Ask the Doctors

Dear Doctor: I'm 58 years old and have begun leaking urine. Once it was while I was at exercise class and another time when I sneezed. I've never had children, so why is this happening? What can I do?

Dear Reader: First, we'd like to reassure you that you're not alone. Urinary incontinence is quite common among women of all ages. Up to 45 percent of women will experience some degree of urinary incontinence, or UI, during their lifetimes. That's twice the rate of UI as occurs in men.

Urinary incontinence is when, due to a lack of bladder control, urine is accidentally released. Although UI falls into two main categories -- stress incontinence or urge incontinence -- some women will experience a combination of both, known as mixed incontinence.

Stress incontinence is when physical movement places pressure on the bladder and causes urine to leak. Urge incontinence is the strong and sudden need to urinate, followed immediately by involuntary bladder contractions that cause it to empty. With either type of incontinence, how full the bladder is doesn't matter.

People with Alzheimer's disease, individuals with damage to the spinal cord or brain, and people with certain neurological conditions like multiple sclerosis or Parkinson's disease can also often experience UI. Temporary UI may be caused by certain medications, drinking large amounts of fluids, a urinary tract infection and constipation, which can exert pressure on the bladder.

From your description, what you have experienced is stress incontinence. It occurs because the muscles of the pelvic floor, which supports the bladder, and of the urinary sphincter, which controls the release of urine, have weakened. As a result, any physical movement that puts pressure on the bladder -- a cough, laughing, lifting a bag of groceries -- may overcome the impaired resistance of the urinary sphincter and cause urine to be released.

You're correct that the physical changes that take place during pregnancy and childbirth can contribute to UI. However, other factors, like weight gain, obesity, menopause and the physiological changes associated with advancing age, can also play a part.

It's a good idea to check in with your family doctor. He or she may ask for a urine sample to rule out infection, and to check for traces of blood or other problems. Bladder function tests and a review of your medical and family history can help your doctor to pinpoint any external factors playing a role in the onset of the UI.

How much the UI bothers you will factor into what steps you take next. Many patients are comfortable using a panty liner to absorb a minor amount of leakage. In severe cases, surgical interventions are possible. At this time, there are no approved medications in the United States to address UI.

In the majority of cases, doctors recommend certain changes to lifestyle and behavior. It's possible you'll be asked to manage how much you drink and at what times. Losing excess weight is often helpful. And exercises known as Kegels, which work the muscles of the pelvic floor, can return strength and tone to help you to regain control.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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