Dear Doctor

Dear Doctor

I’m a 50-year-old woman and leak urine when I laugh or cough. It’s embarrassing. Is it normal?

Stress urinary incontinence (SUI) or leaking urine when coughing, laughing, or exercising is common; but not natural.

It occurs when the pressure on the bladder is greater than the pressure of the bladder neck and urethra to stay shut. Anything that weakens the pressure of the bladder neck and the urethra, or increases the pressure on the bladder can lead to SUI.
The risk of incontinence increases with age. Other risk factors for incontinence include: childbearing, obesity, heavy lifting, medications (prescribed and over the counter), caffeine, alcohol, medical problems such as diabetes, stroke, multiple sclerosis, depression, constipation or fecal incontinence, and family history.
SUI can start at any age. SUI affects 7 percent of women in their 20s and up to 50 percent of women by age 50. Only 46 percent of women with bothersome incontinence will bring it up with their provider, unless directly asked.

SUI may be minimized by maintaining a healthy weight, practicing Kegal exercises, avoiding caffeine and alcohol, or changing medications.

“Bladder retraining” may reduce urge incontinence. Biofeedback and electrical stimulation solves 50 – 70 percent of incontinence cases. Medications, medical devices, and surgery, have a 95 percent success rate of fixing incontinence.

In the young, healthy women, incontinence does not pose much of a health risk.  It is an inconvenience and embarrassing but that is about all.  Incontinence in elderly women can cause infections, sores, and other complications. It is a common reason for admission to a skilled care facility, affecting up to 77 percent of female residents.

Other types of incontinence include:

Urge incontinence. A person has a strong urge to urinate and can not hold the urine from leaking. This is also called overactive bladder, and is thought to be due to uninhibited bladder contractions.

Mixed incontinence is the most common type, and like the name states it is a combination of two or more of the other types of incontinence.

Overflow Incontinence is the leakage of urine due to the incomplete emptying of the bladder.  This can occur because of weakened bladder muscles or blockage of the out flow of urine through the urethra.

If you have incontinence, don’t wait; discuss it with your health care provider.

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