It's not funny when the phrase "I nearly wet myself laughing" becomes true, but for 40 percent of postmenopausal women, it's a reality.
Incontinence, defined as the persistent involuntary leaking of urine, is more common around and, particularly after, menopause, but it's a condition that can pop up, unannounced, regardless of your menopause status.
Urinary incontinence has many causes, including pregnancy and childbirth. But menopause and the natural effects of aging also play a role. So what's the menopause link? Estrogen? Maybe or maybe not. Prior to menopause, estrogen helps increase blood flow to your urogenital tract (the vagina and the urethra-the tube extending from the bladder to the outside), which helps keep muscles and tissue toned and flexible.
Estrogen levels become consistently low in postmenopausal women and the linings of the urethra, the bladder, and the vagina become thinner and weaker. But then, as you age, the bladder muscle also weakens; the bladder simply can't hold as much as it once did. It is estimated that among midlife women about 5 percent suffer severe incontinence, while 60 percent suffer mild incontinence.
So aging is certainly a factor, but not all postmenopausal women experience incontinence, says G. Willy Davila, M.D., who heads the urogynecology and reconstructive pelvic surgery section at Cleveland Clinic Florida in Weston, Fla.
Three main types of urinary incontinence affect women:
• Stress incontinence. When you leak urine during a cough, sneeze, laugh, or physical activity
• Urge incontinence. When you feel the sudden and intense "urge" to urinate, even shortly after emptying your bladder
• Mixed incontinence. This is a combination of stress and urge incontinence
Even with so many women between ages 45 and 64 being affected by urinary incontinence, very few seek evaluation and treatment. Often it's due to embarrassment, or because many women believe that it's a normal aspect of aging and can't be treated. Treatment can be very successful-from simple interventions such as treating a persistent cough, or taking antibiotics for a urinary tract infection, to doing regular Kegel exercises and biofeedback, to taking daily medicine or even having surgery. The most effective approach teams the woman with a healthcare provider and a continence educator (typically a nurse) for coaching and personal support.
Talk about Your Symptoms
Rebecca Kightlinger, D.O., an assistant professor of obstetrics and gynecology at the University of Virginia in Charlottesville, says that up to half of her postmenopausal patients leak urine. She notes, "If I didn't ask, many of them wouldn't bring it up because they think it's normal."
Incontinence isn't normal. And it can have a major impact on your quality of life, from curtailing leisure activities and wardrobe choices to snuffing out your sex life. Yet, studies find less than half of women aged 45 to 64 with urinary incontinence seek evaluation and treatment.
Getting Treatment
When determining how to treat your condition, your healthcare provider will first consider the type of incontinence you have. Not all treatments are appropriate for every type. Most experts recommend trying the least invasive, non-medical options before opting for medication or surgery:
Best for ...
... all types of incontinence
Behavioral therapies. These include Kegel exercises to strengthen and condition pelvic floor muscles and bladder training to lengthen the time between voiding and to control urination urges.
... stress incontinence
Injectable implants. Collagen is injected into the tissue surrounding the opening of the urethra, adding bulk and helping to close it.
Surgery. Surgical techniques, some using "slings" or tape-like material, can prevent further sagging of pelvic structures.
Support and plug devices. These are inserted into the vagina or the urethra to stop urine leakage. These also have good results for mixed incontinence.
... urge incontinence
Medication. Options include oxybutynin (Ditropan(r), Oxytrol(r)), tolterodine (Detrol(r)), darifenacin (Enablex(r)), solifenacin (Vesicare(r)), and trospium (Sanctura(r)) to calm an overactive bladder and topical estrogen therapy to help restore blood flow to the urethra and vagina, and to strengthen the tissue lining.
Electrical stimulation devices.
These direct a painless, mild electrical current to the urogenital area to strengthen the muscles around the urethra. These devices can also be used for stress incontinence.
"Women need to understand that incontinence symptoms are common and can be treated," says Lindsey A. Kerr, M.D., codirector of the Pelvic Care and Continence Center at the University of Utah in Salt Lake City. "They don't have to accept them, and there are solutions other than wearing pads to stay dry."
Get Checked Out
Don't be afraid to make an appointment with your healthcare provider to discuss incontinence symptoms, specifically addressing:
• When and how often your symptoms occur and how they affect your life
• Your typical bathroom patterns (Some clinicians will request a detailed diary, including when and how much you drink, as well as when and how much you urinate-and when you leak)
• How much you urinate
• Medications you take
• Health conditions you may have
• What, if anything, makes your symptoms worse or better. For example, bladder irritants such as coffee, colas, and citrus fruits may make symptoms worse
Kegel Exercises: Get Them Right
Studies find that Kegel exercises, which aim to strengthen pelvic floor muscles, can be more effective than medication in treating urge incontinence, because they address the cause of the problem, not the symptoms. But, there's a catch. You need to learn to do them properly, do them regularly, and keep doing them, says Ivy Alexander, Ph.D, a woman's health expert at Yale University School of Nursing and Changes medical advisor. Here's how:
• Identify the correct muscle groups to strengthen. Try to stop the urine stream while you're urinating. Those are the correct muscle groups, the ones you want to work on. (But don't try Kegels while you're urinating. It could cause irregular voiding patterns)
• Try the strongest contraction you can manage and count to 10, then relax. And go slow, says Alexander. "Quickies" won't make muscles stronger. Each time you contract, hold for increasing lengths of time until you can hold for 10 seconds
• Try five sets of contractions and releases twice a day. Increase to 10 sets twice a day, then 10 sets three times daily
• Schedule Kegels every day. You can practice the contractions throughout your day-waiting in line at the store, on the bus, at your desk-no one needs to know. Challenge yourself by coughing or clearing your throat while performing the exercise. You'll be laughing without fear of leaks in no time!
Still finding it difficult? You can find Kegel instructions and diagrams on the American Physical Therapy Association Web site at www.apta.org (type "Kegel" into the search engine).
Case Study
When Brenda Strong, 61, from Tampa, Fla., was forced to decline an invitation to her local golf invitational, she realized that it was time to do something about her bladder control problems.
"It happened gradually with leakage, but it had gotten to the point of embarrassment for me, and the thought of spending 18 holes without being close to a bathroom caused me anxiety. I couldn't handle the thought of embarrassing myself in front of all my friends and the members of the club," Strong remembers.
But it wasn't until an appointment with her physician that she realized there were lifestyle changes that she could make to lessen the frequency of her urges to use the bathroom and resulting urine leakage.
Strong started a program of Kegel exercises to strengthen her pelvic floor, and, although an avid golfer, started swimming at her local pool three times a week to trim down her tummy.
"After about six weeks of adjusting my exercise routine, by adding three days of swimming along with starting up my weekly golfing schedule again, I started to lose weight. With the added strength of my pelvic muscles, I felt more confident about spending time away from the bathroom without embarrassing myself."
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