Several factors that weaken 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 interfere with bladder function, says Arthur Louis Burnett, MD, professor of urology at the Johns Hopkins School of Medicine in Baltimore. Conditions that affect the prostate can also cause incontinence.
But leakage is not a normal part of aging. “There’s always something that can be done,” says Jason M. Kim, MD, clinical assistant professor of urology at the Renaissance School of Medicine at Stony Brook University in New York.
You may be hesitant to talk about the subject, but speaking up can improve your quality of life. Here’s what you need to know to find the fix that works for you.
Before recommending treatment, your health care provider will determine what 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 to abdominal pressure can force the bladder to lose urine,” says Brian J. Linder, a urologist at the Mayo Clinic in Rochester, Minn.
Overactive bladder, or urgency incontinence, makes people feel like they have a pressing and frequent need to use the bathroom—and if they don’t make it in time, they can have an accident. “Some people need to go every 20 minutes, which limits what they can do,” Kim says.
Evidence-based treatments for urinary incontinence range from lifestyle changes to surgery, and your provider should start with the least invasive options. If your regular doctor doesn’t present you with different strategies to try, a specialist such as a urologist or urologist can help you find what works. “You don’t have to deal with it because you’ve learned to live with it,” Kim says.
lifestyle modification is usually the first line of treatment. If you are overweight, losing a few pounds can help reduce pressure from your bladder. reducing constipation with dietary changes such as increase your fiber intakeor with Medicine, if necessary, can have the same effect. Alcohol and caffeine can irritate the bladder and promote leakage, so even limited use of these may help.
pelvic floor physical therapyGastroenteritis, 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 overactive bladder. They can take several sessions to work, Kim says, and you can practice at home.
Medicine Might be the next option, Linder says. Anticholinergic medications such as oxybutynin (Ditropan and Ditropan XL) can help soothe an overactive bladder, but Research have linked them to symptoms of dementia in older adults, especially in high doses. Kim says a beta-3 agonist such as mirabegron (Myrbetriq) may offer some of the same effects without the cognitive risks.
more invasive procedures are often a last resort. Of these, the gold standard for stress incontinence, Kim says, is a sling procedure, which typically uses a mesh to support the urethra and help prevent leakage. Most people find that this operation eases their symptoms, but complications can sometimes be serious. The doctor may also inject a bulking agent into the bladder. It is less invasive, but there is little long-term data according to American Urological Association guidelines, Botox injection into the bladder muscle, for overactive bladder can help, “It will last about six months,” Linder says, so repeat treatments are needed — and some side effects can be serious.
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