When you just have to go

Urinary incontinence is an embarrassing condition with a multitude of solutions

If you have laughed so hard that you peed a little, chances are you were not terribly amused by it. It is not "normal" to urinate—a little or a lot—when sneezing, coughing or laughing. Urinary incontinence is the inability to control the flow of urine from the bladder. This condition ranges in intensity from small leaks when you sneeze to a strong urge to go immediately before a large amount of urine is released, before you can make it to the bathroom. Though an embarrassing condition, urinary incontinence may be a symptom of a much more serious problem.

There are many kinds of urinary incontinence. Stress incontinence is the release of urine when there is pressure on the bladder from coughing, sneezing, or laughing due to the weakened sphincter muscle of the bladder, which is responsible for holding in urine until you are ready to pee. Pregnancy, childbirth and menopause often lead to physical changes that may cause stress incontinence in women.

Urge incontinence is the sudden and intense need to urinate, followed by an unexpected flow of urine. Urge incontinence may also lead to frequent trips to the bathroom at night. Many conditions can cause urge incontinence, including inappropriate bladder contractions, urinary tract infections, Parkinson’s disease, Alzheimer’s disease, stroke or injury. If no cause is found, the incontinence may be blamed on an overactive bladder.

Other types of incontinence include functional (caused by a disability), overflow (unexpected leakage because of a full bladder), mixed (stress and urge incontinence together), and transient (due to a condition that is temporary, like an infection).

For women with stress incontinence, Kegel exercises
will strengthen the pelvic floor muscles
and the urinary sphincter.

Treatment for incontinence depends on the type of urinary incontinence, its severity and the underlying cause. Your doctor will often start with the least invasive methods, such as bladder training, scheduled trips to the bathroom, and managing what you eat and drink. For women with stress incontinence, Kegel exercises will strengthen the pelvic floor muscles and the urinary sphincter. A more cringe-worthy procedure to do the same is electrical stimulation, where electrodes are placed in the vagina or rectum to stimulate the pelvic floor muscles.

A number of medications can be used to treat urinary incontinence, such as anticholinergics, topical estrogen, imipramine, and duloxetine. If those don’t work there are medical devices that can be inserted, such as a pessary or a urethral insert. More interventional methods include injections into the urethra or bladder muscles, implanted nerve stimulators (sort of a pacemaker for your bladder), and surgery.

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