The Emotional Toll of Female Incontinence

Female incontinence is physical, but it can also have a psychological impact.

Medically Reviewed by Louise Chang, MD on January 17, 2007
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The family dinner was going well -- until a condition known as female incontinence got in the way.

The middle-aged woman has urge incontinence, sometimes called overactive bladder (OAB). As the name suggests, when the urge to go to the bathroom comes on, it often can't be controlled.

She leaked urine through her clothes and onto her son and daughter-in-law's upholstered dining room chair, an embarrassment that didn't go unnoticed.

After the cleanup, even with her daughter-in-law and other family members assuring her that everything was fine, the woman was so humiliated she now has trouble accepting invitations.

Urinary incontinence is primarily a physical problem, affecting an estimated 12 million U.S. adults. But incontinence can also take an emotional toll on a person.

Emotional Toll of Female Incontinence

When you have female incontinence, you may avoid social situations and even sexual intimacy, and that in turn can lead to withdrawal and depression.

"Incontinence is embarrassing," says Jennifer Anger, MD, MPH, an assistant professor of urology at the University of California Los Angeles David Geffen School of Medicine and an attending physician at Santa Monica -- UCLA Medical Center in Santa Monica, Calif.

But if you get a medical evaluation when you first notice symptoms of female incontinence, your doctor can suggest a host of treatments that will improve or eliminate the condition.

"Older women think it's a normal part of aging," Anger says, clarifying that it is not. While the condition does affect older women more than younger, it doesn't have to be a side effect of aging.

Female Incontinence and Depression

Depression is more common in women with female incontinence, according to several studies. In one study, published in a 2005 issue of Obstetrics & Gynecology, researchers found that nearly three times as many women with female incontinence had depression compared to those without the condition.

They surveyed nearly 6,000 women, ages 30 to 90, with more than 40% of them reporting some degree of female incontinence.

Another study, published in Social Science Medicine in 2005, found that urinary incontinence is associated with depression in both women and men. And if a woman is incontinent, her husband is also more likely to be depressed, the researchers found.

Female Incontinence Impact on Quality of Life

Not surprisingly, the more severe the urinary incontinence, the greater the impact on quality of life, report French researchers who evaluated 556 women with female incontinence and compared them to more than 2,000 women without the condition. These women had lower self-esteem, impaired well-being, and reduced sexuality compared to the women without female incontinence.

Urinary incontinence in severe forms should be considered a disability, the French researchers conclude in their report, published in a 2006 issue of Neurourology and Urodynamics.

Female Urge Incontinence

While all types of female incontinence can cause emotional distress, urge incontinence is far more distressing, says Halina Zyczynski, MD, associate professor of obstetrics and gynecology at the University of Pittsburgh School of Medicine and a specialist in female incontinence at the Magee-Womens Hospital.

It's the unpredictable nature of urge incontinence that makes it so distressing, she says. Urge incontinence isn't totally understood, but experts think the bladder muscle may give the wrong messages to the brain, with the bladder feeling fuller than it really is. As a result, a person with urge incontinence feels the urgent need to go to the bathroom, even if they have just done so.

Stress incontinence, which causes urine to leak when lifting objects, laughing, coughing, or sneezing because of weakened pelvic floor muscles, is less emotionally draining, Zyczynski says. "Women can learn which positions or situations predispose them to stress incontinence [and avoid them]."

"If you know, for instance, that doing the Stairmaster makes you leak [urine], you can avoid it," she says. "If you know that sneezing [makes you leak urine], as your sneeze comes on, you can cross your legs or squeeze your pelvic floor muscles."

But, unlike stress incontinence, urge incontinence occurs without warning and is especially upsetting. "Before a woman has a chance to respond to that urge to go [to the bathroom], urine is already running down her leg," says Zyczynski.

The sheer volume of leaking urine associate with urge incontinence is another reason why this condition is so distressing. Women with stress incontinence tend to leak urine in small amounts, perhaps a teaspoon or a tablespoon, says Zyczynski. But with urge incontinence, a woman can leak a cup or two of urine, saturating an absorbent pad and soaking through their clothing.

What Can You Do About Female Incontinence?

Whatever form of female incontinence you have (and some women have both urge incontinence and stress incontinence - called mixed incontinence), it is crucial to seek help before the condition leads to social isolation, Zyczynski tells WebMD. Once women stop socializing, she says, it's easy to see how the withdrawal can lead to depression.

If you notice symptoms of incontinence, such as leaking urine, tell your doctor. He or she may recommend you see a specialist, such as a urogynecologist -- an obstetrician-gynecologist who specializes in the treatment of women with pelvic floor problems, which includes female incontinence - or a urologist with experience treating female incontinence.

Treatment Options for Female Incontinence

Some medications may aggravate female incontinence, such as high blood pressure drugs and antihistamines. If you have female incontinence and are taking these medications, your doctor may switch you to a different drug in hopes of alleviating the problem.

Simple remedies, such as the use of protective garments like pads or adult-size protective panties, may lessen the problem, says Zyczynski. Strengthening the muscles that control the bladder by doing Kegel exercises may also help, she says.

Biofeedback may also improve female incontinence. In one study of 26 women with urge incontinence, presented at the 2006 meeting of the American Geriatrics Society, biofeedback helped the women learn to control their bladder muscles and reduce the number of overactive bladder episodes.

If urinary incontinence is not helped by these remedies and is significantly interfering with your life and activities, your doctor may suggest medications or surgery. In one surgical procedure, surgical threads are used to help lift the bladder up to a normal position. This allows the muscles that help hold urine in to work better.

Another procedure, called a "sling," uses strips of material, either natural or synthetic tissue, to support the bladder neck and prevent urinary incontinence.

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SOURCES: Jennifer Anger, MD, MPH, assistant professor of urology, University of California Los Angeles David Geffen School of Medicine, attending physician, Santa Monica -- UCLA Medical Center, Santa Monica, Ca. Melville, J. Obstetrics & Gynecology, September 1, 2005; vol 106: pp 585-592; Fultz, N.H. Social Science Medicine, June 2005; vol 60: pp 2537-48. Saadoun K. Neurourology and Urodynamics, August 17, 2006; online vol 25: pp 696-702. Halina Zyczynski, MD, associate professor of obstetrics and gynecology, University of Pittsburgh School of Medicine and specialist in female incontinence, Magee -- Womens Hospital, Pittsburgh. American Geriatrics Society 2006 annual meeting, Chicago, May 3-7, 2006; American Urogynecologic Society, Washington, D.C. National Kidney and Urologic Diseases Information Clearinghouse: "Treatments for Urinary Incontinence in Women.'' American Academy of Family Physicians web site: "What Is Incontinence?"

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