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Urinary Incontinence: How to Talk to Your Doctor

By Patty Rasmussen
WebMD Feature
Reviewed by Louise Chang, MD

A year after the birth of her second child, Kathleen (who asked that her last name not be published) developed stress incontinence -- a type of urinary incontinence that can make you leak urine when you cough, sneeze, laugh, or take part in physical activities.

“I was only in my 30s,” Kathleen says. "And I was leaking up to five tablespoons of urine during any activity. I had children in preschool and was dealing with this mess. I thought, ‘I can’t live like this.’"

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There's great news for the millions of people like Kathleen, who develop urinary incontinence: "They don’t have to live with it,” says Kevin Stepp, MD, director of urogynecology and minimally invasive gynecology surgery at the Carolinas Medical Center Women’s Institute in Charlotte, NC. “It’s very common and there are a lot of options that are well tolerated, low risk, and non-surgical or minimally invasive.”

Yet many people do live with urinary incontinence -- and as a result, may withdraw socially or become depressed -- because they never get diagnosed or treated for it. Why? Many are embarrassed to bring it up with their doctors, especially if it occurs during sex. Others believe that it's just a part of aging, and there's nothing to be done.

Knowing what kind of information your doctor needs from you and what you need from your doctor can make it easier to talk about urinary incontinence. Kathleen's experience, along with advice from doctors who treat the condition, may help you start talking -- and start getting relief.

Women and Urinary Incontinence

Twice as many women as men develop urinary incontinence. Two common types are stress incontinence and urge incontinence from overactive bladder (OAB).

It's important to observe as much as possible about your urinary incontinence so you and your doctor can develop the right treatment for you. For example, when you get an intense urge to pee, are you unable to make it to the toilet without urinating -- a sign of urge incontinence? Or do you leak small amounts of urine -- a symptom of stress incontinence?

Stress incontinence is the most common type of incontinence in young and middle-aged women. It can be caused by changes that occur during pregnancy, childbirth, or menopause. In Kathleen's case, the pelvic floor muscles, which support the bladder, had torn during her first delivery. Before the birth of her second child, she religiously did Kegel exercises to strengthen the muscles, which help hold in urine. But the baby was close to 10 pounds and the delivery took a further toll.

Overactive bladder happens when inappropriate nerve signals are sent to the bladder, creating the “gotta go” sensation, although the bladder may not be full or it is an inappropriate time. This can lead to involuntary loss of urine. OAB can be the result of nerve or muscle damage, medical conditions, even a reaction to medications.

“Patients will often have both,” Stepp says. “If a patient has 'urgency,' they may have mild bladder contractions that create the urgency, but don’t actually cause leakage because their muscles are strong enough to keep it in. Sometimes they have severe bladder contractions, and not even the best muscles can stop that. Or they may have a weak muscle from some stress incontinence and mild urgency or bladder contractions causing them to leak with both. That’s where fixing one may fix another.”     

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