs can be at fault.

A number of steps may be needed to find the cause of urinary incontinence. You will be asked about factors that may affect your voiding habits. Your doctor may ask you to keep a voiding diary. This is a record of when and how much urine leaked over 24 72 hours. You also note how much liquid you drank and what you were doing when the leaks occurred. Some tests and exams also may be needed to find the cause, including:

• A pelvic exam
• Lab tests
• Stress tests, to measure how much urine leaks, using a pad or dye
• Urodynamics, to measure the pressure and volume of the bladder as it is filled
• Cystoscopy, to show any structural problems

What treatments are available?

Treatment might be as simple as changes in lifestyle or behavior. Exercise, a change in diet and quitting smoking may reduce how often leaks happen. Avoiding heavy lifting also may help. Behavioral treatment can help you understand why leaks occur and how to avoid them. It may include bladder retraining and pelvic muscle exercises, such as Kegel exercises. These exercises strengthen the muscles at the openings of the urethra, bladder and rectum to provide better control.

Other options are use of medication, special devices and surgery. A device called a pessary can be placed in the vagina to support the pelvic muscles and make them work better. Surgery aims to support the prolapsed organs by attaching them to other structures. When the urethra muscle is very weak, bulking agents may be put into the tissues around the urethra. The extra bulk helps keep the urethra closed.

Symptoms of incontinence can make you depressed, unhappy or just uncomfortable. But treatment is available. So, talking to your doctor is the right thing to do.