Always on the lookout for a bath? Bladder leakage can affect your well-being, and people – especially women – are more likely to experience it as they age. Just 3 percent of women under 35 experience incontinence, compared with 38 to 70 percent of women over 60, according to Wolters Kluwer’s UpToDate, a tool for doctors. Many factors that weaken the pelvic floor muscles—including childbirth, menopause, obesity, and constipation—can increase the risk of bladder leakage. Neurological disorders such as multiple sclerosis and Parkinson’s disease can also affect bladder function, says Arthur Louis Burnett, professor of urology at the Johns Hopkins School of Medicine in Baltimore. Conditions affecting the prostate can also lead to incontinence. But shedding is not a normal part of aging. “There’s always something that can be done,” says Jason M. Kim, clinical assistant professor of urology at Stony Brook University School of Regenerative Medicine in New York. You may be reluctant to broach the subject, but talking can improve your quality of life. Here’s what you need to know to find a solution that will work for you. Before recommending a treatment, your healthcare 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 pressure to the abdomen can cause the bladder to leak urine,” says Brian J. Linder, a urogynecologist at the Mayo Clinic in Rochester, Minn. What is the pelvic floor and how pandemic life could damage yours Overactive bladder, or urge incontinence, makes people feel like they have a pressing and frequent need to use the bathroom — and that if they don’t make it in time, they might have an accident. “Some people have to go every 20 minutes, which limits what they can do,” says Kim. Evidence-based treatments for urinary incontinence range from lifestyle changes to surgery, and the provider should start with the least invasive options. If your regular doctor doesn’t show you different strategies to try, a specialist like a urologist or urogynecologist can help you find what works. “You don’t have to deal with it just because you’ve learned to live with it,” says Kim. Lifestyle modifications is usually the first line of treatment. If you’re overweight, losing a few pounds can take pressure off your bladder. Relieving constipation with dietary changes, such as increasing fiber intake, or with medication, if needed, can have the same effect. Alcohol and caffeine can irritate the bladder and promote leakage, so limiting their use can also help. Pelvic floor physiotherapy, which helps strengthen the muscles involved in urination, is another non-invasive treatment. Known as Kegel exercises, these exercises can help with both stress incontinence and an overactive bladder. It can take several sessions to work, says Kim, and you can practice at home. Medication may be the next option, Linder says. Anticholinergic drugs such as 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 it is often a last resort. Among them, the gold standard for stress incontinence, Kim says, is a sling procedure, which generally uses mesh to help support the urethra and prevent leakage. Most people find that this operation relieves their symptoms, but complications can sometimes be serious. Doctors may also inject swelling agents into the bladder. This is less invasive, but there is little long-term data, according to American Urological Association guidelines. For overactive bladder, Botox injections into the bladder muscle may help. “It will last about six months,” says Linder, so repeated treatments are required—and some side effects can be severe. Copyright 2022, Consumer Reports Inc. Consumer Reports is an independent, not-for-profit organization that works side by side with consumers to create a fairer, safer and healthier world. CR does not endorse products or services and does not accept advertising. Read more at ConsumerReports.org.
