Many factors that weaken the pelvic floor muscles — including childbirth, menopause, obesity and constipation — can increase the risk of bladder leakage. Neurological conditions such as multiple sclerosis and Parkinson’s disease can also interfere with bladder function, says Arthur Louis Burnett, a professor of urology at Johns Hopkins School of Medicine in Baltimore. Conditions that affect the prostate can also lead to incontinence.
But leakage is not a normal part of aging. “There is always something that can be done,” says Jason M. Kim, clinical assistant professor of urology at the Renaissance School of Medicine at Stony Brook University in New York.
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Before recommending treatment, your health care provider will determine the type of incontinence you are experiencing. The most common form is stress urinary incontinence, or leakage when you sneeze, cough, or laugh. “Anything that adds abdominal pressure can force the bladder to lose urine,” says Brian J. Linder, a urogynecologist at the Mayo Clinic in Rochester, Minn.
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Overactive bladder, or urgency incontinence, makes people feel like they have an urgent and frequent need to go to the toilet — and that if they don’t make it in time, they could have an accident. “Some people have to go every 20 minutes, which limits what they can do,” Kim says.
Evidence-based treatments for urinary incontinence range from lifestyle modifications to surgery, and your health care provider should start with the least invasive options. If your regular doctor doesn’t offer you different strategies to try, a specialist such as a urologist or urogynecologist can help you find what works. “You don’t have to deal with this just because you’ve learned to live with it,” Kim says.
Lifestyle changes are usually the first line of treatment. If you are overweight, losing a few pounds can take the pressure off your bladder. Relieving constipation with dietary changes, such as increasing your fiber intake, or with medication, as needed, can have the same effect. Alcohol and caffeine can irritate the bladder and promote leakage, so limiting their use may also help.
Pelvic floor physiotherapy, which helps strengthen the muscles involved in urination, is another non-invasive treatment. Also called Kegel exercises, these exercises can help with both stress incontinence and overactive bladder. They may take several sessions to get to work, Kim says, and you can practice at home.
medication could be the next option, Linder says. Anticholinergics like oxybutynin (Ditropan and Ditropan XL) can help calm an overactive bladder, but research has linked them to dementia symptoms in older adults, especially at higher doses. A beta-3 agonist like mirabegron (Myrbetriq) could provide some of the same effects without the cognitive risks, Kim says.
More invasive procedures are often a last resort. Among these, the gold standard for stress incontinence, Kim says, is a sling procedure, which generally uses mesh to support the urethra and prevent leakage. Most people find that this surgery relieves their symptoms, but complications can sometimes be serious. Doctors can also inject fillers into the bladder. That’s less invasive, but there’s little long-term data, according to guidelines from the American Urological Association. For an overactive bladder, Botox injections into the bladder muscle can help. “It takes about six months,” Linder says, so repeated treatments are needed — and some side effects can be serious.
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