Do you experience involuntary loss of urine that is a social or hygienic problem? Don't be alarmed. 1 in 20 young women are experiencing it too. Not to mention that 20-30% of young adult women and 30-40% of middle-aged women are also struggling. So, what can you do that is effective, natural, and has no severe side effects? First, we have to identify what you’re experiencing and then we can talk about the best treatment options for you.

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What you need to know about urinary incontinence:

• What is urinary incontinence?
• What causes urinary incontinence?
• What’s the difference between stress and urge incontinence?
• Who experiences urinary incontinence?
• Why doctors have failed to address urinary incontinence.
• How to discuss urinary incontinence with your doctor.
• Myths about urinary incontinence.
• Diagnosing urinary incontinence.
• The most common treatment options for urinary incontinence.
• The best treatment option for urinary incontinence.

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What is urinary incontinence?

When you pee your pants while coughing, laughing, sneezing, running, or simply standing in line at the grocery store–you’re experiencing urinary incontinence. There are five types of urinary incontinence. We’ve discussed the most common type (stress incontinence), and we will discuss all 5 types in this post.

Dealing with urinary incontinence, the challenge of bladder control is not uncommon but can be quite awkward. The spectrum of severity varies from occasional leakage during a cough or sneeze to the urgency of needing to urinate so suddenly and intensely that reaching a toilet becomes a race against time.

As mentioned in the intro, you don’t have to feel alone in this struggle. More than 50% of women report urinary incontinence (and that’s only including the women talking about it).

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What causes urinary incontinence?

You and your doctor might talk about why you're having trouble controlling your bladder. Here are some possible reasons:

• Pregnancy and childbirth: When you're pregnant, the baby puts pressure on your bladder, which can lead to incontinence. Giving birth vaginally can also stretch and weaken the muscles that help control your bladder.
• Active lifestyle: Running, sports (soccer, gymnastics, or basketball), and high-intensity workouts (CrossFit) can cause urinary incontinence.
• Genetics: Just as bad eyesight runs in families, weak pelvic muscles can too. It's not that women are overdoing it with exercise. It's just that they've reached the tolerance of their tissues.
• Menopause: When you go through menopause, your estrogen levels drop, and this can make the tissues in your vagina and urethra thinner, which might contribute to incontinence.
• Urinary tract infections (UTIs): These infections can cause temporary incontinence.
• Medications: Some medicines, like diuretics (water pills), can cause bladder incontinence.
• Nerve damage: If a disease or injury is affecting the nerves that control your bladder, it could lead to incontinence.
• Tumors in the urinary tract: Growths anywhere in your urinary tract can be a cause.
• Constipation: If you're constipated, it can put more pressure on your bladder.
• Side effects of hysterectomy: This is when the uterus is surgically removed, and it can sometimes lead to bladder control issues.
• Using too many diuretics: caffeine (found in coffee, tea, sodas, and energy drinks), vitamin C, and chocolate can make you produce more urine, possibly making incontinence worse.

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What are the different types of urinary incontinence?

“Wait, you mean to tell me there is more than one or two types of urinary incontinence?” Unfortunately, yes… there are five different types of urinary incontinence that women struggle with, but two are most common.

Urinary incontinence is a prevalent issue that manifests in various forms, with individuals experiencing occasional minor leaks to more frequent and moderate amounts of urine loss. Let's dive in and make a splash (all pun intended), understanding the nuances of each:

Stress Incontinence:

Description: Stress incontinence occurs when pressure is exerted on the bladder during activities such as coughing, sneezing, laughing, exercising, or lifting heavy objects.

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Example: Imagine a scenario where a woman involuntarily leaks urine while laughing heartily at a friend's joke. This is a classic manifestation of stress incontinence.

Urge Incontinence:

Description: With urge incontinence, individuals experience a sudden and intense urge to urinate, often followed by an involuntary loss of urine. This condition may lead to frequent urination, even disrupting sleep patterns.

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Example: Picture someone suddenly feeling the urgent need to urinate during a crucial business meeting, resulting in an unexpected and uncontrollable loss of urine.

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Overflow Incontinence:

Description: Overflow incontinence entails frequent or constant dribbling of urine due to a bladder that fails to empty completely.

