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    Urinary Incontinence: How to Talk to Your Doctor

    Women and Urinary Incontinence continued...

    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.”

    Urinary Incontinence: Starting the Conversation

    Since discussing urinary incontinence is usually the biggest hurdle for people, some doctors have found ways to integrate it into the conversation.

    “I’ve made asking whether women are leaking urine a part of my routine history that’s taken when they come in,” says Greg Kitagawa, MD, assistant professor in the department of reproductive biology at Case Western Reserve University and an ob-gyn at MetroHealth Medical Center in Cleveland. “That way I’ve already opened the door for them to discuss these things with me.” As a result, Kitagawa says, the topic is less threatening and patients are more open to talking about it.

    So when should you talk about it with your doctor? Stepp says there's no amount of leaking that is too little to discuss. “A woman should speak to her doctor if it bothers her," he tells WebMD.

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