Managing incontinence

Incontinence is the involuntary leakage of urine from the bladder.

“Urinary incontinence is a very common symptom that affects both men and women,” says Frances Stewart, advanced practice nurse and nurse continence advisor at Women’s College Hospital.

“Despite being very common, it often goes unreported,” Stewart says. “People with incontinence should know that they are not alone. They should also know that it’s treatable, and not something they just have to live with.”

In women, incontinence can develop at any age, but is more common in older women.

Types of incontinence

There are several different types of incontinence. Two of the main types are stress incontinence and urge incontinence, which is also called overactive bladder.

People with stress incontinence leak urine when they do things that put pressure on the bladder. They may leak urine when they cough, sneeze or laugh, or when doing physical activity such as sports or lifting heavy objects.

People with overactive bladder – or urge incontinence – have frequent and sudden urges to urinate, and may not be able to make it to the bathroom in time.

Some people have a combination of stress and urge incontinence.

To treat it effectively, it’s essential to know the type of incontinence.

“It’s important to get a correct diagnosis for incontinence, because different types are managed differently,” Stewart explains, adding that conservative management is usually a good place to start.

Managing urge incontinence

For urge incontinence, conservative management often includes making bladder-friendly lifestyle modifications. These are changes to diet and activities designed to cut down on bladder irritants, and improve bladder habits. Lifestyle changes may include:

• cutting down on caffeine
• monitoring fluid intake
• cutting down on wine and beer
• practicing mind over bladder

“Mind over bladder means resisting the temptation to go into every bathroom you pass,” Stewart says. Instead, bathroom visits are timed to help re-train the bladder. “It’s a way of programming your bladder, which is also called prompted voiding.”

There are also effective medications that can help manage urge incontinence, and that don’t have to be taken forever.

Managing stress incontinence

For stress urinary incontinence, conservative management may include doing Kegel exercises or using a pessary.

Kegel exercises strengthen the muscles of the pelvic floor, which support the bladder and other pelvic organs. A pessary is a device that is inserted into the vagina to help support the bladder and pelvic organs.

“A tampon worn intervaginally may help because it supports the front wall of the vagina,” Stewart adds.

Beyond conservative management, stress incontinence can also be surgically corrected. But Stewart notes that women should be finished childbearing before they consider surgery.

How incontinence is treated also depends on how much the condition bothers the person, and how big an impact it has on her life. Someone who is distressed or is avoiding activities because of incontinence may seek more aggressive treatment.

“Incontinence is not life-threatening, but it can be life-altering,” Stewart says. “But what might be a serious problem for one person might not be a big issue for someone else. How aggressively it’s treated depends on how much it’s affecting their quality of life. Treatment has to add something positive to their life, not just add to their healthcare with no perceived benefit.”