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Example: Envision a scenario where a woman experiences continuous dribbling of urine due to an inability to fully empty their bladder, causing discomfort and inconvenience. Women often say that they thought they fully emptied their bladder but when they stood up they dribbled pee into their underwear or down their leg.

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Functional Incontinence:

Description: Functional incontinence arises when physical or mental impairments hinder an individual from reaching the toilet on time.

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Example: Consider a situation where a person with severe arthritis struggles to unbutton their pants swiftly, leading to an inability to make it to the toilet on time.

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Mixed Incontinence:

Description: Mixed incontinence is characterized by experiencing more than one type of urinary incontinence simultaneously. This often involves a combination of stress incontinence and urge incontinence.

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Understanding the diverse manifestations of urinary incontinence is crucial for tailoring effective management and treatment strategies. If you or someone you know identifies with any of these scenarios, we would love for you to schedule an office visit at Epiphany Women’s Health. We have a fantastic team of nurse practitioners ready to address and treat your lifestyle-cramping urinary incontinence.

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But, please keep reading on because all we’ve discussed is cover what’s wrong. Now let's discuss how to make it right!

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Who experiences urinary incontinence?

68% of women over 40 years old suffer from urinary incontinence. As women get older, lower levels of estrogen, especially after menopause, can make the lining of the urethra thinner (the tube carrying urine out of the bladder). The muscles around the pelvic area may also weaken with age, a condition called "pelvic relaxation." This can lead to an increased chance of urinary incontinence, where urine leaks involuntarily. Aging can lead to urinary incontinence, but not ALWAYS.

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Urinary Incontinence in women under 40:

Bladder issues aren't only manifesting in older women. Younger, active women can have them too. Are you one of them? Many women, no matter their age, deal with the awkward problem of peeing when they don't want to. Over 13 million Americans have this issue, and women are more likely to have it than men, says the Agency for Healthcare Research and Quality.

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According to Pamela Moalli, MD, a professor of urogynecology at the University of Pittsburgh Magee-Womens Research Institute, incontinence problems among teens and young women are often linked to sports injuries. She notes, "About 20% of college athletes report leakage of urine during sports activities."

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Moalli emphasizes that women engaged in high-impact sports face the highest risk, including parachuters, gymnasts, and runners. "In these sports, you're hitting the ground hard, which can damage pelvic muscles and connective tissue that support the bladder."

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Niall Galloway, MD, FRCS, professor of urology and director of the Emory Continence Center at Emory University School of Medicine in Atlanta, points out that many young women have pre-existing biological factors that increase their vulnerability. "It runs in families," he states. "Just as bad eyesight runs in families, weak pelvic muscles can too. It's not that they've been overdoing it with exercise. It's just that they've reached the tolerance of their own tissues."

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For these girls and women, Galloway suggests a simple solution such as wearing a tampon or pessary (a device similar to a diaphragm) during exercise. "They just need a little something to support those pelvic tissues, something to put pressure on the urethra."

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Urinary incontinence after childbirth:

Often, it starts after the baby's born. Think about heading to a fitness class, ready to shed those extra pounds, and in the middle of the workout...an accident.

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During pregnancy, hormones stretch the pelvic floor muscles. Additionally, the weight of the expanding uterus can weaken the strength of a woman’s pelvic floor muscles and cause urine to leak. When the baby moves down during birth, the pelvic floor stretches more. This, combined with hormonal changes, weakens the muscles controlling the bladder, sometimes causing accidental urine leaks.

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After childbirth, many women experience urinary incontinence (leaking urine), with 1 in 3 women facing this issue after childbirth.

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Factors increasing the risk include pre-existing bladder or bowel problems, bladder issues during pregnancy, being a first-time mom, delivering a large baby, enduring long or difficult labor, and even having a c-section. While a c-section can reduce severe incontinence risk, it doesn't eliminate it.

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Despite being a common occurrence after childbirth, some new moms may feel shame or embarrassment about experiencing incontinence. Limited discussion on this topic in various communities might make women believe it's an issue without easy solutions. In reality, incontinence is not only widespread but also responsive to numerous noninvasive treatments that can significantly improve or eliminate symptoms.

