Women wait more than six years, on average, before they speak up about urinary symptoms - a shame, since there are simple ways to find relief
By Sari Harrar
Urinary symptomsAnna Albrecht was a fit 31-year-old mother of two when the Big Leak happened one day. "I was jumping rope at the gym when - splash! - I completely wet my pants," she recalls. "I was so embarrassed." So did Albrecht go to the doctor? "Not for seven years," she admits. "I just didn't jump rope."
The leaks have stopped, thanks to a class aimed at strengthening her pelvic floor - the hammock of muscles that supports the internal organs, including the bladder, bowels, and uterus. "It made a huge difference - I can jump rope or go out dancing and stay dry," says Albrecht, 47, of La Grange, IL.
Leaks, urinary pain, wild sprints to the ladies' room, and a purse packed with pads are a reality for millions of American women. Yet two out of three of us never tell our doctors, and those who do speak up have waited, on average, 6.5 years. Instead, we cross our legs with every sneeze, scope out the fastest route to the toilet at parties, and hope for the aisle seat at movies and on airplanes.
"Talking about it can be embarrassing," says urogynecologist Sharon Knight, M.D., at the University of California, San Francisco. "Or women think it's an inevitable consequence of childbearing and aging and that nothing can be done."
If that's you, here's the headline: Women's biggest urinary problems are all treatable. Often, easy solutions like exercises, weight loss, and a couple of new habits (goodbye, diet-cola refills!) work wonders. Even when the problem is stubborn, there are new, effective treatments. (Out: cranberry juice to treat bladder infections. In: behavioral therapy for "tiny bladder syndrome.")
If you've got annoying symptoms, read the scenarios below, then learn about the newest ways to fix the problem you're not talking about.
Related: Drink to Your Health
You leak when you laugh, cough, sneeze, exercise, carry heavy stuff, or have sex.
DIAGNOSIS Stress incontinence
WHAT'S HAPPENING Pregnancy, childbirth, extra pounds, declining estrogen levels in perimenopause and menopause, and normal age-related muscle loss can all weaken pelvic-floor muscles, resulting in more pressure on your bladder and on your urethra - the tube that carries urine out of your bladder.
STAT It's the most common form of incontinence in women, affecting one in four from ages 25 through 44 and one in three from 45 through 64.
Start with low-tech solutions, which significantly improve or even "cure" stress incontinence for most women...
WEIGHT LOSS Dropping pounds eases the pressure on your bladder and pelvic floor, says Kristene Whitmore, M.D., chair of urology and female pelvic medicine and reconstructive surgery at Drexel University College of Medicine in Philadelphia. "In one study, women who lost 17 pounds reduced leaking episodes nearly 50%." Even those who lost a mere three pounds were 28% drier.
SMARTER SIPPING Chugging multiple cups of coffee inflates your bladder like a ready-to-burst water balloon. Instead, sip water or herbal tea slowly, over a half hour or an hour, Dr. Whitmore suggests. Cut back on caffeine, carbonation, alcohol, artificial sweeteners, citrus, and tomato juice, all of which can irritate your bladder.
DAILY KEGELS For nearly half the women in a 2010 study, pelvic-floor-strengthening exercises helped a lot, stopping at least three-quarters of leaks. "If you isolate the right muscles and do the exercises daily, you'll start getting results in six to eight weeks," says Chicago-based pelvic-floor physical therapist Judith Florendo. (See Squeeze, Relax, Repeat)
STILL LEAKING? A specially fitted vaginal pessary, a rubber device somewhat like a contraceptive diaphragm, can lift your bladder and keep your urethra shut. Sling surgery uses a synthetic material to support the urethra in a position that reduces pressure. Another option: injections of a gel-like substance to thicken the wall of the urethra. Your M.D. can help you figure out which option is best for you.
Related: Is Acupuncture Right for You?
You have sudden urges to go - and can't always hold it
DIAGNOSIS Overactive bladder/urge incontinence (or "tiny bladder syndrome")
WHAT'S HAPPENING Your bladder is calling the shots instead of your brain. "As your bladder fills with urine, it decides when it wants to go - contracting even though the brain hasn't sent the signal," explains uro-gynecologist Shameem Abbasy, M.D., of Swedish Covenant Hospital in Chicago. Diuretic drugs, diabetes, nerve damage, and serious neurological conditions can cause this disconnect, though in most cases, no one knows why the condition develops.
STAT Some 17% of women have experienced the "gotta go now" symptoms of overactive bladder. A third of them also have stress incontinence.
BEST FIXES Try behavioral therapy strategies. For both overactive bladder and combo symptoms, they can improve or even resolve incontinence, say University of Minnesota researchers, who reviewed 99 studies:
A BLADDER DIARY Track when you went, what you were doing just before, and your food and drink intake for three days. Since urge incontinence is often tied to specific cues, a diary can help you uncover them. "You may discover you always have urges in the same situations, such as when you put the key in the front door or when you go from a warm environment to a cold one," says Michael Guralnick, M.D., associate professor of urology at the Medical College of Wisconsin. "You may find connections with drinking large amounts of fluid or with certain beverages. I've got plenty of sophisticated diagnostic equipment, but the bladder diary is one of the best tools for seeing patterns and finding solutions."
BLADDER RETRAINING You set times for bathroom breaks, then gradually increase the intervals between them. "The goal is to break your bladder's cycle of going whenever it feels like it," explains Dr. Guralnick. "By delaying for a few more minutes every few weeks, you're training it to hold more urine and to stay relaxed so you have time to walk to the bathroom."
MIND-BODY THERAPIES Hypnotherapy with visualization techniques and mindfulness-based stress reduction are both showing promise for urge incontinence. In one small study, the hypnotherapy/mental-imagery approach helped cut the average number of urge episodes by at least half per week.
Anna Raisor, 56, who works in website technology for a large corporation, had mixed stress and urge incontinence that began in her 30s and kept her from meeting friends for dinner or taking her two children on outdoor adventures. "I went for help when it got so bad I couldn't get in the door after work without an accident," says Raisor, who lives in Oak Park, IL. "The training helped me learn to relax and hold it, even on the commuter train."
QUICK FLICKS Kegels also come in handy, says Florendo: "When you have the urge to go, doing a couple of fast squeezes - called 'quick flicks' - can calm the bladder."
STILL LEAKING? Try acupuncture. In one Oregon Health and Science University study of 85 women, just four weekly sessions reduced accidents 59%. And there are many medications - tolterodine (Detrol) and solifenacin (Vesicare) are well-known ones - your doctor may prescribe.
Next: How to relieve a urinary tract infection
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