Who’s Affected?

• 1 in 4 reproductive-age women
• 44-57% of middle-aged/postmenopausal women
• 75% of older women
• Biggest Risk Factor? Obesity (3x higher risk!)

Other Risk Factors:

• Multiple pregnancies, vaginal births, family history
• Diabetes, stroke, menopause, smoking, pelvic surgeries
• Medications like ACE inhibitors (coughing makes it worse!) and diuretics (make you pee more)

Stress Urinary Incontinence (SUI) – Leaks happen when coughing, sneezing, laughing, or lifting.

• Treatment: Weight loss, Kegel exercises, pelvic therapy, pessaries, or surgery (midurethral sling).
• Urgency Urinary Incontinence (UUI) – A sudden, intense need to pee, often with leakage.
• Due to: Overactive bladder (muscle contractions that won’t stop!)
• Mixed Incontinence – Combo of stress + urgency incontinence.
• Overflow Incontinence – Bladder doesn’t empty fully, leading to continuous dribbling.
• Nocturnal Enuresis – Bedwetting in adults while sleeping.
• Coital Incontinence – Leaking during sex (yes, it’s a thing!).
• Postural Incontinence – Leaking when changing positions (like sitting to standing).
• Continuous Incontinence – Constant leaking (could be from a fistula—a connection between organs).

Managing Urinary Incontinence (UI)

Many effective treatments are available! The right choice depends on the cause, severity, and personal goals.

Behavioral Therapy (First Line Treatment)

• Avoid bladder irritants (Caffeine, alcohol, spicy foods, smoking)
• Timed voiding (Pee at scheduled intervals, not just when urgent!)
• Limit fluids to <2L per day & cut down after 6 PM to reduce nighttime trips Bladder training (Gradually increase time between bathroom visits)
• Keep a bladder diary (Track what you drink & how often you go!)
• Weight loss (Reduces UI in overweight & obese women!)

Pelvic Floor Exercises (Kegels)

• Squeeze like stopping urine flow, hold for 10 sec, release
• Repeat 10-20 times, 3x a day
• Expect improvement in 6 weeks!
• Best results under supervision (Pelvic PT can help!)
• Pessaries: A supportive device for stress incontinence

Anticholinergics (Oxybutynin, Tolterodine, etc.) → Reduce bladder spasms

• Side effects: Dry mouth, constipation, dizziness, blurry vision

• Avoid in women over 70 (Dementia risk!)

• Not for narrow-angle glaucoma patients

Beta-3 Agonist (Mirabegron/Myrbetriq) → Relaxes bladder muscle

• Side effect: Can raise blood pressure!

• Avoid if uncontrolled hypertension or liver/kidney issues

Vaginal Estrogen → Helps postmenopausal women with UI (but NOT systemic HRT!)

Botox Injections (OnabotulinumtoxinA) – Relaxes bladder muscle, lasts 4-10 months

• Risk: UTI, temporary urinary retention (5%)
• Tibial Nerve Stimulation – Stimulates nerves to control bladder function
• Sacral Neuromodulation – Small implant to regulate bladder signals

Midurethral Sling (Most Common!) – Mesh supports the urethra

✔ Burch Colposuspension – Lifts the bladder neck for support

✔ Bulking Agents – Injections to tighten urethra (Less effective, but non-invasive!)

✔ Fascial Bladder Neck Sling – Uses your own tissue (Great for severe SUI!)

Leaking urine isn’t just part of aging—you have options! If bladder issues impact your daily life, talk to your doctor and reclaim your confidence!