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*We are not saying that vaginal birth WILL cause permanent damage with urinary incontinence, and we want to make it clear that we are not saying women should avoid labor/vaginal birth and skip straight to c-section in order to prevent urinary incontinence or other tissue damage. There are countless benefits to vaginal birth, and you should discuss your specific situation with your healthcare provider.

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“Whether I’m older or younger, how can I treat urinary incontinence?” We’ll cover that further down the article.

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Why have doctors failed to address urinary incontinence?

Many doctors overlook asking patients about urinary incontinence. Conversely, patients tend not to bring up their embarrassing symptoms, specially in the presence of a male doctor.

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For effective diagnosis and personalized treatment, doctors should rely on symptoms to identify the underlying issue. Overcoming this barrier of embarrassment requires proper education, raising awareness about the problem, and approaching the conversation with great tact and sensitivity.

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How to discuss urinary incontinence with your doctor or nurse practitioner

Providing an effective treatment plan is essential for physicians, but overlooking certain symptoms could potentially jeopardize the patient's life (not trying to be dramatic, it’s important to take this seriously). Symptoms that women may find embarrassing could be indicative of severe health issues. Warning signs that might signify more than mere embarrassment include:

• Passing air or stool in urine
• Frequent or painful urination
• Blood in urine
• Post-menopausal vaginal bleeding
• Stress incontinence
• Pain with sex

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These symptoms could be indicative of various serious health conditions such as interstitial cystitis, urinary tract infection, ovarian cancer, bladder cancer, endometrial cancer, or a fistula between the bowel and bladder. Identifying and addressing these issues promptly is crucial for effective medical care.

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Now keep in mind that MOST women do not suffer from serious health concerns regarding urinary incontinence, but to receive the best care and live the healthiest life it’s important to be clear and honest with your provider.

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Myths about urinary incontinence:

• Incontinence is a normal part of aging.
• There's nothing you can do about incontinence, so just wear a pad.
• You'll have to have surgery to fix your incontinence.
• Your doctor can't help you with incontinence.
• Running for the bathroom is a good idea.

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Myth #1: Incontinence is a normal part of aging.

Contrary to the myth that aging inevitably leads to incontinence, lifestyle, genetics, and underlying conditions can all play a role in whether women will struggle with urinary incontinence. 

• Example 1: Jane is a vibrant 70-year-old who practices healthy habits. Despite her age, she has never experienced urinary incontinence due to her commitment to regular exercise, a balanced diet, and pelvic floor exercises. Jane's story illustrates that aging alone doesn't dictate bladder control; lifestyle choices play a crucial role.
• Example 2: Emma is a 28-year-old who recently gave birth to a baby girl. During her pregnancy, hormonal changes stretched Emma's pelvic floor muscles, and the weight of the expanding uterus further weakened these muscles, leading to occasional leaks of urine. As her baby moved down during birth, the pelvic floor stretched even more. The combination of hormonal shifts and stretched muscles contributed to Emma's struggle with urinary incontinence after childbirth.

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Emma could have been just as focused on healthy living as Jane, however, due to the circumstances and how Emma’s body responded to pregnancy and childbirth she is now struggling with Urinary incontinence. 

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Myth #2: There's nothing you can do about incontinence, so just wear a pad and deal with it.

While there are a majority of women who think there are no viable treatment options for urinary incontinence, leading them to rely on wearing pads as a temporary solution, the reality is that they’ve simply not been informed of their options. Many treatment options exist beyond simply wearing pads. Behavioral therapy, including pelvic muscle training and bladder training, offers effective non-invasive approaches. Additionally, relaxation exercises, dietary modifications, and specific medications can be tailored to each individual, addressing the underlying causes and improving overall bladder control.

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Myth #3: You'll have to have surgery to fix your incontinence.

Due to a lack of communication between provider and patient, there are a lot of rumors surrounding viable treatment for urinary incontinence. Non-surgical treatments play a crucial role in managing incontinence. Pelvic muscle training through Kegel exercises, bladder training, relaxation exercises, dietary adjustments, and prescribed medications are non-invasive alternatives. Surgery is reserved for specific cases, highlighting the importance of exploring less invasive options first.

