Dr. Harriette Scarpero is a board certified, fellowship trained urologist and nationally recognized expert in female pelvic health and reconstruction (FPM/RS). She is in practice at Associated Urologists in Nashville, TN. An expert in her field, Dr. Scarpero is active on many national urologic boards. She is past president of The Society of Women in Urology, on the executive committee of The Society for Urodynamics and Female Urology, and participates on several committees for The American Urologic Associaton. Her website is www.ThePelvicProfessor.com.

Q: I’ve heard it’s “normal” to have bladder control loss as you age. Is that true? Is there anything I can do about it?

A: It is a common misconception that urinary leakage is an inevitable consequence of aging. Although the prevalence of urinary incontinence increases as age increases, it is not normal for women of any age to experience incontinence. If a woman is incontinent and bothered by it, she should first educate herself about urinary incontinence from a reputable source such as the American Urological Association Foundation (urologyhealth.org) or a trusted medical provider. Not all medical providers are experienced with urinary incontinence so they may refer you to a specialist such as an urologist.

Pelvic floor muscle exercises (PFME), also called Kegel exercises, are simple to perform and can be helpful to improve bladder control. When performing PFME the woman squeezes the muscles surrounding her vagina as if she were trying to stop her urine stream while urinating. A sensation of drawing up the muscles to tighten the vagina is often described. If performed correctly and consistently, a woman can expect to see some improvement in bladder control within 6 to 8 weeks.

When PFME are not enough, other options are available and are based on the type of urinary incontinence a woman has:

  • Stress Urinary Incontinence- the involuntary loss of urine that occurs with activity or effort such as coughing, sneezing, jumping etc.
  • Urgency Urinary Incontinence- the involuntary loss of urine associated with a sudden strong urge to urinate at unexpected times.
  • Mixed Urinary Incontinence- both stress and urgency urinary incontinence.

If interested in more information, my patient education website provides additional information about options for the different types of urinary incontinence (www.ThePelvicProfessor.com).

Q: What’s the most important thing I can do to keep my waterworks running the way they should?

A: This is an important question, and you may be surprised by the answer: Maintain good overall health. Medical problems such as obesity, diabetes, coronary artery disease and chronic obstructive pulmonary disease are just a few of the chronic medical problems that can contribute to urinary incontinence. Eating nutritious foods, exercising regularly, and seeing your doctor for appropriate checkups helps prevent and manage these ailments.

Maintain a healthy weight. Overweight and obese women are more prone to both stress and urgency urinary incontinence. Even moderate weight loss in these women can improve urinary control.

Fluid and Diet Management. Watch what you drink and eat. If you are drinking high volumes of caffeinated beverages and low volumes of water, you may be aggravating your bladder. If you drink large volumes of liquid a day then you will produce a large amount of urine. High urine output can aggravate urinary incontinence.

Stop Smoking. Smoking often leads to a chronic cough which will aggravate stress urinary incontinence. Smoking impedes healing which may compromise success with any surgical intervention for urinary incontinence.

Q: I don’t have sudden urges, problems urinating or anything, but every now and again a sneeze or hard laugh can cause some leakage. When is it serious enough that I should see a doctor?

A: The term for the type of incontinence you describe is stress urinary incontinence (SUI). SUI is a very common condition that affects one in three women at some time in their lives. SUI is a quality of life issue. When the leakage is causing distress because it is limiting your lifestyle then it is time to consult a doctor. Degree of bother from urinary incontinence varies between women. There is no level or degree of incontinence that is required to justify treatment, and everyone deserves a life free from the embarrassment and worry over SUI.

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