We have all been there before, laughing at a funny joke, jogging, or bending down to pick up something off the floor and feeling that warm liquid drip down our legs. It’s that moment where we say to ourselves,” WTF!” If it happens at home, it’s a bit easier to manage and put to the back of our minds.  While other times it can happen at a cocktail party or while out with girlfriends.  And even worse was when it was during a passionate love making session when it happened as the perfect orgasm was just about to happen.

Problems related to your bladder and loss of urine is as taboo as talking about any other issue related to the vagina. If you are on social media, you can see the new tidal wave of conversations and information around menopause and embracing healthy aging for women. But the problem remains, we are just not talking enough about it.  Let’s face it talking about losing urine is embarrassing and no one really wants to admit that it’s happening to them and certainly not to extent where wearing sanitary pads are part of their daily wardrobe.

So, who is peeing in their pants? Raise your hands?  I for one have my hand raised!

You are not alone since 20 million women have urinary incontinence. Another 27 million feel the need to urinate with increasing urgency and frequency

The American Academy of Physicians (AAP) found that 50% of women between the gas of 40 to 60y and almost 75% of women over the age of 75 suffer from loss of urine. It’s thought these statistics low ball the true numbers since urinary incontinence is “underreported”.  In fact, the AAP also found that 50% of women who suffer from incontinence do not report these humiliating symptoms to their doctors. And to no one’s surprise, stress incontinence affects twice as many women as it does men.

Loss of urine also known as incontinence can be classified as stress or urge incontinence.

Urinary incontinence occurs when you actually lose urine.  The term “stress” incontinence happens during coughing, sneezing, laughing, exercising, lifting anything heavy, walking, standing up, getting out of the car or having sex.  Any activity that increases abdominal pressure can bring about stress incontinence especially if your bladder is full.  The tube that carries urine from the bladder to outside the body is called the urethra which can weaken over time and with common life trauma.

When a woman experiences stress incontinence it makes her feel embarrassed and isolated, often limiting activities that brings on exercises or typical daily activities.  Personal distress can be overwhelming for women affecting social activities and sexual intimacy. Women suffering with urinary often have to wear pads and diapers which is not only humiliating but also causes a perpetual “diaper rash” on the vulva of the vagina.

Stress incontinence occurs when the pelvic floor muscles have been weakened during child birth, obesity, chronic coughing, sneezing, lifting, constipation and high impact exercises over time.  The aging process, vaginal deliveries, obesity and women undergoing hysterectomies are more prone to stress incontinence.  You can even inherit urinary incontinence from Aunt Selma!

“Urge” incontinence is when you lose urine unintentionally unrelated to an activity you may be doing. Stress and urge incontinence can occur together for a group of unlucky women.  Urge incontinence often occurs as a result of an overactive bladder muscle, called the detrusor muscle, which controls the bladder.

Certain lifestyle habits make stress continence worse and include:

• Alcohol
• Caffeine
• Soda
• Chocolate
• Artificial Sweeteners
• Cigarette smoking
• Obesity
• Urinary Tract Infections
• Complications of Diabetes
• Medications causing frequent or excessive urine production

Diagnosis

A detailed history, pelvic exam, urine analysis and culture, post-void residual, and urodynamic testing is done for women who complain of loss of urine.  A diary of your urination habits, including how often you urinate and how much fluid you drink, is important at identifying women at risk for stress or urges incontinence.

Women often have to see a Urologist who can perform special tests called urodynamic testing and cystoscopy, to make an accurate diagnosis and treatment plan.

Treatment

Basic lifestyle changes can make all the different in the world for women who have loss of urine. Treatment options include the following depending on how disruptive your loss of urine is in your everyday life routine.

• Limit fluid intake especially after dinner!
• Pelvic Floor Muscle Training is taught by a trained physical therapist.
• Kegel exercises are an easy and helpful tool in flexing your pelvic floor muscles.
• Biofeedback helps identify your pelvic floor muscles if you are contraction them correctly.
• Bladder training-allows you to empty your bladder regularly and avoid “holding it in” too long!
• Pelvic Floor Muscle Training
• Controlling asthma and other lung problems with the right medications.
• Avoid food triggers
• Stop smoking!
• Control your BMI to <30

Some women have to resort to using incontinence products such as absorbent pads, adult diapers and hand-help urinals to prevent embarrassing accidents. Wearing incontinence pad may be part of a person’s daily attire but are especially needed while exercising-even walking-, during pregnancy and postpartum, going out during the day when bathroom access could be limited and while sleeping.

There are safe medications you can use to treat incontinence that can be discussed with a Urologist. A special ring, called a vaginal pessary, is sometimes used to keep the bladder in its normal anatomical position which can improve symptoms.  Women may often use a vaginal pessary to avoid surgical procedures.

Treating urge incontinence can be done with Botox which can improve symptoms by 90% over a one-year period. Just be sure you get that Botox injection form a trained Urologist and not your neighborhood beauty salon!

When loss of urine is really annoying and disruptive, surgery is often a last resort.  Sling procedures and colpo-suspension are commonly performed surgery to help support the urethra and bladder neck improving symptoms of loss of urine. Sling procedures are the most common surgery perform to strengthen and support the muscles responsibly for urination.

Injecting urethral ‘bulking agents’ is done to help strengthen the muscles supporting the urethra which is the long tube that leaves the bladder carrying urine and is often damaged with aging and vaginal deliveries.

For more complicated types of urinary incontinence, there are other more advanced surgical treatment options that should be discussed with a Urologist.

Teaching women how to do Kegel exercises and encouraging healthy life choices including weight control, are easy behavioral options that may help avoid bladder incontinence in the future. Keep track of how often you are peeing and how much liquid you are consuming is helpful in identifying if you are just drinking a ton of water or if you have problem with a weak bladder.  Are you losing urine with exercise, laughing or sex? How often are you getting up in the middle of the night to pee? How much liquid are you consuming during the day? After dinner? Do you feel like your insides are coming out of your vagina? Are you avoiding social interactions as result of loss of urine?

This may not be the ideal journal you had always wanted to keep but it certainly can help let you know if you are destine to be wearing diapers later in life. No one should ever be embarrassed about their bladder incontinence; trust me you are in good company!

If urinary incontinence becomes persistent or bothersome, it’s advisable to consult a healthcare provider. They can offer a thorough evaluation and personalized treatment options tailored to your situation. Addressing this issue can greatly improve quality of life and overall well-being during perimenopause and menopause.