The Agency for Healthcare Research and Quality (AHRQ), an arm of the Department of Health and Human Services, recently published an exhaustive report on urinary incontinence (UI), calling it an age-old problem, but pointing out that women don’t need to suffer with it in the same way past generations did. "People are much more aware that urinary incontinence is a problem, and they’re more willing to go for help," says researcher Jean F. Wyman, PhD, APRN, who has worked in the field of incontinence since the early 1980s and who stresses that when women do get help it can change their life.
Today, we have a better understanding of urinary incontinence and know that age isn’t the only risk factor. Pregnancy, childbirth, menopause, hysterectomy and obesity are among other risk factors that can occur across a woman’s lifespan. These reasons help to explain why a quarter of all young women experience UI, along with half the women in middle age or after menopause and up to three quarters of older women.
UI also affects women very differently, with leaking that can range from slightly bothersome to debilitating, severely impacting quality of life even when using with the best adult pads and other incontinence supplies.
To present a big picture look at the treatment of urinary incontinence among women for AHRQ, an independent team of investigators at the Minnesota Evidence-based Practice Center, including Dr. Wyman, analyzed nearly 900 studies and parsed through the findings. The review looked at treatment options including pelvic floor muscle training using Kegel exercises; bladder training, which includes voiding on a set schedule; medical devices and weight loss. Said Wyman, "This report was unique in that we tried to compare the benefits of drugs as well as non-pharmacological treatments, and we looked at the harms of treatments."
Before Treatment of Urinary Incontinence: Understanding Your UI
The quick definition of incontinence is the involuntary loss of urine. But it’s important to understand the type of urinary incontinence you have to find the right treatment. Stress incontinence can typically be traced to a problem with the sphincter muscle that helps control urine flow, a problem that results in leakage during everyday actions like coughing or sneezing. Urgency incontinence is marked by an involuntary loss of urine associated with a sudden and compelling urge to go. Overactive bladder is usually characterized by a frequent urge to go, including having to get up during the night; about a third of those women experience urge UI, too. It is possible to have both stress and urge incontinence; that’s usually referred to as mixed UI.
There are various risk factors for each kind of UI—these can overlap—and, more importantly, different treatments. Stress incontinence is more common in younger women in association with pelvic floor trauma and prolapse of the uterus, both of which are often related to vaginal delivery and may require surgical treatment to put the uterus back into its normal position so that it doesn’t affect the bladder. Urgency and mixed UI are more common in older women and related to an overactive bladder with or without a sphincter that’s not working properly.
Treatment of Urinary Incontinence: Can It Help?
When talking about the success of UI treatment options, the researchers point out that improvement in UI is defined very differently by patients and by scientists. For women, improvement means living with fewer restrictions on their activities and a lessening of bothersome bladder symptoms, especially urine leakage. Researchers define improvement as a decrease in the amount of lost urine during adult pad tests or a significant decrease in the frequency of leakage episodes. So the success of any given treatment really depends on whether you feel it improves your quality of life.
Standard UI treatments for women include lifestyle changes like going to the bathroom on a regular schedule and moderating the timing and amount of beverages you drink, pelvic floor muscle training, electrical stimulation and, for predominantly stress incontinence, surgical treatments. In addition, several drugs have been approved for adults with overactive bladder, with or without urge incontinence.
According to the report, the benefits from the two lifestyle changes, pelvic floor muscle training and bladder training, rated high, along with electrical stimulation. Weight loss, another lifestyle change, improved UI in obese women. Among those who are candidates for UI drugs, 1 of every 8 to 12 women (depending on the specific drug) achieved continence; others found some degree of improvement, but side effects caused a certain percentage of women to stop taking them.
The bottom line: You may be able to improve symptoms of UI with one or more approaches that make sense for you. Kegels and bladder training cost nothing to try and may help urge UI the most. Surgery might seem like an extreme option, but if you have the type of UI that can be helped by it, you may regain so much quality of life that it’s the right choice. Start by working with an experienced urologist to explore your options.