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Myth #4: Your doctor can't help you with incontinence.

Again this is due to the lack of communication on the doctor's part (and the patient's at times) to adequately discuss the entire women’s health situation when in the office. Urologists, Gynecologists, and Nurse Practitioners specializing in women’s health are equipped to address urinary incontinence comprehensively. Seeking medical advice, whether from a primary care physician, gynecologist, or urogynecologist, ensures appropriate evaluation and personalized treatment plans, improving the quality of life for individuals dealing with urinary incontinence.

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Myth #5: Running for the bathroom is a good idea.

We’ve ALL seen the pharmaceutical ads of women DASHING to the bathroom while on a quiet dinner date, or watching a movie with family and friends. It’s important to note that there are numerous options to address urinary incontinence (that don’t include pharmaceutical prescriptions). Things as simple as taking a moment to practice a deep breath and engage in a robust Kegel contraction can help manage urgent bladder spasms. This provides a more controlled and effective solution, allowing individuals to calmly walk to the bathroom without exacerbating the urgency.

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We’ll keep busting down the myth doors and providing you with everything you need to know to treat your urinary incontinence. Speaking of treating, next, let’s check out those treatment options.

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Diagnosing urinary incontinence:

To effectively treat urinary incontinence, it is essential to visit your healthcare provider to assess contributing factors. Your appointment may include:

• Medical History Assessment: discussing past health issues, surgeries, and medications.
• Comprehensive Physical Examination: examinations help assess the condition of pelvic muscles and identify any structural or functional abnormalities.
• Urine Sample Analysis: this diagnostic step helps determine if an underlying urinary tract issue contributes to incontinence symptoms.
• Neurological Exam: aids in understanding the neural factors that may be influencing urinary incontinence.
• Urinary Stress Test: practical assessment helps gauge the impact of external stressors on bladder control.

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Treatment options for urinary incontinence:

Your healthcare provider may suggest different ways to help with incontinence, such as:

• Pelvic floor exercises
• Fluid management (NOT recommended)
• Lifestyle changes
• Bladder training
• Medications
• Vaginal pessary
• Urethral inserts
• Sling procedure
• Injectable bulking agent
• Retropubic Colposuspension
• Inflatable Artificial Sphincter

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How to naturally treat (or cure) urinary incontinence:

• Pelvic Floor Exercises: These are workouts for the muscles that help control urine flow. A healthcare provider or physical therapist can guide you through exercises, known as Kegel exercises, to strengthen these muscles.
• Fluid Management: Your provider might advise on when and how much you should drink during the day. However, it's important not to reduce fluid intake too much, as dehydration is not good.
• Lifestyle Changes: Making healthy choices like quitting smoking, losing extra weight, or treating a chronic cough can reduce the risk of incontinence and improve symptoms.
• Bladder Training: If you have mixed incontinence, your provider may suggest a schedule for using the bathroom. Going more often might reduce urge incontinence episodes.

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Healthy habits to help with urinary incontinence:

• Lose extra weight: If you're carrying too much weight, shedding some pounds can ease the pressure on your bladder and pelvic muscles. Consult your doctor (or schedule an appointment with us at Epiphany Women’s Health) for weight loss advice.
• Eat more fiber: Keep bowel movements regular and soft to reduce strain on your pelvic floor muscles. Include high-fiber foods like whole grains, legumes, fruits, and veggies in your diet to prevent constipation.
• Decrease sugar and caffeine: Some foods and drinks can irritate your bladder. If chocolate, coffee, tea, or carbonated beverages make you urinate more, try cutting back on them, especially on days when you want to avoid leakage.
• Quit smoking: Smoking can cause a chronic cough, worsening stress incontinence symptoms. It's also linked to bladder cancer, so quitting can improve your overall bladder health.

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Medications to treat urinary incontinence:

There are over 20 prescription medications available to treat urinary incontinence. Several of these medications cause dehydration and drowsiness. At Epiphany Women’s Health, we do not recommend the use of medications for urinary incontinence. There is a far more effective treatment option that does not involve the risk or symptoms that can be caused by medication taken for urinary incontinence.

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Although this is our opinion, every woman has unique circumstances and should consult her healthcare provider.

