The Medicine Cabinet: Ask the Harvard Experts
Q: I often have a problem leaking urine when I cough or sneeze or get the urge to go. I would rather avoid medication. What else can I do?
A: You have lots of company. An estimated 45 percent of women experience some form of urinary incontinence at some point in their lives. That’s almost half of all women! It’s a very big deal. Urinary incontinence can negatively affect physical and emotional well-being. For example, women may avoid going out because they’re worried about having an accident away from home.
Here’s what else to do besides medications or surgery.
First, talk to a healthcare provider: There are readily identifiable medical factors that can cause or worsen incontinence: Certain medications, uncontrolled diabetes, bladder infections, constipation, and menopausal changes, to name a few.
Then take care of the area: If moisture isn’t absorbed, it will irritate the skin and can lead to infections in the genital area. Sometimes the issue is reluctance to explore the world of incontinence pads (which are now available in a variety of brands and styles), but often, it’s the expense. Barrier ointments, even plain old petroleum jelly, can help to protect skin from moisture. Daily bathing is also helpful.
Watch fluid intake: Limit bladder-irritating beverages such as caffeinated or acidic drinks (alcohol, coffee, black tea, green tea, sodas and seltzers with citric acid added). For women who make nighttime trips to the bathroom, decreasing fluid intake in the evening (especially alcohol) can help.
Lose a few pounds: Extra abdominal fat can create pressure on the bladder. Losing just 5 percent of body weight can help a lot. But even losing a few pounds can improve symptoms.
Exercise: The more physically active a woman is, the less likely she is to suffer from urinary incontinence. This may be related to better core and pelvic floor muscle tone in women with increased fitness.
Do pelvic floor exercises and physical therapy: Those Kegel squeezes can really work! They’re not difficult, but it’s important to do them correctly. Believe it or not, formal pelvic floor physical therapy with a trained provider can be hugely helpful.
Train your bladder: Scheduling bathroom visits can help women to “train” an overactive bladder. Sometimes bladder training is done along with pelvic floor physical therapy, and can be more successful that way.
(Monique Tello, M.D., is an internist at Massachusetts General Hospital and Instructor in Medicine at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.)
