What every female needs to know about incontinence

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Jacqueline Giannelli, FNP-BC, is a nurse practitioner specializing in sexual wellness and peri/menopause. Jacqueline is currently a clinical expert at Elektra Health, a next gen healthcare and telemedicine platform specializing in the care of women through the menopause transition.

Note: references to "female", "male", "women", and "men" in this article refer to sex assigned at birth, not gender.

Let’s be clear – leakage of urine is not an inevitable part of aging.

Incontinence is actually a very common problem that affects up to 25% of females. Incontinence is defined as loss of bladder control. Unfortunately, many females are embarrassed about this and as a result, do not talk about it or seek help. This can have many negative effects, one of which is a predisposition to urinary tract infections (UTIs).

If you’re one of the 15 million American feamles with this problem, or even if you’re not (yet) – keep reading. This is yet another women’s health taboo that needs some smashing. 

First, let’s start by identifying the most common types of incontinence experienced by females. One major type of urinary leakage is known as “urge incontinence”. This is the feeling that you need to get to the bathroom as soon as possible, or you may have an accident. This can be triggered by many things including the sound of water running, or even just the sight of your home as you pull into the driveway. Both of these are cues that send a message to your bladder that it is time to void (also known as pee).

In urge incontinence, the connection between the brain and the bladder becomes altered, and your bladder may have involuntary contractions causing you to feel the need to urinate – sometimes, at very inconvenient moments. Urge incontinence can accelerate with age, and is especially common after menopause.

The second type of urinary leakage we see regularly is known as “stress incontinence”. Many times, females will describe it as a gush of urine that occurs when they laugh, cough, sneeze or jump up and down. This is very common during and after pregnancy, and when the muscles of the pelvic floor begin to weaken post-menopause.

There also exists a third type of leakage called mixed incontinence, which is easy to remember because it is a combination of stress and urge incontinence - as we just described.

Now that we’ve identified the most common types of incontinence, it’s important to recognize that urinary incontinence can have many negative effects beyond the obvious inconvenience, discomfort, and potential for UTIs.

You may avoid exercise if you leak every time you go to the gym. Or you may not want to go for long car rides, for fear that you won’t make it to a bathroom in time. And clearly if you’re worried about incontinence in the bedroom, this can have a big effect on your sex life. Females with incontinence that goes untreated can end up avoiding intimacy all together.

There are a variety of approaches to managing incontinence, which are listed below ranging from least invasive to most invasive. This list is by no means exhaustive, but it's a good place to start when discussing with your doctor.

• Lifestyle: decrease typical bladder irritants such as tobacco, alcohol, coffee, tea, carbonated beverages, certain acidic fruits and fruit juices, and spicy foods.   These can all cause irritation to the lining of the bladder, leading to an increased urge to void. Another lifestyle tip is to avoid constipation by increasing fiber intake (constipation can lead to worsening lower urinary tract symptoms like urgency and thus incontinence.)
• Behavioral: bladder training, where you actively try to void at set times and slowly increase the interval of time between voids, can be helpful for urinary frequency and urge incontinence.
• Exercises: working on Kegel exercises, which strengthen the pelvic floor muscles (the muscles that help us to control urination) is a great place to start for improving stress incontinence. If you aren't sure how to do a Kegel, if you are postpartum, or if you have moderate to severe to incontinence, often times an evaluation and treatment from a pelvic floor physical therapist is a great next step.
• Products: pelvic floor trainers are a relatively new addition to the incontinence market. They help assist in pelvic floor exercises and give real time feedback to the user. They are convenient because they can be used discretely and on your own time, however they can be costly.
• Medications: unfortunately, for stress incontinence there are no FDA approved medications available to treat this condition. However, for urge incontinence, there are several prescription medications that help calm the bladder and improve urgency and frequency. They do have side effects, so this is an important risk and benefit conversation to have with your urologist.
• Surgery/invasive procedures: if your incontinence is severe, you have tried all of the above to no avail, and it is impacting the quality of your life - it may be time to seek a surgical evaluation. Specialists (Urogynecologists) have special training in this area and may be able to offer you more advanced therapies ranging from botox injections, nerve stimulator implants, urethral slings and bladder lifts to name a few.

If you are a woman who is affected by incontinence of any kind, I urge you (pun, intended!) to speak with a healthcare professional, such as the ones at Elektra Health. There are many treatments available including lifestyle and behavioral modifications, exercises, physical therapy, products and medications that can make a big difference. Despite the availability of effective treatments, one out of every three females will not seek medical help for her incontinence.

In practice, we see many females who have been experiencing this problem for far too long, and once treated they wonder “why was I putting up with this?” We believe females deserve better.

Visit Elektra Health to join us in smashing the menopause taboo and get the expertise and guidance you deserve to manage symptoms, including incontinence, and live well through menopause and beyond. 

Jacqueline Giannelli, FNP-BC is one of Elektra Health’s clinical experts and providers who specializes in the care of females through the menopause transition. Elektra Health is on a mission to smash the menopause taboo by empowering females with world-class education, care & community. There are as many as 34 symptoms of menopause, and due to the stigma and taboo around this time in a feamle's life, many females will stay silent about their struggles and don’t seek care - or aren’t offered it - when their issues are, in fact, treatable. Urinary incontinence, or loss of urine, is a common symptom experienced by female in midlife. We think it’s crucial to explain what exactly incontinence is and what you can do about it. Whether you’re experiencing these symptoms today, or want to get smart about your health for the future, Elektra Health is here for you with education, resources and support from clinical experts.