Incontinence is more common than most women realize, yet it’s a topic often avoided because of embarrassment or the belief that nothing can be done. On a recent episode of the Healthful Woman podcast, Dr. Nathan Fox spoke with Dr. Nathan Garely, a fellowship-trained urogynecologist, about what causes incontinence, how it’s diagnosed, and what treatment options are available for women of all ages.
Why Incontinence Happens
Many people assume that leaking urine is simply a normal part of aging or something that must be endured. In reality, incontinence can have several causes, and understanding them is the first step toward effective treatment. Stress incontinence, which causes leakage during activities like coughing, sneezing, or exercising, is often due to weakened pelvic muscles or connective tissue.
Some women try to prevent leaks by going to the bathroom frequently, but this can unintentionally train the bladder to hold less urine, sometimes creating symptoms of an overactive bladder. As Dr. Garely explains, “If you go to the bathroom within 45 minutes of peeing, then you won’t leak if you cough, laugh, or sneeze. But when you start increasing your urinary frequency, it can actually cause another type of overactive bladder.” Fortunately, the bladder can be retrained to hold more comfortably with proper behavioral modification.
How Incontinence is Diagnosed
When evaluating incontinence, the first step is a detailed medical history and a pelvic exam. Doctors look for pelvic organ prolapse, a condition where organs like the bladder or uterus drop from their normal position, sometimes causing a bulge or difficulty during bowel movements. The severity of symptoms typically matches what patients describe, but even a small amount of leakage can significantly affect quality of life. Understanding the individual’s experience helps guide the right course of treatment.
For a definitive diagnosis, doctors may perform a bladder stress test, which involves filling the bladder with a small amount of water and asking the patient to cough or bear down. This is done while lying down and sometimes standing to see when and if leakage occurs.
Treatment Options for Stress Incontinence
First-line treatment for stress incontinence is often pelvic floor therapy. Specialized physical therapists teach patients how to strengthen the muscles that support the bladder, often using biofeedback to ensure the right muscles are engaged.
Dr. Garely notes, “Most people, when they try to do Kegels on their own, are really just tightening their butt muscles. It’s not really doable without proper guidance.” While pelvic floor therapy can significantly improve symptoms, it rarely provides a complete cure.
When non-surgical measures aren’t enough, minimally invasive surgery is highly effective. The standard today is a tension-free vaginal tape, or TVT, sling, which supports the urethra and prevents leakage during everyday activities. The procedure is quick, usually performed in 15 to 20 minutes, allows patients to go home the same day, and has a high success rate that often lasts 10 years or more.
Managing Urge Incontinence
Urge incontinence, which is characterized by a sudden and strong need to urinate, can often be managed with pelvic floor therapy or medications. Anticholinergic medications, such as Ditropan or Detrol, work effectively but may have side effects like dry mouth or constipation. An alternative, Myrbetriq, targets a different receptor and avoids neurological risks, though it may slightly raise blood pressure in some patients.
For women who do not respond to medication, there are additional treatments, including Botox injections in the bladder or nerve stimulation therapies. Dr. Garely explains, “If you have failed pharmacologic therapy, the next step is either a Botox injection in the bladder or sacral nerve root stimulation. These are highly effective options for women who don’t respond to medications.”
Taking the First Step
Despite the variety of effective treatments, many women delay seeking care due to embarrassment. Dr. Garely emphasizes that incontinence is extremely common, and patients are often relieved to discover that others have had the same issue and successfully treated it. “Every other person sitting in the waiting room has the same exact problem, and that they’re not alone,” he says. Recovery from modern therapies is quick, and nearly all women have access to expert care, especially in areas with fellowship-trained urogynecologists.
Pregnancy and delivery are often concerns for women wondering about future incontinence. While a C-section may reduce the risk compared to a vaginal delivery, it does not eliminate it entirely. Genetics, pregnancy itself, and family history of hernias or pelvic issues also contribute. Even if incontinence develops after childbirth, minimally invasive treatments are effective and safe, making it unnecessary to adjust life plans out of fear of leakage.
Learn More
The key takeaway, according to Dr. Garely and Dr. Fox, is that recognizing the problem and seeking evaluation are the most important steps. Incontinence is treatable, recovery is fast, and solutions exist for women at nearly every stage of life. There’s no reason to suffer in silence, and early intervention can make a profound difference in quality of life. To learn more, listen to the full Healthful Woman podcast episode.
If you are experiencing symptoms of incontinence, please do not hesitate to reach out to Carnegie Women’s Health for an evaluation.