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Devices used to treat urinary incontinence in women:

• Vaginal Pessary: A specialized ring-shaped device is placed by your provider to support the bladder base, preventing leaks during activities. It's a good non-surgical option but needs regular cleaning.
• Urethral Inserts: This tampon-like device inserted into the urethra acts as a barrier to prevent leakage. It's usually used for specific activities but can be worn throughout the day.

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Surgery and procedures to treat urinary incontinence:

• Sling Procedure: The surgeon creates a sling or hammock using the person's tissue, synthetic material, or donor tissue to support the urethra. This common procedure is also used for men with mild stress incontinence.
• Injectable Bulking Agents: Polysaccharides or gels such as Bulkamid are injected to bulk up tissues around the urethra, improving sphincter closure.
• Retropubic Colposuspension: Sutures attached to ligaments lift and support tissues near the bladder neck. This surgery can be done laparoscopically or with an abdominal incision.
• Inflatable Artificial Sphincter: This surgically implanted device, mainly for men, replaces the function of the sphincter. It includes a cuff, tubes, and a pressure-regulating balloon, providing better control.

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The most effective way to treat urinary incontinence:

The O-Shot® (Platelet-Rich Plasma injection) for urinary incontinence -

Traditionally, surgical procedures were common for managing stress incontinence, but the O-Shot® offers an alternative approach. Developed over a decade ago, the O-Shot® involves injecting platelet-rich plasma (PRP), derived from the woman's blood, back into her body. PRP, containing highly active growth factors, stimulates cell and tissue regeneration, benefiting the area around the urethra (pee tube) causing incontinence.

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How the O-Shot® works:

Platelet-rich plasma is obtained by separating blood into plasma, platelets, and red blood cells. A centrifuge (spinning device) is used to separate the blood. The platelets and plasma are removed via a syringe for treatment. The injection, administered near the urethra, prompts the bone marrow to create new blood vessels and tissues. Over several days, weeks, and months, this new tissue develops, potentially treating urinary incontinence.

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Urinary incontinence is caused by weakening tissue around the urethra. If your muscles, ligaments, and tissues that support the bladder have lost strength or tension, the bladder and urethra are unsupported, leading to leakage.

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The O-Shot® helps create fresh, revitalized tissue that supports the bladder and urethra. This gives women better control and helps reduce urinary incontinence.

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FAQs About O-Shot®:

Is the O-Shot® FDA approved? 

Procedures are not approved or disapproved by the FDA. The FDA (Food and Drug Administration) monitors the safety of foods and drugs produced in the United States. 

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Since the O-Shot® is neither a food nor a drug the FDA is not involved, in the same way, that hysterectomies, c-sections, and PRP injections for sports-related injuries are not “approved by the FDA”. With that in mind, the procedure itself is not FDA-approved, but the kits used for the O-Shot® contain FDA-approved components.

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Can anyone administer the O-Shot®? 

No. Proper training and certification are required to administer the O-Shot® safely. Every provider at Epiphany Women’s Health is certified to administer the O-Shot®. You can verify this by visiting the Cellular Medicine Association.

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Now what? How to take action and ditch urinary incontinence:

Find a healthcare provider who's willing to work with you to determine the best way to treat your incontinence. Choosing the right treatments for you should be a partnership between you and your provider.

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Ask your provider these simple questions about urinary incontinence:

• Will it get worse?
• Can pelvic floor exercises help? How do I do them?
• Does my weight affect it?
• Could my medicines make it worse?
• What tests might I need?
• Will I need surgery?

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Here's what your doctor might ask you about urinary incontinence: 

• How often do you leak urine?
• Is it just a few drops or do your clothes get all wet?
• Are there specific times when you know you'll leak?
• Does it happen when you're exercising?
• Do you wake up at night to pee? How much?
• How much do you drink every day?
• Does anything make it better or worse?
• What bothers you the most about it?
• Do you also have trouble with bowel leakage? How often? Does it affect what you do?
• Does it feel like something is coming out of your pelvis or vagina?

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Looking for urinary incontinence treatment in Peoria, IL? We’d love to help. Book an appointment at Epiphany Women’s Health with one of our female Nurse Practitioners.